Prevalence and predictors of tumour necrosis factor inhibitor persistence in psoriatic arthritis

Stober, Carmel B.; Ye, Weiyu; Guruparan, Thushyanthan; Htut, Eiphyu; Clunie, Gavin; Jadon, Deepak R.

doi:10.1093/rheumatology/kex387

Cited by 57 publications

(44 citation statements)

References 20 publications

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“…The results from this real-life study indicate that adalimumab can be considered as a therapeutic option for the long-term treatment in PsA patients, regardless of their prior exposure to biologics or DMARDs or the presence of comorbid diseases. The majority of patients (86.6%) retained treatment with adalimumab for up to 1 year with only a slight reduction observed at 2 years (73.8% persistence), corroborating with findings from European registry studies (70-88%) for 1 year persistence rates (Heiberg et al, 2008;Saad et al, 2009;Glintborg et al, 2011;Aaltonen et al, 2017;Stober et al, 2018). However, our results showed higher rates than another real-life registry performed in Italy, with 2-year retention rate of 48% in PsA patients treated with golimumab (Manara et al, 2017).…”

Section: Discussionsupporting

confidence: 90%

Effectiveness of Adalimumab for the Treatment of Psoriatic Arthritis: An Italian Real-Life Retrospective Study

D’Angelo¹,

Cantini

Ramonda

et al. 2019

Front. Pharmacol.

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Background: Few studies have evaluated the effectiveness of adalimumab in the real-life setting in psoriatic arthritis (PsA).Objective: To evaluate the 2-year retention rate of adalimumab in PsA patients. Potential baseline parameters influencing persistence on treatment were also evaluated.Methods: PsA patients from 16 Italian Rheumatology Units treated with adalimumab as firstor second-line biological therapy were retrospectively evaluated. Adalimumab retention rate was evaluated at 12 and 24 months. Logistic regression was used to evaluate the association between predictor variables and adalimumab retention rate.Results: From 424 patients (53.5% male, aged 48.3 ± 12.8 years) who started treatment with adalimumab, 367 (86.6%) maintained treatment for 12 months and 313 (73.8%) for 2 years. At 24-months, Disease Activity in PsA (DAPSA) remission (defined as ≤4) and Low Disease Activity (LDA) (≤14) were achieved in 22.8% and 44.4% of patients, respectively. Adalimumab treatment significantly decreased the number of tender (7.0 ± 5.7 at baseline vs. 2.3 ± 3.5 at 24 months, p < 0.001) and swollen joints (2.7 ± 2.8 at baseline vs. 0.4 ± Frontiers in Pharmacology | www.frontiersin.org 0.9 at 24 months, p < 0.001), DAPSA (25.5 ± 10.9 at baseline vs. 11.0 ± 8.4 at 24 months, p < 0.001), PASI (5.3 ± 5.7 at baseline vs. 2.7 ± 2.8 at 24 months, p < 0.001) and CRP (3.8 ± 6.3 at baseline vs. 1.2 ± 1.7 at 24 months, p < 0.001). Among a range of laboratory and clinical variables, only female gender was associated with improved adalimumab persistence at 24 months (OR: 1.98, 95% CI: 1.2-3.2, p = 0.005).Conclusions: Independent of a range of predictor variables, adalimumab was shown to be effective, while maintaining a high retention rate after 2 years in PsA patients.

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Section: Discussionsupporting

confidence: 90%

Effectiveness of Adalimumab for the Treatment of Psoriatic Arthritis: An Italian Real-Life Retrospective Study

D’Angelo¹,

Cantini

Ramonda

et al. 2019

Front. Pharmacol.

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“…[23][24][25] Patients with psoriasis benefit from switching to a second TNF antagonist after the failure of the first, even though response rates to the second anti-TNF-based therapy are lower than the first. [26][27][28][29] The mechanisms that underlie primary nonresponse and secondary loss of response effects are believed to be multifactorial. Among them are the specific disease characteristics, such as phenotype, location, and severity.…”

Section: Limitations Of Parenteral Administration Of Anti-tnf Agentsmentioning

confidence: 99%

“…Refractory RA patients are commonly managed by switching from one anti‐TNF drug to another, despite first‐line therapies often yielding better results than the second‐line therapies . Patients with psoriasis benefit from switching to a second TNF antagonist after the failure of the first, even though response rates to the second anti‐TNF‐based therapy are lower than the first …”

Section: Introductionmentioning

confidence: 99%

Immune rebalancing by oral immunotherapy: A novel method for getting the immune system back on track

Ilan

2018

Journal of Leukocyte Biology

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Immune modulating treatments are often associated with immune suppression or an opposing anti‐inflammatory paradigm. As such, there is a risk of exposing patients to infections and malignancies. Contrarily, eliciting only mild immune modulation can be insufficient for alleviating immune‐mediated damage. Oral immunotherapy is a novel approach that uses the inherent ability of the gut immune system to generate signals that specifically suppress inflammation at affected sites, without inducing generalized immune suppression. Oral immunotherapy is being developed as a method to rebalance systemic immunity and restore balance, getting it back on track, rather than pushing the immune response too much or too little in opposing directions. Here, I review recent preclinical and clinical data examining the technique and describe its primary advantages.

