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There are two types of PsA patients: Biologic naïve patients who take medication persistence seriously and patients who've given up due to a history of failed TNFi therapy.
Most patients with psoriatic arthritis continue with their tumor necrosis factor inhibitor therapy regardless of whether or not they are naive to biologic treatment or experienced. However, patients who have never before tried biologic therapy exhibit more persistence than those who have taken tumor necrosis factor inhibitors in the past.
Psoriatic arthritis, which can cause swollen and painful joints, dactylitis, enthesitis, skin and nail disease while increasing the risk of both metabolic syndrome and cardiovascular disease, is becoming increasingly common.
Since effective treatment improves the quality of life and the ability to function well for those with psoriatic arthritis, it is important to identify factors that effect patient’s willingness to persist with therapy. “Persistence is often associated with treatment efficacy,” write the authors of a study recently published in Clinical Rheumatology.
The researchers found that with increased disease activity in both biologic naÃ¯ve and experienced patients, came higher rates of non-persistence.
Leslie Harrold and fellow researchers point out that persistence in biologic therapy has been well described in relation to rheumatoid arthritis and that their results mirror such reports which also show patients with higher disease activity and prior experience with biologics experience lower persistence.
This study was a retrospective observational examination of psoriatic arthritis patients in the Corrona registry, a United States disease-based registry of rheumatology patients collecting data since 2001.
The study included 1,241 patients with similar characteristics initiated on tumor necrosis factor inhibitors during registry collection.
They found that 52% of patients continued TNFi therapy at 24 months. While the majority of patients remained persistent with TNFi therapy, that number dropped from 83.2% at six months to 36.1% at 48 months.
Furthermore, 87% vs 80% of biologic-naÃ¯ve to biologic-experienced patients at 6 months and 42% to 31% respectively at 48 months remained persistent - which represents a statistically significant difference (p= 0.0002).
Predicting who will continue therapy was also associated with disease activity. In both groups, biologic-naÃ¯ve and experienced patients with higher clinical disease activity indices experienced higher rates of non-persistence. Lack of persistence was also found in patients with more extensive skin involvement.
Higher rates of persistence were found in subjects who experienced shorter disease duration.
Results highlight the need for physicians to carefully consider treatment options when prescribing the initial biologic, since patient experience affects the likelihood that they will continue therapy.
Physicians should carefully monitor their patients with psoriatic arthritis on biologic therapy to promote persistence and alter therapy before non-persistence occurs.
The authors point out, “The PsA treatment landscape is evolving, with the availability of new agents possibly changing patterns of persistence. “
The authors concluded, “Understanding the factors associated with persistence in patients with PsA with different biologic experience may be important for making treatment decisions. “
The study was funded by Corrona, LLC with support for the Corrona registry provided by: AbbVie, Amgen, BMS, Crescendo, Genentech, Horizon Pharma USA, Janssen, Eli Lilly, Novartis, Pfizer and UCB.
Leslie Harrold and co-authors disclosed relevant relationships with Corrona LLC, the University of Massachusetts Medical School, Pfizer and Roche, Amgen Inc., Genentech, Eli Lilly, Janssen, Novartis, and Merck.
Leslie R. Harrold, Bradley S. Stolshek, Sabrina Rebello, et al. “Impact of prior biologic use on persistence of treatment in patients with psoriatic arthritis enrolled in the US Corrona registry,” Clinical Rheumatology. Published online Mar. 07, 2017. DOI: 10.1007/s10067-017-3593-x