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
Open Access
- 3 June 2021
- journal article
- research article
- Published by BMJ in Annals Of The Rheumatic Diseases
- Vol. 80 (11), 1410-1418
- https://doi.org/10.1136/annrheumdis-2021-220097
Abstract
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.Funding Information
- NordForsk
- Novartis
This publication has 23 references indexed in Scilit:
- A randomized placebo-controlled trial of methotrexate in psoriatic arthritisRheumatology, 2012
- Infliximab plus methotrexate is superior to methotrexate alone in the treatment of psoriatic arthritis in methotrexate-naive patients: the RESPOND studyAnnals Of The Rheumatic Diseases, 2011
- Treatment response, drug survival, and predictors thereof in 764 patients with psoriatic arthritis treated with anti–tumor necrosis factor α therapy: Results from the nationwide Danish DANBIO registryArthritis & Rheumatism, 2010
- Psoriatic arthritisDermatologic Therapy, 2009
- The effectiveness of a traditional therapeutical approach in early psoriatic arthritis: results of a pilot randomised 6-month trial with methotrexateClinical Rheumatology, 2007
- Adalimumab for the treatment of patients with moderately to severely active psoriatic arthritis: Results of a double‐blind, randomized, placebo‐controlled trialArthritis & Rheumatism, 2005
- Sustained benefits of infliximab therapy for dermatologic and articular manifestations of psoriatic arthritis: Results from the infliximab multinational psoriatic arthritis controlled trial (IMPACT)Arthritis & Rheumatism, 2005
- Etanercept treatment of psoriatic arthritis: Safety, efficacy, and effect on disease progressionArthritis & Rheumatism, 2004
- Quantifying heterogeneity in a meta-analysisStatistics in Medicine, 2002
- Randomized, Double‐Blind, Placebo Controlled Trial of Low‐Dose Pulse Methotrexate in Psoriatic ArthritisArthritis & Rheumatism, 1984