Original articleTreatment response, drug survival and safety of anti-tumour necrosis factor α therapy in 193 patients with psoriatic arthritis: A twelve-year “real life” experience
Introduction
Psoriatic arthritis (PsA) is a form of spondyloarthritis. The therapeutic approach is essentially multidisciplinary and must take rheumatological as well as dermatological aspects into account [1], [2], [3]. Non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids (systemic or intra-articular) have a place in the treatment of PsA together with cs-DMARDs (methotrexate, leflunomide, sulfasalazine) for the treatment of peripheral forms of the disease [1], [2], [3]. Following failure of cs-DMARDs or in predominantly axial forms, anti-TNFα therapy constitutes the reference biotherapy for the treatment of PsA [1], [2], [3]. The clinical and structural efficacy of anti-TNFα therapy was demonstrated during therapeutic trials and five anti-TNFα drugs are currently marketed in France for the treatment of PsA: etanercept (soluble receptor) [4], [5], [6], infliximab (chimeric monoclonal antibody) [7], [8], [9], [10], adalimumab (humanised monoclonal antibody) [11], golimumab (humanised monoclonal antibody) [12], [13] and certolizumab (pegylated monoclonal antibody) [14].
Clinical experience acquired from patient registries or so-called “real life” studies provides valuable information to assess routine management of PsA by anti-TNFα and can be used to validate the results obtained during therapeutic trials in populations of older patients with multiple comorbidities. Several national registries are available: DANBIO for Denmark [15], [16], NOR-DMARD for Norway [17], [18], BSR-BR for England [19], and SSATG for Sweden [20]. However, the available data remain fairly limited, based on relatively short patient follow-up with sometimes contradictory results and conclusions, particularly concerning the value of switching anti-TNFα [16], [17] and the relevance of concomitant treatment with methotrexate and an anti-TNFα at the time of initiation especially to achieve better drug survival [18], [20].
The objective of this study was to evaluate the “real life” use of anti-TNFα therapy for the management of PsA in a large patient cohort with a maximum duration of follow-up of 10 years, with particular emphasis on efficacy, drug survival, safety and predictive factors of discontinuation of first-line anti-TNFα therapy.
Section snippets
Patients
This single centre, retrospective, observational study was conducted from April 2001 to April 2013. The charts of all patients with PsA treated with at least one anti-TNFα drug for more than 6 months were reviewed. Patient charts were retrieved from the health informatics department. Moll and Wright and/or CASPAR criteria were used to establish the diagnosis of PsA [21], [22]. In doubtful cases, the final diagnosis was validated by the use of the new ASAS criteria for axial and peripheral
Patient characteristics at the time of initiation of first-line anti-TNFα therapy
More than one half of the 193 patients with PsA who had received treatment with at least one anti-TNFα drug were men (55%). The mean age was 46.8 years with a mean history of disease of 6.7 years (Table 1). These patients predominantly presented peripheral forms in 89% of cases. The great majority of patients (83%) reported a personal history of psoriasis of the skin and/or nails. Patients had received a mean of slightly more than 2 cs-DMARDs (mean: 2.5 ± 1.8) before initiation of first-line
Discussion
This cohort of 193 patients, with a maximum duration of follow-up of 10 years, provides valuable information concerning the use of anti-TNFα drugs for the treatment of PsA. Based on the use of pragmatic criteria, this study demonstrated a high response rate at 3 months and satisfactory drug survival rates for first-line, as well as second-line and third-line anti-TNFα therapy, thereby confirming the value of treatment switch. On the other hand, the value of co-prescription of cs-DMARDs at the
Disclosure of interest
The authors declare that they have no conflicts of interest concerning this article.
Acknowledgements
This study was supported by a grant from Pfizer.
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