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 Szczuková
AU  - Prodromos Sidiropoulos
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  - Tumor 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  - 2021 Jan 01
TA  - The Journal of Rheumatology
PG  - 48--57
VI  - 48
IP  - 1
4099  - http://www.jrheum.org/content/48/1/48.short
4100  - http://www.jrheum.org/content/48/1/48.full
SO  - J Rheumatol2021 Jan 01; 48
AB  - Objective. To investigate whether tumor necrosis factor inhibitor (TNFi) combination therapy with conventional synthetic disease-modifying antirheumatic drugs (csDMARD) 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 analyzed 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 (1) the combined Italian/Swiss cohorts for change in rate of Disease Activity Score in 28 joints (DAS28); and (2) the combined Italian, Swiss, and Bath cohorts for change in rate of Health Assessment Questionnaire (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 methotrexate had longer drug survival compared to monotherapy, while in Italy the monotherapy group persisted longer (P = 0.030). In eligible patients from the combined Italian/Swiss dataset (n = 1056), 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 it may improve TNFi drug survival.