Tumor Necrosis Factor Inhibitor Monotherapy Versus Combination Therapy for the Treatment of Psoriatic Arthritis: Combined Analysis of European Biologics Databases.

DOI
Publisher DOI
PubMed ID
32238520
Abstract
OBJECTIVE

To investigate whether tumor necrosis factor inhibitor (TNFi) combination therapy with conventional synthetic disease-modifying antirheumatic drugs (csDMARD) is more effective for psoriatic arthritis (PsA) and/or improves TNFi drug survival compared to TNFi monotherapy.

METHODS

Five PsA biologics cohorts were investigated between 2000 and 2015: the ATTRA registry (Czech Republic); the Swiss Clinical Quality Management PsA registry; the Hellenic Registry of Biologics Therapies (Greece); the University of Bari PsA biologics database (Italy); and the Bath PsA cohort (UK). Drug persistence was analyzed using Kaplan-Meier and equality of survival using log-rank tests. Comparative effectiveness was investigated using logistic regression with propensity scores. Separate analyses were performed on (1) the combined Italian/Swiss cohorts for change in rate of Disease Activity Score in 28 joints (DAS28); and (2) the combined Italian, Swiss, and Bath cohorts for change in rate of Health Assessment Questionnaire (HAQ).

RESULTS

In total, 2294 patients were eligible for the drug survival analysis. In the Swiss (P = 0.002), Greek (P = 0.021), and Bath (P = 0.014) databases, patients starting TNFi in combination with methotrexate had longer drug survival compared to monotherapy, while in Italy the monotherapy group persisted longer (P = 0.030). In eligible patients from the combined Italian/Swiss dataset (n = 1056), there was no significant difference between treatment arms in rate of change of DAS28. Similarly, when also including the Bath cohort (n = 1205), there was no significant difference in rate of change of HAQ.

CONCLUSION

Combination therapy of a TNFi with a csDMARD does not appear to affect improvement of disease activity or HAQ versus TNFi monotherapy, but it may improve TNFi drug survival.
Date Issued
2021-01-01
Publication Type
Article
Subject(s)
Language(s)
en
Author(s)
Thomas, Matthew L
Shaddick, Gavin
Charlton, Rachel
Cavill, Charlotte
Holland, Richard
Iannone, Florenzo
Lapadula, Giovanni
Lopriore, Simona
Závada, Jakub
Uher, Michal
Pavelka, Karel
Szczuková, Lenka
Sidiropoulos, Prodromos
Flouri, Irini
Drosos, Alexandros
Nissen, Michael J
Müller, Rüdiger B
Scherer, Almut
McHugh, Neil
Nightingale, Alison
Additional Credits
Journal
The journal of rheumatology
Publisher
The Journal of Rheumatology Publishing Company Limited
ISSN
0315-162X
Access(Rights)
restricted
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