Uptake and effectiveness of newer biologic and targeted synthetic disease-modifying antirheumatic drugs in psoriatic arthritis: results from five Nordic biologics registries

Abstract

BackgroundWe aimed to describe the uptake of newer biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) in psoriatic arthritis (PsA) in the Nordic countries and to compare their retention and effectiveness.MethodsPatients with PsA starting a b/tsDMARD in 2012–2020 in five Nordic rheumatology registers were included. Uptake and patient characteristics were described, with comorbidities identified from linkages to national patient registries. One-year retention and 6-month effectiveness (proportions achieving low disease activity (LDA) on the Disease Activity Index for PSoriatic Arthritis based on 28-joint evaluation) for the newer b/tsDMARDs (abatacept/apremilast/ixekizumab/secukinumab/tofacitinib/ustekinumab) were compared with adalimumab through adjusted regression models stratified by treatment course (first, second/third, and fourth or more).ResultsIn total, 5659 treatment courses with adalimumab (56% biologic-naïve) and 4767 courses with a newer b/tsDMARD (21% biologic-naïve) were included. The uptake of newer b/tsDMARDs increased from 2014 and plateaued in 2018. Patient characteristics appeared similar across treatments at treatment start. Adalimumab was more often used as the first course and newer b/tsDMARDs more often in biologic-experienced patients. Used as a second/third b/tsDMARD, the retention rate and the proportion achieving LDA were significantly better for adalimumab (rate 65%, proportion 59%) compared with abatacept (45%, 37%), apremilast (43%, 35%), ixekizumab (LDA only, 40%) and ustekinumab (LDA only, 40%), but not significantly different from other b/tsDMARDs.ConclusionUptake of newer b/tsDMARDs occurred mainly in biologic-experienced patients. Regardless of mode of action, only a minority of patients starting a second or later b/tsDMARD course remained on drug and achieved LDA. Superior outcomes for adalimumab indicate that the positioning of newer b/tsDMARDs in the PsA treatment algorithm remains to be established.

Drug survival superiority of tumor necrosis factor inhibitors and interleukin-17 inhibitors over Janus kinase inhibitors and interleukin-12/23 inhibitors in German psoriatic arthritis outpatients: retrospective analysis of the RHADAR database

“…The drug survival rates reported here are consistent with drug survival times reported in recently published analyses of other PsA registries ( 5 , 8 , 19 , 28 ). However, these other analyses evaluated retention for individual drugs but did not group their analyses into drug classes based on MoA .…”

“…IL-12/23i- and JAKi-treated patients had more previous treatments on average than IL-17i and TNFi-treated patients. A recent study reported similar treatment patterns: First-line treatment was still a TNFi, while IL-17i and IL-12/23i were used as second- or third-line treatments, and JAKi were predominantly found as fourth-line therapies ( 19 ). Additionally, OA, which can mimic PsA disease activity, was more prominent in the IL-12/23i and JAKi subgroups.…”

Four-year effectiveness, safety and drug retention rate of secukinumab in psoriatic arthritis: a real-life Italian multicenter cohort

“…These ndings con rmed its notable effectiveness on all PsA domains (arthritis, enthesitis, dactylitis, spine symptoms such as those on psoriasis, and PROs and in ammatory markers), regardless of the biologic treatment line. In this study conducted on 685 PsA patients followed up for 48-months, we found that this improvement was maintained or even increased after 3 and 4 years of treatment, and was numerically -although not signi cantly -better in biologic-naïve patients, indicating that secukinumab is effective in both naïve and non-naïve patients in line with data reported in the literature [27,28,39,40]. The ndings of our study further con rmed that secukinumab was effective across all GRAPPA-OMERACT PsA core domains.…”

Difficult‐to‐Treat Psoriatic Arthritis: A Conceptual Approach

“…Registries and prospective studies offering long-term data on b/tsDMARD use in PsA are showing responses as low as 20% even after switching to a second or third b/tsDMARD independent of the mechanism of action. 5,[10][11][12] Key factors leading to treatment resistance and proposed management Several factors may be responsible for resistance to treatments in PsA, and these may act alone or in combination to reflect the heterogeneity of the inflammatory process in PsA, which renders a one-size-fits-all approach to treatment unlikely. Clinical cases are often nuanced and include both objective and subjective factors that determine disease activity and resistance to treatment, such as a patient's own perception of disease and concerns about medication side effects.…”

“…Nonetheless, it seems more reasonable to consider PsA failing at least two b/tsDMARDs with different mode of action as “treatment resistant,” which implies a substantially reduced availability of remaining therapeutic options. Registries and prospective studies offering long‐term data on b/tsDMARD use in PsA are showing responses as low as 20% even after switching to a second or third b/tsDMARD independent of the mechanism of action 5,10‐12 …”