PT  - JOURNAL ARTICLE
AU  - Matthew L.  Thomas
AU  - Gavin Shaddick
AU  - Rachel Charlton
AU  - Charlotte Cavill
AU  - Richard Holland
AU  - Florenzo Iannone
AU  - Giovanni Lapadula
AU  - Simona Lopriore
AU  - Jakub Závada
AU  - Michal Uher
AU  - Karel Pavelka
AU  - Lenka Szczukova
AU  - Prodromos Sidiropolous
AU  - Irini Flouri
AU  - Alexandros Drosos
AU  - Burkhard Möller
AU  - Michael J  Nissen
AU  - Rüdiger B  Müller
AU  - Almut Scherer
AU  - Neil McHugh
AU  - Alison Nightingale
TI  - Tumour Necrosis Factor Inhibitor monotherapy versus combination therapy for the treatment of psoriatic arthritis: combined analysis of European biologics databases
AID  - 10.3899/jrheum.190815
DP  - 2020 Apr 01
TA  - The Journal of Rheumatology
PG  - jrheum.190815
4099  - http://www.jrheum.org/content/early/2020/03/25/jrheum.190815.short
4100  - http://www.jrheum.org/content/early/2020/03/25/jrheum.190815.full
AB  - Objective To investigate whether tumour necrosis factor inhibitor (TNFi) combination therapy with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) is more effective for psoriatic arthritis (PsA) and/or improves TNFi drug survival compared to TNFi monotherapy. Methods Five PsA biologics cohorts were investigated between 2000 and 2015; the ATTRA registry (Czech Republic), the Swiss Clinical Quality Management PsA registry, the Hellenic Registry of Biologics Therapies (Greece), the University of Bari PsA biologics database (Italy) and the Bath PsA cohort (UK). Drug persistence was analysed using Kaplan-Meier and equality of survival using Log-Rank tests. Comparative effectiveness was investigated using logistic regression with propensity scores. Separate analyses were performed on: (a) the combined Italian/Swiss cohorts for change in rate of DAS-28; and (b) the combined Italian, Swiss and Bath cohorts for change in rate of HAQ. Results In total, 2294 patients were eligible for the drug survival analysis. In the Swiss (p=0.002), Greek (p=0.021) and Bath (p=0.014) databases patients starting TNFi in combination with MTX had longer drug survival compared to monotherapy, whilst in Italy the monotherapy group persisted longer (p=0.030). In patients from the combined Italian/Swiss dataset (n=1066) there was no significant difference between treatment arms in rate of change of DAS28. Similarly, when also including the Bath cohort (n=1205) there was no significant difference in rate of change of HAQ. Conclusion Combination therapy of a TNFi with a csDMARD does not appear to affect improvement of disease activity or HAQ versus TNFi monotherapy but may improve TNFi drug survival.