PT  - JOURNAL ARTICLE
AU  - Elsa Vieira-Sousa
AU  - Mónica Eusébio
AU  - Pedro Ávila-Ribeiro
AU  - Nikita Khmelinskii
AU  - Rita Cruz-Machado
AU  - Teresa Martins  Rocha
AU  - Miguel Bernardes
AU  - Daniela Santos-Faria
AU  - Joana Leite  Silva
AU  - Helena Santos
AU  - Cláudia Miguel
AU  - Pedro Carvalho
AU  - Tiago Costa
AU  - Ana Catarina  Duarte
AU  - Tiago Meirinhos
AU  - Patrícia Nero
AU  - João Eurico  Fonseca
AU  - Maria José  Santos
TI  - Real-World Long-Term Effectiveness of Tumor Necrosis Factor Inhibitors in Psoriatic Arthritis Patients from the Rheumatic Diseases Portuguese Register
AID  - 10.3899/jrheum.181272
DP  - 2019 Aug 01
TA  - The Journal of Rheumatology
PG  - jrheum.181272
4099  - http://www.jrheum.org/content/early/2019/07/23/jrheum.181272.short
4100  - http://www.jrheum.org/content/early/2019/07/23/jrheum.181272.full
AB  - Objective To assess long-term effectiveness of tumor necrosis factor inhibitors (TNFi) in psoriatic arthritis (PsA) patients registered in the Rheumatic Diseases Portuguese Register, exposed to at least one TNFi, prospectively followed between 2001-2017. Methods Kaplan-Meier analysis was performed for first-, second-, and third-line TNFi. Response included European League Against Rheumatism (EULAR), 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 PsA patients showed drug retention of 4.1±3.4 y (follow-up 5.8±3.8 y) for first TNFi. Switching to a second (189 patients) or third (50 patients) TNFi further decreased survival by 1.1 y. Female gender, higher baseline Disease Activity Score 28, and infliximab were predictors of first TNFi discontinuation. After 6 months of the first TNFi, 48.7% of patients achieved good EULAR, 20.9% DAPSA remission, 11.4% MDA, and 56.4% ASDAS responses. Responses to the second TNFi were significantly inferior to those to the first TNFi. Female gender 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 impact of gender and obesity on TNFi effectiveness.