Comorbidities may predict poor outcomes in patients with PsA

MADRID — The presence of baseline comorbidities was associated with adverse outcomes in psoriatic arthritis, including poor response to and discontinuation of tumor necrosis factor inhibitors, according to findings presented at the EULAR Annual Congress.

Lars Erik Kristensen, MD, PhD, of The Parker Institute at Copenhagen University Hospital in Bispebjerg and Frederiksberg in Denmark, noted that many comorbidities, such as infections, neoplasms, cardiovascular disorders, and mental disorders, are present at the time of psoriatic arthritis diagnosis.

“Mental disorders become significantly increased after diagnosis,” Kristensen said, noting increased levels of anxiety and depression. “There is an impact on society due to health care costs. We spend a lot of money diagnosing and treating these patients, and much of that cost is driven primarily by comorbidities. What we wanted to do here was look at comorbidities and whether they had an impact on the disease itself or disease management.”

The study included 1,750 patients who were categorized into three groups based on Charlson Comorbidity Index (CCI) status. Overall, there were 1,066 patients with a CCI of 0; 493 patients with a CCI of 1; and 191 patients with a CCI of at least 2. With the lowest tertile group as the index, treatment discontinuation was comparable in the middle group (hazard ratio [HR] = 1.02) but considerably higher in the highest group (HR = 1.72).

“When there are more comorbidities, there is a clear dose-response relationship,” Kristensen said.

Adherence to treatment was also lower among patients with depression and/or anxiety disorders. Among those with none of these disorders, the treatment duration was 2.4 years compared with a duration of 1.7 years for those with depression and/or anxiety.

“Anxiety and depression are a pivotal thing here,” Kristensen said. “They have a detrimental effect on treatment adherence.”

Baseline comorbidities also impacted EULAR response, according to Kristensen. A good response was reported in 41% of those with a CCI of 0 compared with a response rate of 23% among those in the group with a CCI of at least 2. A good-or-moderate response was reported in 54% of those in the lowest CCI group compared with 47% of those in the highest CCI group.

Other findings indicated that no baseline comorbidities had a favorable impact on ACR50 and ACR70 response compared with patients who had comorbidities.

A key question pertains to the source and nature of pain and fatigue, according to Kristensen.

“Pain and fatigue are hallmarks of this disease,” he said. “They should be taken seriously.” — by Rob Volansky

Reference:

Ballegaard C, et al. Abstract #OP0106. Presented at: EULAR Annual Congress; June 14-17, 2017; Madrid.

Disclosure: Kristensen reports being on the speakers bureau of AbbVie, Amgen, BMS, Celgene, Eli Lilly, Janssen Pharmaceuticals, Pfizer and UCB.