Longterm Clinical Outcomes in 420 Patients with Psoriatic Arthritis Taking Anti-tumor Necrosis Factor Drugs in Real-world Settings.

Abstract

OBJECTIVE:

An observational study to evaluate the longterm clinical outcomes of adalimumab (ADA), etanercept (ETN), and infliximab (IFX) in patients with psoriatic arthritis (PsA), in real-world settings.

METHODS:

From a prospective cohort we studied 420 biologic-naive patients with PsA who had peripheral arthritis and were beginning a treatment with ADA, ETN, or IFX. Drug survival was evaluated by Kaplan-Meier life analysis, and baseline predictors of drug discontinuation were assessed by Cox regression analysis. The frequency of concomitant glucocorticoids and the daily mean dosage were compared by chi-square test and ANOVA repeated measures across 4 years.

RESULTS:

After 4 years the overall survival of the first anti-tumor necrosis factor-α (anti-TNF) was 51.0%, but significantly higher for ETN (58.9%) than ADA (43.9%) or IFX (44.0%; p = 0.003). Patients taking ETN also had the lowest HR of drug discontinuation (HR 0.57, 95% CI 0.34-0.93, p = 0.02). The strongest predictor of drug interruption was female sex (HR 2.02, 95% CI 1.28-3.20, p = 0.002). The disease duration was inversely correlated with drug discontinuation (HR 0.96, 95% CI 0.93-0.99, p = 0.02). The average daily dose of prednisone significantly decreased from baseline: 5.6 ± 2.5 to 4.7 ± 1.9 at 1 year (p = 0.01) to 4.0 ± 1.8 at 4 years (p = 0.001). Additionally, compared to baseline (49.6%), a significant reduction of patients taking glucocorticoids was detected at 2 years (36.5%, p < 0.05), 3 years (29.9%, p < 0.01), and 4 years (22.6%, p < 0.01).

CONCLUSION:

In real-world settings, TNF inhibitors showed a high rate of drug survival at 4 years. Further, the need for glucocorticoids for controlling active PsA was lowered with time.

• Authors: Florenzo Iannone, Simona Lopriore, Romano Bucci, Giuseppe Lopalco, Angela Chialà, Luca Cantarini, Giovanni Lapadula
• Journal: The Journal of rheumatology (J Rheumatol) Vol. 43 Issue 5 Pg. 911-7 (05 2016) ISSN: 0315-162X [Print] Canada
• PMID: 26980583 (Publication Type: Journal Article, Observational Study)

Chemical References

• Antirheumatic Agents
• Glucocorticoids
• Tumor Necrosis Factor-alpha
• Infliximab
• Adalimumab
• Etanercept

Topics

• Adalimumab (therapeutic use)
• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Antirheumatic Agents (therapeutic use)
• Arthritis, Psoriatic (drug therapy)
• Drug Therapy, Combination
• Etanercept (therapeutic use)
• Female
• Glucocorticoids (therapeutic use)
• Humans
• Infliximab (therapeutic use)
• Male
• Middle Aged
• Patient Dropouts
• Prospective Studies
• Treatment Outcome
• Tumor Necrosis Factor-alpha (antagonists & inhibitors)
• Young Adult