medwireNews: Patients initiating their first tumor necrosis factor inhibitor (TNFi) for psoriatic arthritis (PsA) have a longer time to discontinuation and are less likely to switch treatment than those previously treated with a drug from the same class, say researchers.
Philip Mease (University of Washington, Seattle, USA) and colleagues believe that their real-world data “can help inform treatment decisions when selecting later lines of therapy for patients with PsA.”
The study included 171 TNFi-naive and 147 TNFi-experienced patients aged 18 years and older with PsA enrolled in the US-based Corrona Psoriatic Arthritis/Spondyloarthritis Registry who initiated a TNFi between 2013 and 2017.
During a median follow-up of 23.0 months, Mease and team found that TNFi-experienced patients were significantly more likely than TNFi-naive patients to discontinue treatment (54.4 vs 43.9%) or switch to a new biologic (32.7 vs 19.3%).
In addition, the median time to discontinuation was significantly shorter among the TNFi-experienced versus TNFi-naive patients, at 20 versus 27 months.
The majority of both TNFi-experienced (73.8%) and TNFi-naive (65.3%) patients who discontinued or switched treatment had done so by the first follow-up visit, an average of 11.5 months from baseline.
A higher proportion of patients who discontinued or switched treatment rather than continued with their index TNFi were women in both the TNFi experienced (69.0 vs 51.7%) and TNFi-naive cohorts (62.5 vs 52.5%), but the difference was only statistically significant in the TNFi-experienced cohort.
Furthermore, Mease and co-investigators observed “a trend towards higher baseline disease activity and worse [patient-reported outcomes] among patients who discontinued their index TNFi by the first follow-up visit compared with those who continued in both the TNFi-naive and TNFi-experienced cohorts.” However, they remark that “most differences did not reach statistical significance.”
Lack of efficacy was the most common provider-reported reason for discontinuing or switching the index TNFi in both the TNFi-experienced cohorts and TNFi-naive cohorts, at 73.2% and 90.2%, respectively, with side effects second most common, at 26.8% and 12.2%, respectively.
The researchers conclude that their study, published in RMD Open, “provides insight into the persistence and switching of TNFi therapy among TNFi-naive versus TNFi-experienced patients with PsA.”
By Laura Cowen
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