Tumor Necrosis Factor Inhibitor Persistence in Patients with Psoriatic Arthritis

x-ray of two hands with psoriatic arthritis
x-ray of two hands with psoriatic arthritis
TNFi persistence and factors influencing persistence were investigated in patients who were treated with TNFi therapy for the first time.

Female patients with psoriatic arthritis (PsA) and metabolic syndrome-related comorbidities are more likely to have lower tumor necrosis factor-alpha inhibitor (TNFi) persistence, and switching to a second TNFi therapy can be a valid therapeutic strategy, according to a retrospective cohort study published in Rheumatology.1

The investigators reviewed electronic medical records from a single center for patients with PsA who were prescribed either adalimumab (n=86) or etanercept (n=102) as first-line biologic therapy between 2003 and 2015.1 Baseline demographics and clinical characteristics were similar in both groups and 49% of patients were male. There was no difference in either group in the incidence of metabolic syndrome-related comorbidities, but more patients in the etanercept group had hypertension compared with patients in the adalimumab group (48% vs 23%; P =.03).

This study demonstrated a one-year TNFi persistence rate of 79%,1 which is consistent with previous studies that demonstrated rates of 70% to 88%.2-5 A multivariable analysis revealed that female gender and the presence of metabolic syndrome-related comorbidities (hypertension, diabetes, and/or dyslipidemia) were predictors of low persistence.A total of 32 patients were switched to a second TNFi (59% to adalimumab and 41% to etanercept) and persistence at 12 months was 56%. Although persistence was lower in patients who switched to a second TNFi, persistence was 2-fold less likely in these patients compared with first-line TNFi users (P =.01) and therefore switching to a second TNFi was demonstrated to be an effective therapeutic strategy.

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The investigators concluded that, “TNFi remain[s] the mainstay of management for patients with PsA who fail synthetic DMARD [disease-modifying antirheumatic drug] therapy.”1


  1. Stober C, Ye W, Guruparan T, Htut E, Clunie G, Jadon D. Prevalence and predictors of tumour necrosis factor inhibitor persistence in psoriatic arthritis [published online October 25, 2017]. Rheumatology (Oxford). doi:10.1093/rheumatology/kex387
  2. Glintborg B, Ostergaard M, Dreyer L, et al. Treatment response, drug survival, and predictors thereof in 764 patients with psoriatic arthritis treated with anti-tumor necrosis factor alpha therapy: results from the nationwide Danish DANBIO registry. Arthritis Rheum. 2011;63:382-390.
  3. Carmona L, Gomez-Reino JJ; BIOBADASER Group. Survival of TNF antagonists in spondylarthritis is better than in rheumatoid arthritis. Data from the Spanish registry BIOBADASER. Arthritis Res Ther. 2006;8:R72.
  4. Heiberg MS, Koldingsnes W, Mikkelsen K, et al. The comparative one-year performance of anti-tumor necrosis factor alpha drugs in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis: results from a longitudinal, observational, multicenter study. Arthritis Rheum. 2008;59:234-240.
  5. Saad AA, Ashcroft DM, Watson KD et al. Persistence with anti-tumour necrosis factor therapies in patients with psoriatic arthritis: observational study from the British Society of Rheumatology Biologics Register. Arthritis Res Ther. 2009;11:R52.