‘Large proportion’ of patients with PsA fail to meet treatment targets
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A “large proportion” of patients with psoriatic arthritis fail to reach treatment targets despite medication, with residual musculoskeletal and skin disease frequently observed, according to data published in Rheumatology and Therapy.
“Our current understanding of unmet need in treated patients is limited, yet this knowledge is essential to refine care to address residual disease,” Laura C. Coates, MBChB, MRCP, PhD, of the University of Oxford, and colleagues wrote. “This includes residual disease among patients meeting treatment targets, as well as persistent symptoms in patients not meeting treatment targets.”
To investigate real-world data on residual PsA symptoms in patients who have received treatment and been assessed against remission or low disease activity targets, Coates and colleagues conducted a systematic review of literature published since Jan. 1, 2015, using terms related to PsA, treatment targets and observational studies. To be included in the review, reports needed to quantify relevant disease outcomes in adults who received at least one pharmacological treatment in a real-world setting. Certain studies, such as those that were interventional or economic in nature, or editorials, were excluded from the analysis.
Articles that reviewed the same patient cohorts were counted as a single unit, and information from the papers was compiled into a single grid, which was then checked by a second investigator. Depending on the severity, discrepancies were resolved by way of consensus or arbitration.
In all, 2,328 records from 42 publications were included in the study. Among those records, 23 reported outcomes for patients assessed for minimal disease activity (MDA), and 14 studies reported outcomes for those assessed for the Disease Activity Index in PsA (DAPSA). In these studies, physician- and patient-reported residual disease was “less frequent” in patients who met their targets, but was rarely totally absent, the authors wrote.
A total of 18 studies reporting musculoskeletal disease were included in the analysis. In these studies, among patients that achieved MDA or DAPSA or clinical DAPSA, 2% to 85% of patients demonstrated a tender joint count of more than one. Skin outcomes were reported in 14 studies, and among patients achieving at least MDA, 19% to 34% of patients demonstrated a mean psoriasis area index score of more than one.
“This systematic review is, to our knowledge, the first to characterize the real-world evidence of residual disease among treated PsA patients grouped by thresholds of disease control,” the authors wrote. “The evidence demonstrated that, despite treatment, a large proportion of patients may not reach treatment targets and consequently face substantial residual disease.”
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Coates LC, et al. Rheumatol Ther. 2022;doi:10.1007/s40744-022-00443-y.
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