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Prior Biologic Use Affects TNFi Treatment Persistence

A history of having taken biologics affects whether patients will adhere to prescribed TNFi therapy, researchers show.

Researchers report that psoriatic arthritis patients who are biologic-naïve have greater tumor necrosis factor inhibitors, or TNFi, treatment persistence than patients who are biologic-experienced. 

In the study, published online March 7 in Clinical Rheumatology, researchers explored the impact of treatment persistence in patients psoriatic arthritis who had initiated tumor necrosis factor inhibitor therapy as well as predictors of persistence.

Led by Leslie Harrold, M.D, of the University of Massachusetts in the United States, this retrospective study evaluated data obtained from the Corrona registry. The goal of the study was to better understand the factors that impact medication persistence and switching of medications among psoriatic arthritis patients with different histories of using biologics. 

Psoriatic arthritis is a systemic inflammatory disease that affects the musculoskeletal system and the skin. Patients with this disease may experience pain, swelling of the joints, skin disease, and enthesitis. Because psoriatic arthritis patients are at higher risk of developing cardiovascular disease and other co-morbidities, proper management of the disease is critical and highly associated with medication persistence. Treatment options for psoriatic arthritis include nonsteroidal anti-inflammatory drugs, nonbiologic disease-modifying antirheumatic drugs, and biologic agents such as TNFis.

The Corrona registry is a US-based, prospective disease registry of rheumatology patients, including those with psoriatic arthritis. Patients are enrolled into the registry by participating rheumatologists. Both patients and physicians complete questionnaires as part of routine clinical encounters. The registry encompasses approximately 600 rheumatologists and 6000 patients with psoriatic arthritis.

To date, most of the research on medication persistence and treatment outcomes has been conducted in rheumatoid arthritis patients, with few studies examining this relationship in psoriatic arthritis patients.

The study

This was a retrospective study of psoriatic arthritis patients in the Corrona registry, aged 18 and over, who initiated TNFi therapy between October 1, 2002 and March 21, 2013. All patients included in the analysis had to have had at least 1 follow up visit in the registry after initiating TNFi therapy. Patients were categorized as either being persistent or nonpersistent. Biologic-naïve patients had no record of biologic use at time of TNFi initiation, while those classified as “biologic-experienced” had a record of prior biologic use at TNFi initiation.

In total, 1,241 TNFi initiations were identified for the study. Most patients had used a biologic (56%) or nonbiologic disease-modifying antirheumatic drug (86%) prior to initiating the TNFi.

The main finding was that 46% of patients discontinued TNFi therapy during the study. The number of persistent patients declined from 83.2% at 6 months to 36.1% at 48 months. Moreover, of the 1241 total TNFi initiations, researchers found 572 cases of nonpersistences, 309 of which included patients who switched medications.

Overall, biologic-naïve patients were more likely to be persistent than biologic-experienced patients at all time points. In both biologic-naïve and biologic experienced patients, disease activity and disease duration were associated with persistence.

“The findings from this study overall suggest the need for careful and continued monitoring to ensure that patients remain persistent in order to enhance their opportunity to obtain the greatest therapeutic benefit from any TNFi that they may be using. Monitoring may also help physicians intervene and switch patients to a different medication when necessary,” wrote Harrold and colleagues. 



Funding:  This research was funded by Corrona, LLC.

Disclosures:  LRH is an employee and shareholder of Corrona, LLC and an employee of the University of Massachusetts Medical School (UMMS), has a research grant through UMMS from Pfizer, and is a consultant for Roche; BSS and DHC are employees and shareholders of Amgen Inc.; SR is an employee of Corrona, LLC; AM is a former employee  and shareholder of Amgen Inc.; SWW is a partner in Wade Outcomes Research and Consulting and a consultant for Amgen Inc.; WM is an employee of Corrona, LLC and Lamar University; JDG is an employee and shareholder of Corrona, LLC and consultant of Genentech, Eli Lilly, Janssen, Novartis, and Pfizer; and CJE is an employee of Corrona, LLC and advisory board member for Merck.




Harrold L, Stolshek B, Rebello S, 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 March 7, 2017. DOI: 10.1007/s10067-017-3593-x.