Depression, treatment order impact biologic therapy persistence in psoriatic arthritis
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Key takeaways:
- Biologic persistence in PsA depends on the whether the drug was a first or second therapy.
- Depression and anxiety can lead to drug discontinuation.
Biologic therapy persistence in psoriatic arthritis often depends on whether the drug was a first or second treatment, with depression, anxiety, older age and higher tender joint count also leading to discontinuation, according to data.
“The development of new biological disease-modifying antirheumatic drugs (bDMARDs) for PsA has led to better disease control as well as slowing of radiographic progression,” Mohamad-Ali Rida, MD, of the Center for Prognosis Studies at Toronto Western Hospital, in Canada, and colleagues wrote in Arthritis Care & Research. “Once an advanced therapy fails, due to either lack of efficacy or side effects, switching to another one from the same or different class is the norm.”
To evaluate trends regarding biologic therapy for PsA, Rida and colleagues conducted a retrospective analysis of data from patients who visited the Toronto Western Hospital’s PsA clinic between Jan. 1, 2000, and July 7, 2020. Demographic data, medications, disease activity scores and new predictions were recorded for each patient. For each medication record, treatment start and stop dates, as well as the reasons for therapy discontinuation, were included.
Biologic therapies included in the analysis were five TNF inhibitors — adalimumab (Humira, AbbVie), certolizumab pegol (Cimzia, UCB), etanercept (Enbrel, Amgen), golimumab (Simponi, Janssen) and infliximab (Remicade, Janssen) — and three interleukin-17 inhibitors — ixekizumab (Taltz, Eli Lilly & Co.), secukinumab (Cosentyx, Novartis) and brodalumab (Kyntheum, LEO Pharma), all combined due to the small number of patients taking each individual IL-17 inhibitor. Other biologics were not included as the sample size of patients receiving them were too small.
Patients were considered to have received a single course of therapy if the break between prescriptions was less than 180 days. In cases where patients had a break of more than 180 days before receiving the same advanced therapy, it was considered a second course of therapy.
The analysis included 571 patients. According to the researchers, depression and anxiety were associated with higher rates of therapy cessation due to any cause (RR = 1.68; 95% CI). Additionally, higher tender joint counts were linked to higher levels of cessation (RR = 1.02; 95% CI), as was older age at the time of therapy initiation (RR = 1.03; 95% CI). Meanwhile, attainment of higher levels of education was associated with lower levels of therapy cessation (RR = 0.56; 95% CI).
Regarding drug-specific data, the therapy with the highest probability of 3-year survivability at first treatment was certolizumab (0.8; 95% CI, 0.52-1). The drug with the lowest probability of 3-year survival were interleukin-17 inhibitors combined (0.48; 95% CI, 0.28-0.81). When initiated as the second biologic therapy, certolizumab demonstrated the lowest 3-year survival of the included therapies (0.23; 95% CI, 0.09-0.62). In this group, infliximab had the highest 3-year survival (0.62; 95% CI, 0.42-0.9).
“Certolizumab seemed to have the highest drug survival when used as first line while IL-17i had the lowest probability although data were very sparse for IL-17i biologics,” Rida and colleagues wrote. “Our results were mostly consistent with the previously published literature with few exceptions where obesity was found to be protective against drug discontinuation.”
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