RT Journal Article SR Electronic T1 Tumour Necrosis Factor Inhibitor monotherapy versus combination therapy for the treatment of psoriatic arthritis: combined analysis of European biologics databases JF The Journal of Rheumatology JO J Rheumatol FD The Journal of Rheumatology SP jrheum.190815 DO 10.3899/jrheum.190815 A1 Matthew L. Thomas A1 Gavin Shaddick A1 Rachel Charlton A1 Charlotte Cavill A1 Richard Holland A1 Florenzo Iannone A1 Giovanni Lapadula A1 Simona Lopriore A1 Jakub Závada A1 Michal Uher A1 Karel Pavelka A1 Lenka Szczukova A1 Prodromos Sidiropolous A1 Irini Flouri A1 Alexandros Drosos A1 Burkhard Möller A1 Michael J Nissen A1 Rüdiger B Müller A1 Almut Scherer A1 Neil McHugh A1 Alison Nightingale YR 2020 UL http://www.jrheum.org/content/early/2020/03/25/jrheum.190815.abstract 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.