Treating psoriatic arthritis to target: discordance between physicians and patients’ assessment, non-adherence, and restricted access to drugs precluded therapy escalation in a real-world cohort

Ferreira, M.F.; Kohem, Charles Lubianca; Xavier, Ricardo Machado; Abegg, Everton Hiraiwa; Martins, Odisséia Marli Gimenes; Resmini, M.B.; Mello, Ariele Lima de; Menegat, Franciele de Almeida; Hax, Vanessa; Gasparin, Andrese Aline; Brenol, Claiton Viegas; Andrade, Nicole Pamplona Bueno de; Viecceli, Daniela; Brenol, João Carlos Tavares; Palominos, Penélope Esther

doi:10.1007/s10067-018-4383-9

Cited by 6 publications

(4 citation statements)

References 22 publications

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“…The importance of non-adherence in PsA management cannot be overstated. It significantly affects remission rates and is associated with higher medical costs [ 21 , 22 ]. Therefore, the survey results highlight the need for better identifying non-adherence, and also the necessity for strategies that improve patient adherence to optimize both clinical outcomes and healthcare resource utilization in PsA management.…”

Section: Discussionmentioning

confidence: 99%

Deciphering difficult-to-treat psoriatic arthritis (D2T-PsA): a GRAPPA perspective from an international survey of healthcare professionals

Ribeiro,

Singla,

Chandran

et al. 2024

Rheumatology Advances in Practice

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Objectives This study contributes to the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)’s effort to define ‘difficult-to-treat’ PsA (D2T-PsA), leveraging insights of healthcare professionals who are GRAPPA members. The primary objective is to inform GRAPPA’s D2T PsA project, ensuring the consensus definition reflects clinical experience and expertise. Methods An online survey was conducted among GRAPPA’s healthcare professionals managing PsA patients. The survey covered demographic details, structured questions, and open-ended queries to gather comprehensive insights into the experts’ viewpoints. Results About 223 physicians completed the survey, comprising 179 (80.2%) rheumatologists and 40 (17.9%) dermatologists. The majority, 184 (82.5%), favoured establishing distinct definitions for D2T-PsA and complex-to-manage PsA (C2M-PsA). Furthermore, 202 (90.5%) supported a definition that includes objective inflammation signs (clinical, laboratory, imaging, among others). However, opinions varied on the criteria for prior treatment failures, with most (93, 41.7%) favouring a definition that includes at least one conventional synthetic disease-modifying anti-rheumatic drug and two or more biological- or targeted-synthetic-DMARDs with different mechanisms of action. Conclusion The survey reveals a majority opinion among GRAPPA experts favouring the differentiation between D2T-PsA and C2M-PsA, and the inclusion of objective inflammatory markers in these definitions. However, there is less than 50% agreement on the specific treatment failure criteria, particularly regarding the number of therapies needed to classify PsA as D2T. These findings suggest a need for continued discussion to reach a more unified approach in defining D2T-PsA, reflecting the complexity of the condition.

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Section: Discussionmentioning

confidence: 99%

Deciphering difficult-to-treat psoriatic arthritis (D2T-PsA): a GRAPPA perspective from an international survey of healthcare professionals

Ribeiro,

Singla,

Chandran

et al. 2024

Rheumatology Advances in Practice

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“…In our investigation, RCT and real-world studies had similar frequencies of MDA probably because the selected observational studies were carried out mainly in university hospitals located in developed countries, where patients with PsA have adequate education levels, receive a high standard of care, and have easy access to DMARD. In underdeveloped countries, in contrast, restricted access to DMARD and low education levels leading to poor understanding of medication instructions were barriers to achieving MDA in the real-world context 10 .…”

