Predictors of Achieving Remission among Patients with Psoriatic Arthritis Initiating a Tumor Necrosis Factor Inhibitor.

Abstract

OBJECTIVE:

To examine predictors of remission among patients with psoriatic arthritis (PsA) initiating a tumor necrosis factor (TNF) inhibitor.

METHODS:

Patients with PsA enrolled in the Corrona Registry between 2005 and 2013 were followed from initiation of a TNF inhibitor (TNFi; etanercept, adalimumab, infliximab, certolizumab, or golimumab) to the visit closest to 12 months. Additional inclusion criteria included 3 tender or 3 swollen joints. Outcomes of interest were Clinical Disease Activity Index (CDAI) ≤ 2.8 (remission), low disease activity (LDA; CDAI ≤ 10), change in the modified Health Assessment Questionnaire (mHAQ) ≥ 0.35 and achievement of mHAQ < 0.30. Predictors were measured on or before TNFi initiation. Covariates significant in univariable logistic regression models and ≤ 5% missing values were included in a multivariable model and removed individually until all remaining variables were significant (p < 0.05).

RESULTS:

Among 1832 TNFi initiations, 774 initiations (624 patients) met inclusion criteria. Median age at initiation was 52 years [interquartile range (IQR) 44-60], 56% were female, median PsA duration was 4 years (IQR 2-11), and median CDAI at baseline was 20 (IQR 14.5-28). Remission was achieved by 14% and LDA (or remission) by 37%. Achieving remission was positively associated with college education (OR 1.88, 95% CI 1.11-3.19) but negatively associated with female sex (0.62, 95% CI 0.40-0.97), obese body mass index (0.51, 95% CI 0.32-0.81), hypertension (0.55, 95% CI 0.32-0.95), previous biologic use (0.41, 95% CI 0.26-0.65), and baseline pain (0.80 per 10 mm visual analog scale, 95% CI 0.73-0.87). Predictors for LDA, mHAQ < 0.30, and mHAQ change were similar.

CONCLUSION:

Few patients with PsA in a US-based registry achieved remission by CDAI criteria. Female sex, obesity, comorbidities, and education influence achievement of remission on a TNFi.

• Authors: Alexis Ogdie, J Lynn Palmer, Jeffrey Greenberg, Jeffrey R Curtis, Leslie R Harrold, Daniel H Solomon, Arthur Kavanaugh, Joel M Kremer, Philip J Mease
• Journal: The Journal of rheumatology (J Rheumatol) Vol. 46 Issue 5 Pg. 475-482 (05 2019) ISSN: 0315-162X [Print] Canada
• PMID: 30647182 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Tumor Necrosis Factor Inhibitors
• Tumor Necrosis Factor-alpha

Topics

• Adult
• Arthritis, Psoriatic (diagnosis, drug therapy)
• Cohort Studies
• Dose-Response Relationship, Drug
• Drug Administration Schedule
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Multivariate Analysis
• Pain Measurement
• Quality of Life
• Range of Motion, Articular (drug effects)
• Registries
• Retrospective Studies
• Severity of Illness Index
• Time Factors
• Treatment Outcome
• Tumor Necrosis Factor Inhibitors (administration & dosage)
• Tumor Necrosis Factor-alpha (antagonists & inhibitors)
• United States