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Similar number of patients with PsA remained on TNFi mono- or combo therapy
Patients with psoriatic arthritis who received monotherapy or combination therapy with tumor necrosis factor inhibitors persisted with treatment, but the efficacy of monotherapy compared to combination therapy requires further investigation, according to researchers involved with the Corrona registry.
Researchers studied data from 519 patients enrolled in the U.S.-based, prospective, observational Corrona study between 2005 and Oct. 1, 2012, including 318 patients who received tumor necrosis factor inhibitors (TNFis) in combination with traditional disease-modifying anti-rheumatic drugs (DMARDs) and 201 who received monotherapy with TNFis. All patients were biologic-naïve, about half were women, over 95% were white and the mean age was 51.6 years.
Treatment history and demographics were similar between groups with the exception that about twice as many patients with combination therapy received infliximab (Remicade, Janssen) compared to the monotherapy group, which had more patients who received adalimumab (Humira, AbbVie) or etanercept (Enbrel, Amgen). Combination therapy included methotrexate for 91% and sulfasalazine or leflunomide for 9% of the patients. The mean follow-up duration was 2.1 years and all patients had at least one follow-up by 90 days following treatment initiation.
Patients were evaluated with the Change in Disease Activity Index (CDAI) score, Physician Global Assessment of disease activity and skin, Patient Global Assessment of disease activity and skin, modified Health Assessment Questionnaire (mHAQ), tender and swollen joint counts, and measurements of the erythrocyte sedimentation rate and C-reactive protein.
Adalimumab was prescribed to 218 patients, while 158 patients received etanercept and 114 patients received infliximab at baseline. No statistically significant difference in treatment persistence was seen between patients who received monotherapy or combination treatments. Persistence was longest in the monotherapy group with etanercept, similar between groups with adalimumab and longer in combination therapy with infliximab.
Univariate analysis showed prior treatment with methotrexate, a history of coronary artery disease, higher BMI and some measurements of disease activity and disability at baseline were predictive of shorter duration of persistence. In multivariate analysis, higher mHAQ and CDAI scores were predictive of shorter persistence.
No differences were observed in the median time to remission in either group, however, multivariate analysis showed female sex, higher BMI, higher disease activity and disability at baseline and history of diabetes or hypertension were predictive of a longer time to achieve remission. – by Shirley Pulawski
Disclosure: Mease reports the receipt of grants, research support, and is a consultant and/or on the speakers bureau from/for AbbVie, Amgen, Biogen Idec, Bristol Myers Squibb, Genentech, Janssen, Lilly, Pfizer and UCB and the receipt of grants, research support, and is a consultant from/for Celgene, Merck, and Novartis. Please see the full study for a list of all other authors’ relevant financial disclosures.