Objective: To evaluate the performance of anti-TNFα therapy in psoriatic arthritis (PsA) in a routine care setting.
Methods: Inclusion criteria were patients with PsA who initiated anti-TNFα therapy between April 2001 and April 2013 with a follow-up of at least 6 months. For peripheral forms, treatment was considered to be effective for patients with a favourable expert opinion or>30% clinical improvement of swollen and tender joint counts. For axial forms, efficacy criteria were: improvement of BASDAI by at least 2 points on a scale from 0 to 10 or 50% improvement (BASDAI 50) or expert opinion. Drug survival of first anti-TNFα therapy was also investigated.
Results: The study included 193 patients (107/86M/F, mean age: 46.8 years, mean disease duration: 6.7 years, 171/22 peripheral/axial forms). Only 48 (25%) patients received concomitant DMARD therapy (65% were treated with methotrexate). The majority of patients started with first-line etanercept (n=102), followed by adalimumab (n=46), infliximab (n=44) and golimumab (n=1). At 3 months, 90% of patients had obtained an adequate response, 7% had discontinued due to lack of efficacy and 3% due to adverse events. Median drug survival was 2 years. One-year and 2-year drug survival rates were 77% and 67%, respectively. Seventy-nine (41%) patients switched to a second anti-TNFα and 29 to a third anti-TNFα; 82% of switchers responded to second-line therapy and 83% responded to third-line therapy.
Conclusion: High drug survival and high response rates were observed in these patients with PsA receiving their first anti-TNFα therapy in routine clinical practice.
Keywords: Anti-TNFα; Drug survival; Methotrexate; Psoriatic arthritis; Safety; Switching.
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