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Hepatic steatosis, carotid plaques negatively predicted minimal disease activity for PsA patients
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Hepatic steatosis and carotid plaques were negative predictors for achieving and maintaining minimal disease activity among psoriatic arthritis patients who began tumor necrosis factor-alpha blocker therapy in a recent study.
Researchers in Italy evaluated 270 patients (45.9% men) with active psoriatic arthritis (PsA) for the presence of metabolic syndrome (MetS), hepatic steatosis (HS) and carotid plaques (CPs) before initiating tumor necrosis factor-alpha (TNF-a) blocker treatment. Minimal disease activity (MDA) incidence was evaluated at 12 and 24 months.
At baseline, 91 participants (33.7%) showed MetS presence, 58 (21.5%) exhibited CPs and 76 (28.1%) had HS. These conditions were found in higher prevalence among participants who did not achieve MDA compared with those who did (P<.001). HS and CPs presence at baseline, after adjusting for MetS and other demographic/clinical characteristics, predicted risk for failing to achieve MDA (HR=1.91; 95% CI, 1.04-3.38; and HR=3.21; 95% CI, 1.64-6.29, respectively), which was confirmed by Kaplan-Meier survival models. Progressively increasing hazard ratios for not achieving MDA were found in patients with HS, CPs or a combination at baseline.
After patients were assigned adalimumab (40 mg/every 2 weeks; n=80), etanercept (50 mg/week; n=111) or infliximab (5 mg/kg every 8 weeks; n=79), 98 patients (36.3%) displayed MDA at 12-month follow-up. During the second year, 17.3% had relapsed while 82.7% maintained MDA. Relapse risk at 24 months was predicted by HS and/or CPs presence (HR=2.85; 95% CI, 1.27-6.37; and HR=3.17; 95% CI, 1.57-6.41, respectively).
“In PsA subjects starting a treatment with TNF-a blockers, this prospective study shows that HS or CPs at baseline are associated per se with a high risk of not achieving MDA,” the researchers said. “Because of their high cost and their side effects, the identification of predictors of success of TNF-alpha blockers is mandatory. By stratifying the achieving of a good clinical response, a risk/benefit evaluation may be performed. This … would hamper the use of TNF-alpha blockers in subjects with a low probability of success.”
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