Age, sex may predict TNF inhibitor success in psoriatic arthritis
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Key takeaways:
- Factors that may predict psoriatic arthritis remission include age and sex.
- More than 60% of patients receiving TNF inhibitors maintained the therapy for 12 months.
Age, disease duration and sex are factors that may predict how likely a patient with psoriatic arthritis may be to enter remission following therapy with a TNF inhibitor, according to data published in Rheumatology.
“Tumor necrosis factor inhibitors (TNFi) have contributed to major improvements in clinical outcomes and quality of life for patients with psoriatic arthritis (PsA),” Louise Linde, MD, of the Copenhagen Center for Arthritis Research, in Denmark, and colleagues wrote. “However, many patients treated with TNFi fail to achieve the recommended treatment target of remission or, alternatively, low disease activity.”
To investigate and identify predictors of DAS28 remission and DAPSA28 moderate response, as well as drug adherence, in patients with PsA who initiate TNF inhibitor therapy, Linde and colleagues analyzed data from 13 European registries. The study included patients with PsA who were aged 16 years and older who began treatment with a TNF inhibitor sometime between diagnosis and reaching the age of 90 years. The first dose of TNF inhibitor must have been initiated between Jan. 1, 2009, and Dec. 31, 2018.
The primary outcome was the number of patients who achieved DAPSA28 remission at 6 months while receiving their first TNF inhibitor. Secondary endpoints included DAPSA28 moderate response at 6 months and drug retention at 12 months. In cases where 6-month data were not available, the researchers assessed factors such as discontinued or changed therapies to infer patients’ remission status.
The analysis included a total of 13,369 patients, of whom 25% achieved remission at 6 months, 34% achieved a moderate response at 6 months and 63% achieved drug retention at 12 months. According to the researchers, there were several indicators that appeared to predict all three outcomes of interest. Factors that predicted remission included age per year (OR = 0.97; 95% CI, 0.96-0.98), disease duration in years — with ORs ranging from 1.2 (95% CI, 0.89-1.6) for 2 to years, to 1.42 (95% CI, 1.09-1.84) for 4 to 9 years, and 1.66 (95% CI, 1.26-2.2) for 10 or more years, compared with fewer than 2 years — and male sex vs. female sex (OR = 1.85; 95% CI, 1.54-2.23).
A C-reactive protein of more than 10 mg/l, compared with 10or fewer mg/l (OR = 1.52; 95% CI, 1.22 to 1.89), and a 1mm increase in patient fatigue score (OR = 0.99; 95% CI, 0.98-0.99) were additionally common among those who achieved remission.
“Baseline predictors of remission, response and drug retention in European patientswith PsA treated with a first TNFi were identified, five of which were common across the outcomes,” Linde and colleagues wrote. “The consistency of predictors across registries and treatment outcomes, despite heterogeneity in patient characteristics and treatment practices, indicate that the baseline predictors emerging from our pooled analyses may be considered generalizable from the country to disease level.”
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