RT Journal Article
SR Electronic
T1 Real-world Longterm Effectiveness of Tumor Necrosis Factor Inhibitors in Psoriatic Arthritis Patients from the Rheumatic Diseases Portuguese Register
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP jrheum.181272
DO 10.3899/jrheum.181272
A1 Elsa Vieira-Sousa
A1 Mónica Eusébio
A1 Pedro Ávila-Ribeiro
A1 Nikita Khmelinskii
A1 Rita Cruz-Machado
A1 Teresa  Martins Rocha
A1 Miguel Bernardes
A1 Daniela Santos-Faria
A1 Joana  Leite Silva
A1 Helena Santos
A1 Cláudia Miguel
A1 Pedro Carvalho
A1 Tiago Costa
A1 Ana Catarina  Duarte
A1 Tiago Meirinhos
A1 Patrícia Nero
A1 João Eurico  Fonseca
A1 Maria José  Santos
YR 2019
UL http://www.jrheum.org/content/early/2020/01/10/jrheum.181272.abstract
AB Objective To assess longterm effectiveness of tumor necrosis factor inhibitors (TNFi) in patients with psoriatic arthritis (PsA) registered in the Rheumatic Diseases Portuguese Register, exposed to at least 1 TNFi, prospectively followed between 2001 and 2017. Methods Kaplan-Meier analysis was performed for first-, second-, and third-line TNFi. Responses included European League Against Rheumatism (EULAR) criteria, Disease Activity Index for Psoriatic Arthritis (DAPSA), minimal disease activity (MDA), and Ankylosing Spondylitis Disease Activity Score (ASDAS) at 3 and 6 months. Baseline predictors of discontinuation and response were studied using Cox and multivariable multinomial/logistic regression models. Results The 750 patients with PsA showed drug retention of 4.1 ± 3.4 years (followup 5.8 ± 3.8 yrs) for first TNFi. Switching to a second (189 patients) or third (50 patients) TNFi further decreased survival by 1.1 years. Female sex, higher baseline 28-joint count Disease Activity Score, and infliximab were predictors of first TNFi discontinuation. After 6 months of the first TNFi, 48.7% of patients achieved a good EULAR criteria response and 20.9% were in DAPSA remission. There were 11.4% in MDA, and 56.4% had a good ASDAS. Responses to the second TNFi were significantly inferior compared to responses to the first TNFi. Female sex and higher baseline Health Assessment Questionnaire–Disability Index were negatively associated with good EULAR response at 3 months, and obesity decreased the chance of response at 6 months. Conclusion In this study, switching to a second or third TNFi was associated with significantly lower drug survival and response rates for patients with axial and peripheral PsA subtypes. More successful therapeutic approaches will require considering the effect of sex and obesity on TNFi effectiveness.