Trends in Biologics Use Assessed Among Patients With Psoriatic Arthritis

Tumor necrosis factor inhibitor (TNFi) certolizumab was found to have the highest 3-year drug survival probability when used as first-line treatment, while interleukin (IL)-17 inhibitors were found to have the lowest probability, among patients with psoriatic arthritis (PsA), according to study results published in Arthritis Care & Research.

Researchers conducted a retrospective analysis to examine the trends and drug survival probability of biologic therapies, including TNFi and IL-17 inhibitors, for the treatment of PsA over a 20-year period. The study period was divided into 2 periods: 2000 to 2009 and 2010 to 2020.

Suspension of medications of greater than 180 days was considered a new course of treatment, and suspension of medications of 180 days or fewer was considered as 1 course of treatment.

A total of 571 patients with PsA receiving therapy were included in the study. Patients had a mean age of 48 years; 58% were men; and 10% had concomitant fibromyalgia. Patients were evaluated at least once or twice yearly, with additional follow-ups as needed.

Five TNFis (etanercept [39%], adalimumab [27%], infliximab [8%], golimumab [7%], and certolizumab pegol [5%]) were used as first-line treatments.

Certolizumab had the highest 3-year drug survival probability (0.80; 95% CI, 0.52-1.00) and IL-17 inhibitors had the lowest probability (0.48; 95% CI, 0.28-0.81) when used as first-line treatments. However, certolizumab had the lowest and IL-17 inhibitors had the highest 3-year drug survival probability when used as second-line treatments.

Higher number of tender joints increased the risk for treatment discontinuation due to all causes and side effects (relative risks [RRs], 1.02; [95% CI, 1.00-1.03]; P =.01 and 1.03; [95% CI, 1.00-1.06]; P =.03, respectively).

Older age at the start of treatment (RR, 1.03; 95% CI, 1.01-1.05; P =.01) and depression/anxiety due to all causes (RR, 1.68, 95% CI, 1.11-2.53; P =.01) also increased the risk for drug discontinuation. Having a college degree or higher (RR, 0.56; 95% CI, 0.33-0.96; P =.03) reduced the risk for discontinuation due to any other reasons, and a higher number of swollen joints reduced the risk for, specifically, adalimumab discontinuation.

Study authors noted that obesity (RR, 0.56; 95% CI, 0.31-1.00; P =.05) prevented the discontinuation of IL-17 inhibitors.

One of the major study limitations was that other biologics and disease-modifying antirheumatic drugs (DMARDs), including IL-12/23, IL-23, and phosphodiesterase-4 (PDE4) inhibitors, had limited availability and were not included in the analysis.

“Certolizumab seemed to have the highest drug survival when used as first line while IL-17 [inhibitors] had the lowest probability…” the study authors noted. “This study has a major strength as it included biologics other than TNFi and examined predictors of drug persistence,” they concluded.