Ustekinumab, TNF inhibitors result in comparable improvements in psoriatic arthritis
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Key takeaways:
- Patients with psoriatic arthritis reported similar outcome improvements following 3 years of either therapy.
- Those receiving TNF inhibitors began with lower baseline work productivity scores on average, and achieved greater improvements in this area vs. ustekinumab.
Patient-reported outcomes in individuals with psoriatic arthritis receiving either ustekinumab or TNF inhibitors were “generally comparable” after 3 years of follow-up, according to data published in Arthritis Research & Therapy.
“Patients with PsA have reduced [health related quality of life (HRQoL)] compared with the general population and have worse quality of life (QoL) than people with psoriasis alone,” Laure Gossec, MD, PhD, of Pitié-Salpêtrière University Hospital and Sorbonne University, in Paris, and colleagues wrote. “Therefore, it is important to use patient-reported outcome (PRO) measures, in addition to physician-derived joint count or composite measure assessments, to assess physical, social and psychological functioning from the patient’s perspective in order to guide treatment decisions.
“While randomized clinical trials (RCTs) provide evidence on the short-term efficacy and safety of a drug, PsA is a long-term condition; thus, it is important to know the effects PsA treatments have on PROs in real-world settings over longer periods of time,” they added. “Real-world data provide a greater understanding of treatment effectiveness in a patient population in routine clinical care and are, therefore, meaningful for patients and physicians making treatment decisions.”
To investigate the difference in patient reported outcomes among patients with PsA who received ustekinumab (Stelara, Janssen) or a TNF inhibitor, Gossec and colleagues analyzed 3-year data from PsABio, a multinational, prospective study comparing the safety and efficacy of these treatment strategies. The study included patients aged older than 18 years with a diagnosis of PsA who received either ustekinumab or an approved TNF inhibitor as a first-, second- or third-line therapy.
Patients recorded their outcomes on three scales, including the EUROQol-5 dimensions health state VAS (EQ-5D VAS), the 12-item Psoriatic Arthritis Impact of Disease Questionnaire (PsAID-12), and the Work Productivity and Activity Impairment for Psoriatic Arthritis (WPAI) questionnaire. The primary outcome was the change from baseline to 3 years in each score.
The current analysis included a total of 437 patients across 92 sites in Belgium, France, Greece, Italy, the Netherlands, Russia, Spain and the United Kingdom. Among these participants, 219 received ustekinumab while 218 were in the TNF-inhibitor group. After 3 years of follow-up, patients treated with either regimen exhibited similar improvements in EQ-5D VAS, with those receiving ustekinumab demonstrating a mean change from baseline of 11% (95% CI, 6.5-15.4), compared with 18.9% (95% CI, 14 – 23.9) for those in the TNF-inhibitor group.
Meanwhile, PsAID-12 scores changed –2.9% (95% CI, -3.2 to -2.5) from baseline in patients receiving ustekinumab and –3.5% (95% CI, -3.9 to -3.2) in patients receiving TNF inhibitors.
Lastly, patients receiving TNF inhibitors saw a greater improvement in work productivity scores, but began at a lower baseline, Gossec and colleagues wrote. Mean improvements in work productivity after 3 years were 44.5% (95% CI, 38.4-50.6) in the TNF-inhibitor group and 24.9% (95% CI, 15.8-34) in those who received ustekinumab.
“The results from the 3-year PsABio study demonstrated that, generally, ustekinumab and TNFi treatment led to an improvement in PROs,” Gossec and colleagues wrote. “In certain PROs, TNFi-treated patients showed greater improvement compared with ustekinumab-treated patients but may have been confounded by differential baseline factors influencing treatment decisions. Patients achieving effectiveness endpoints had improved PROs, independent of treatment group. These findings may be useful for physicians in aiding treatment decisions in clinical practice.”
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