In patients with psoriatic arthritis (PsA), a lack of efficacy associated with the use of immunomodulatory therapy is common, and was the predominant reason for treatment switching, according to results from a real-world study published in Clinical Rheumatology.

Researchers sought to evaluate immunomodulatory therapy (biologics and apremilast) use; the extent of treatment failure; and the association of treatment failure with reduced physical functioning, health-related quality of life, and work productivity and activity impairment. The analysis, performed using data obtained from the Adelphi PsA Disease Specific Program (DSP), was carried out between 2015 and 2016 in 18 countries. All of the physicians who participated in the DSP survey, designed to collect evidence on real-world clinical practice, were instructed to complete a prespecified questionnaire for the next 1 to 8 (varying according to country) consecutive patients with active PsA who visited their practice for routine care. 

Patients qualified for study inclusion were age 18 years or older, had a confirmed physician diagnosis of PsA, and were not presently involved in a clinical trial. A total of 949 physicians participated in the analysis, 48.2% of whom were rheumatologists and 51.8% of whom were dermatologists.

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Participants were categorized as “failing to respond” on current immunomodulatory therapy if they fulfilled 1 or more of the following criteria after 3 months of treatment with a tumor necrosis factor inhibitor, apremilast, or ustekinumab: disease severity (ie, mild, moderate, or severe PsA) had worsened or remained severe; disease activity (ie, improving, stable, unstable, or deteriorating) was either unstable or deteriorating; the physician reported dissatisfaction with the patient’s current control of PsA; and the physician did not consider the patient’s current treatment regimen to be a success.

Among the 3714 patients with PsA evaluated, 40.6% had never received immunomodulatory treatment, 50.1% had received 1 immunomodulatory therapy, and 9.2% had received 1 or more immunomodulatory treatment. The most common reason for switching treatments was lack of efficacy with the initial immunomodulatory therapy. Patients whose physician indicated “primary lack of efficacy” as the reason for changing treatments were switched after a mean of 9.4 months. 

Overall, the 246 patients who failed to respond to immunomodulatory treatments failed had significantly poorer health-related quality of life compared with the 1472 patients who reported treatment success, according to the following measures: 5-dimension EuroQoL (0.60% vs 0.77%, respectively; P <.0001); Short-Form 36 Physician Component Summary (40.8% vs 46.1%, respectively; P <.0001); and Short-Form-36 Mental Component Summary (41.1% vs 45.3%, respectively; P <.0001).   

Moreover, physical functioning, activity, and work productivity were also more impaired among those who failed to respond to  immunomodulatory therapy compared with those reporting treatment success, as measured by Health Assessment Questionnaire-Disability Index (0.88% vs 0.56%, respectively; P <.0001), activity impairment (46.7% vs 29.7%, respectively; P <.0001), and overall work impairment (35.4% vs 26.1%, respectively; P <.0001).

The investigators concluded that poorer treatment response among individuals with PsA is associated with a significant negative effect on patients. Regarding primary treatment failure, timely switching is necessary. 

Reference

Alten R, Conaghan PG, Strand V, et al. Unmet needs in psoriatic arthritis patients receiving immunomodulatory therapy: results from a large multinational real-world study [published online February 4, 2019]. Clin Rheumatol. doi: 10.1007/s10067-019-04446-z