Section: Discussionmentioning

confidence: 99%

“…Participants in RCT usually present higher levels of disease activity, fewer comorbidities 8 , and better adherence rates to therapy than patients analyzed in observational studies 9 . In real life, factors such as poor adherence and restricted access to drugs preclude the achievement of MDA status in a treat-to-target strategy 10 .…”

mentioning

confidence: 99%

Prevalence of Psoriatic Arthritis Patients Achieving Minimal Disease Activity in Real-world Studies and Randomized Clinical Trials: Systematic Review with Metaanalysis

Zardin-Moraes

Silva²,

Saldanha³

et al. 2019

J Rheumatol

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Objective.To estimate the frequency of patients with psoriatic arthritis (PsA) achieving minimal disease activity (MDA) status in real-world studies and randomized controlled trials (RCT).Methods.A systematic literature search for 2009–2017 was performed in PubMed, Embase, Cochrane Library, and LILACS. Study selection and data extraction were performed by 2 independent researchers. Random-effects single-arm metaanalyses were performed and heterogeneity was assessed using I2.Results.A total of 405 records were identified and 45 studies were analyzed: 39 (86.7%) observational studies and 6 (13.3%) RCT; they included 12,469 patients. The overall prevalence of MDA in cross-sectional studies was 35% (95% CI 30%–41%, I2 = 94%), varying from 17% (95% CI 7%–34%) in patients taking synthetic disease-modifying antirheumatic drugs (DMARD) to 57% (95% CI 41%–71%) in those taking biological DMARD. Prevalence of MDA in cohort studies increased with longer followup time, ranging from 25% (95% CI 15%–40%) with 3- to 4-month followup to 42% (95% CI 38%–45%) with > 24-month followup. Patients with PsA receiving biological DMARD in a real-world context and RCT had similar prevalence of MDA at 6-month followup: 30% (95% CI 21%–41%, I2 = 85%) versus 32% (95% CI 26%–39%, I2 = 79%), respectively.Conclusion.Patients with PsA included in real-world studies had similar prevalence of MDA compared to those in controlled clinical trials. This finding suggests that MDA is a useful treatment target for PsA in the real-world setting.

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“…In previous series, we found that the delay or lack of biologic therapy contributed remarkably to the evolution of AM (14). Lack of adherence to therapy in patients with PsA is one of the major causes that prevents from achievement of remission or minimal disease activity (15). Psychic conditions, such as stress, anxiety, depression and alexithymia are comorbidities that are often present in patients with PsA and lead to poor collaboration with the doctor and non-acceptance of the disease.…”

Section: Case Reportmentioning

confidence: 98%

Psoriatic spondyloarthritis and Sjögren syndrome: a casual association?

et al. 2020

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The association between Sjögren syndrome (SS) and psoriatic arthritis (PsA) is rare. Herein, we report a case of SS in a PsA patient with the mutilans variant. A 67-year old woman developed PsA with progressive articular destruction up to the typical deformation of ‘telescoping fingers’ in the distal phalanges. Psoriatic onychopathy presented ten years after the osteolytic damage in the hands. This late appearance led to delayed diagnosis and therapy, and, consequently, worsened the articular destruction. Thereafter, the patient developed a typical SS with clinical symptoms, such as xerophthalmia and xerostomia. This diagnosis was confirmed by positive diagnostic tests, such as Schirmer test, ANA, and anti-SSA/Ro and anti-SSB/La antibodies. A potential association between the two diseases is discussed.

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Treating psoriatic arthritis to target: discordance between physicians and patients’ assessment, non-adherence, and restricted access to drugs precluded therapy escalation in a real-world cohort

Cited by 6 publications

References 22 publications

Deciphering difficult-to-treat psoriatic arthritis (D2T-PsA): a GRAPPA perspective from an international survey of healthcare professionals

Deciphering difficult-to-treat psoriatic arthritis (D2T-PsA): a GRAPPA perspective from an international survey of healthcare professionals

Prevalence of Psoriatic Arthritis Patients Achieving Minimal Disease Activity in Real-world Studies and Randomized Clinical Trials: Systematic Review with Metaanalysis

Psoriatic spondyloarthritis and Sjögren syndrome: a casual association?

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