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Effectiveness and treatment retention of TNF inhibitors when used as monotherapy versus comedication with csDMARDs in 15 332 patients with psoriatic arthritis. Data from the EuroSpA collaboration

Authors :
Johan Askling
Burkhard Möller
Matija Tomšič
Lennart T H Jacobsson
Jakub Zavada
Thorvardur Jon Love
Daniela Di Giuseppe
Adrian Ciurea
Manuel Pombo-Suarez
Maria José Santos
Bjorn Gudbjornsson
Pedro Avila-Ribeiro
Catalin Codreanu
Brigitte Michelsen
Michael John Nissen
Carlos Sánchez-Piedra
Lykke Midtbøll Ørnbjerg
Karen Minde Fagerli
Bente Glintborg
Žiga Rotar
Bénédicte Delcoigne
Gareth T. Jones
Ruxandra Ionescu
Servet Yolbas
Ulf Lindström
Lucie Nekvindová
Heikki Relas
Mikkel Østergaard
Nuh Atas
Florenzo Iannone
Kari K. Eklund
HUS Inflammation Center
Department of Medicine
Reumatologian yksikkö
Repositório da Universidade de Lisboa
Source :
Annals of the Rheumatic Diseases, Repositório Científico de Acesso Aberto de Portugal, Repositório Científico de Acesso Aberto de Portugal (RCAAP), instacron:RCAAP, Lindström, U, Di Giuseppe, D, Delcoigne, B, Glintborg, B, Möller, B, Ciurea, A, Pombo-Suarez, M, Sanchez-Piedra, C, Eklund, K, Relas, H, Gudbjornsson, B, Love, T J, Jones, G T, Codreanu, C, Ionescu, R, Nekvindova, L, Závada, J, Atas, N, Yolbas, S, Fagerli, K M, Michelsen, B, Rotar, Tomšič, M, Iannone, F, Santos, M J, Avila-Ribeiro, P, Ørnbjerg, L M, Østergaard, M, Jacobsson, L T H, Askling, J & Nissen, M J 2021, ' Effectiveness and treatment retention of TNF inhibitors when used as monotherapy versus comedication with csDMARDs in 15 332 patients with psoriatic arthritis. Data from the EuroSpA collaboration ', Annals of the Rheumatic Diseases, vol. 80, no. 11, 220097, pp. 1410-1418 . https://doi.org/10.1136/annrheumdis-2021-220097
Publication Year :
2021
Publisher :
BMJ Publishing Group, 2021.

Abstract

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.<br />Background: Comedication with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) during treatment with tumour necrosis factor inhibitors (TNFi) is extensively used in psoriatic arthritis (PsA), although the additive benefit remains unclear. We aimed to compare treatment outcomes in patients with PsA treated with TNFi and csDMARD comedication versus TNFi monotherapy. Methods: Patients with PsA from 13 European countries who initiated a first TNFi in 2006-2017 were included. Country-specific comparisons of 1 year TNFi retention were performed by csDMARD comedication status, together with HRs for TNFi discontinuation (comedication vs monotherapy), adjusted for age, sex, calendar year, disease duration and Disease Activity Score with 28 joints (DAS28). Adjusted ORs of clinical remission (based on DAS28) at 12 months were calculated. Between-country heterogeneity was assessed using random-effect meta-analyses, combined results were presented when heterogeneity was not significant. Secondary analyses stratified according to TNFi subtype (adalimumab/infliximab/etanercept) and restricted to methotrexate as comedication were performed. Results: In total, 15 332 patients were included (62% comedication, 38% monotherapy). TNFi retention varied across countries, with significant heterogeneity precluding a combined estimate. Comedication was associated with better remission rates, pooled OR 1.25 (1.12-1.41). Methotrexate comedication was associated with improved remission for adalimumab (OR 1.45 (1.23-1.72)) and infliximab (OR 1.55 (1.21-1.98)) and improved retention for infliximab. No effect of comedication was demonstrated for etanercept. Conclusion: This large observational study suggests that, as used in clinical practice, csDMARD and TNFi comedication are associated with improved remission rates, and specifically, comedication with methotrexate increases remission rates for both adalimumab and infliximab.

Details

Language :
English
ISSN :
14682060 and 00034967
Volume :
80
Issue :
11
Database :
OpenAIRE
Journal :
Annals of the Rheumatic Diseases
Accession number :
edsair.doi.dedup.....022e520d9e5e31bc0cc0baf6321a0476