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“…1,2 Patients (pts) with PsA and comorbid MetS frequently demonstrate decreased therapeutic responses and lower probability of achieving minimal disease activity. 3,4 Objectives: To compare key efficacy and safety endpoints in tofacitinib-treated pts with PsA and MetS in Phase (P) 3 studies. Methods: Two double-blind P3 studies enrolled pts with active PsA who either had an inadequate response (IR) to !1 conventional synthetic (cs)DMARD and were TNFi-naïve (OPAL Broaden; n=422; 12 months; NCT01877668) or IR to !1 TNFi (OPAL Beyond; n=395; 6 months; NCT01882439).…”

mentioning

confidence: 99%

SAT0318 Do patients in remission in psoriatic arthritis, have less fatigue? and does this depend on the definition of remission? an analysis of 304 patients

Gorlier¹,

Puyraimond-Zemmour²,

Kiltz³

et al. 2018

Saturday, 16 JUNE 2018

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BackgroundFatigue is a critical element of life impact for patients with Psoriatic Arthritis (PsA) and is not considered in remission definitions. In PsA, remission can be defined using composite scores (Minimal Disease Activity (MDA), Disease Activity in PSoriatic Arthritis (DAPSA)≤4), Patient Acceptable Symptom State (PASS), Patient Global Assessment (PGA)(for example ≤1/10), or as a single for remission item.ObjectivesTo explore the relationship between fatigue and remission in PsA, when using different definitions of remission.MethodsReFlaP (NCT03119805) is a cross-sectional study in 14 countries of consecutive adult patients with definite PsA and more than 2 years of disease duration. Patient-perceived fatigue was assessed by a 11-point numerical rating scale. Remission status was defined from the physician’s perspective as MDA, DAPSA≤4 and physician-perceived remission (single question yes/no), and from the patient’s perspective as PASS, PGA ≤1 and patient-perceived remission (single question yes/no). We calculated fatigue group means and deltas by remission status and compared these by Student’s t test. For known groups validity of each remission definition we used ROC curves and corresponding areas under the curve (AUC).ResultsOf 366 patients, 304 had both fatigue and remission data available: 148 (49.8%) were male, mean age was 53.9±12.3 years, mean disease duration was 10.8±7.7 years; 90.3% had predominant peripheral disease, 56.3% were taking methotrexate, 66.5% a biologic and 19.4% oral glucocorticoids. Disease activity was moderate: 41.1% had no current psoriasis skin lesions, mean Tender Joint Count (TJC) was 4.3±8.9, mean Swollen Joint Count (SJC) was 2.66±8.3, mean Physician’s global assessment was 3.0±2.4, mean PGA was 4.19%±2.7. 80.6% patients had DAPSA levels<28 (ie, remission, low or moderate disease activity).Mean patient’s assessment of fatigue was 4.26±3.0. The frequency of remission varied from 17.4% to 64.8% (the most stringent definition being DAPSA and the least PASS). Fatigue levels were much lower in remission than non-remission with group differences in fatigue ranging from 1.66±0.3) (Physician remission single question yes/no) to 3.81±0.3 (DAPSA remission) (all p<0.0001) (figure 1). Corresponding AUCs ranged from 0.66 (Physician’s remission question) to 0.87 (DAPSA).ConclusionsFatigue levels were relatively high in these PsA patients whose disease was often well-controlled. Fatigue was lower in patients in remission, according to all definitions of remission; the remission definition with best known-groups validity for fatigue was DAPSA remission. Moreover both composite measures perform better than the physicians opinion of remission. These elements may be important in a context of shared decision-making.AcknowledgementsThis study was funded by Pfizer.Disclosure of InterestNone declared

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Prevalence and predictors of tumour necrosis factor inhibitor persistence in psoriatic arthritis

Cited by 57 publications

References 20 publications

Effectiveness of Adalimumab for the Treatment of Psoriatic Arthritis: An Italian Real-Life Retrospective Study

Effectiveness of Adalimumab for the Treatment of Psoriatic Arthritis: An Italian Real-Life Retrospective Study

Immune rebalancing by oral immunotherapy: A novel method for getting the immune system back on track

SAT0318 Do patients in remission in psoriatic arthritis, have less fatigue? and does this depend on the definition of remission? an analysis of 304 patients

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