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.