Prevalence of Psoriatic Arthritis Patients Achieving Minimal Disease Activity in Real-world Studies and Randomized Clinical Trials: Systematic Review with Metaanalysis

Mariele Zardin-Moraes; André Luis Ferreira Azeredo da Silva; Carla Saldanha; Charles Lubianca Kohem; Laura C Coates; Lilian Rodrigues Henrique; Penélope Esther Palominos; Rafael Mendonça da Silva Chakr

doi:10.3899/jrheum.190677

Prevalence of Psoriatic Arthritis Patients Achieving Minimal Disease Activity in Real-world Studies and Randomized Clinical Trials: Systematic Review with Metaanalysis

J Rheumatol. 2020 Jun 1;47(6):839-846. doi: 10.3899/jrheum.190677. Epub 2019 Oct 1.

Authors

Mariele Zardin-Moraes^{1

2}, André Luis Ferreira Azeredo da Silva^{1

2}, Carla Saldanha^{1

2}, Charles Lubianca Kohem^{1

2}, Laura C Coates^{1

2}, Lilian Rodrigues Henrique^{1

2}, Penélope Esther Palominos^{1

2}, Rafael Mendonça da Silva Chakr^{3

4}

Affiliations

¹ From the Rheumatology Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
² M. Zardin-Moraes, MSc, Rheumatology Department, Hospital de Clínicas de Porto Alegre; A.L. Azeredo da Silva, PhD, Rheumatology Department, Hospital de Clínicas de Porto Alegre; C. Saldanha, MSc, Rheumatology Department, Hospital de Clínicas de Porto Alegre; C.L. Kohem, PhD, Rheumatology Department, Hospital de Clínicas de Porto Alegre; L.C. Coates, PhD, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; L.R. Henrique, Rheumatology Department, Hospital de Clínicas de Porto Alegre; P.E. Palominos, PhD, Rheumatology Department, Hospital de Clínicas de Porto Alegre; R.M. Chakr, PhD, Rheumatology Department, Hospital de Clínicas de Porto Alegre.
³ From the Rheumatology Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK. rchakr@hcpa.edu.br.
⁴ M. Zardin-Moraes, MSc, Rheumatology Department, Hospital de Clínicas de Porto Alegre; A.L. Azeredo da Silva, PhD, Rheumatology Department, Hospital de Clínicas de Porto Alegre; C. Saldanha, MSc, Rheumatology Department, Hospital de Clínicas de Porto Alegre; C.L. Kohem, PhD, Rheumatology Department, Hospital de Clínicas de Porto Alegre; L.C. Coates, PhD, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; L.R. Henrique, Rheumatology Department, Hospital de Clínicas de Porto Alegre; P.E. Palominos, PhD, Rheumatology Department, Hospital de Clínicas de Porto Alegre; R.M. Chakr, PhD, Rheumatology Department, Hospital de Clínicas de Porto Alegre. rchakr@hcpa.edu.br.

PMID: 31575702
DOI: 10.3899/jrheum.190677

Abstract

Objective: To estimate the frequency of patients with psoriatic arthritis (PsA) achieving minimal disease activity (MDA) status in real-world studies and randomized controlled trials (RCT).

Methods: A systematic literature search for 2009-2017 was performed in PubMed, Embase, Cochrane Library, and LILACS. Study selection and data extraction were performed by 2 independent researchers. Random-effects single-arm metaanalyses were performed and heterogeneity was assessed using I².

Results: A total of 405 records were identified and 45 studies were analyzed: 39 (86.7%) observational studies and 6 (13.3%) RCT; they included 12,469 patients. The overall prevalence of MDA in cross-sectional studies was 35% (95% CI 30%-41%, I² = 94%), varying from 17% (95% CI 7%-34%) in patients taking synthetic disease-modifying antirheumatic drugs (DMARD) to 57% (95% CI 41%-71%) in those taking biological DMARD. Prevalence of MDA in cohort studies increased with longer followup time, ranging from 25% (95% CI 15%-40%) with 3- to 4-month followup to 42% (95% CI 38%-45%) with > 24-month followup. Patients with PsA receiving biological DMARD in a real-world context and RCT had similar prevalence of MDA at 6-month followup: 30% (95% CI 21%-41%, I² = 85%) versus 32% (95% CI 26%-39%, I² = 79%), respectively.

Conclusion: Patients with PsA included in real-world studies had similar prevalence of MDA compared to those in controlled clinical trials. This finding suggests that MDA is a useful treatment target for PsA in the real-world setting.

Keywords: OBSERVATIONAL STUDIES; PSORIATIC ARTHRITIS; RANDOMIZED CONTROLLED TRIALS.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Antirheumatic Agents* / therapeutic use
Arthritis, Psoriatic* / drug therapy
Arthritis, Psoriatic* / epidemiology
Cohort Studies
Humans
Prevalence
Severity of Illness Index
Treatment Outcome

Substances

Antirheumatic Agents

Grants and funding

CS-2016-16-016/DH_/Department of Health/United Kingdom