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Psoriatic arthritis
Original article
Long-term persistence of TNF-inhibitor treatment in patients with psoriatic arthritis. Data from the British Society for Rheumatology Biologics Register
  1. Karen Minde Fagerli1,2,
  2. Lianne Kearsley-Fleet1,
  3. Kath D Watson1,
  4. Jon Packham3,
  5. BSRBR-RA Contributors Group1,
  6. Deborah P M Symmons1,4 and
  7. Kimme L Hyrich1,4
  1. 1 Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
  2. 2 Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  3. 3 Institute of Applied Clinical Sciences, Keele, UK
  4. 4 NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester, UK
  1. Correspondence to Dr Kimme L Hyrich; kimme.hyrich{at}manchester.ac.uk

Abstract

Background Long-term effectiveness of tumour necrosis factor alpha inhibitors (TNFi) has mainly been explored in patients with rheumatoid arthritis (RA) and the data available on patients with psoriatic arthritis (PsA) includes limited follow-up.

Objective Investigate long-term effectiveness of first TNFi in a PsA population by describing treatment persistence, identify factors associated with 5-year persistence and further investigate comparative long-term effectiveness of subsequent TNFi treatments through persistence to treatment.

Methods Patients with a rheumatologist diagnosis of PsA receiving their first TNFi registered in the British Society for Rheumatology Biologics Register (BSRBR) (2002–2006) were included. Treatment at different time points was described and factors associated with 5-year treatment persistence were identified by logistic regression. Kaplan-Meier analysis was used to assess factors associated with persistence to first TNFi and subsequent TNFi treatments.

Results At 5 years, 46.7% of patients were still on their initial TNFi treatment. Better 5 -year persistence was associated with male gender, use of etanercept or adalimumab rather than infliximab and absence of baseline comorbidity. Five-year persistence estimates (95% CI) of first, second and third TNFi were 53% (49% to 57%), 60% (43% to 57%) and 48% (36% to 59%), respectively.

Conclusion We found good long-term persistence of TNFi in this PsA population both for the first and subsequent TNFi treatments. The relationship between persistence and relevant clinical factors was not strong and demonstrates the difficulties in predicting outcome of TNFi treatment in PsA.

  • psoriatic arthritis
  • anti-tnf
  • dmards (biologic)

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 and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/rmdopen-2017-000596

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    Footnotes

    • Contributors KMF, JP, DPMS and KLH were responsible for the study concept and design. BSRBR Control Centre Consortium carried out acquisition of data. KMF and LK-F wrote the statistical analysis. KMF and KLH drafted the manuscript. All authors contributed to and approved the final manuscript. KMF, KDW and KLH had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

    • Funding This work was supported by the British Society for Rheumatology (BSR). The BSR commissioned the BSR Biologics Register in rheumatoid arthritis (BSRBR-RA) as a UK-wide national project to investigate the safety of biologic agents in routine medical practice. KH is the principal investigator. BSR receives restricted income from the UK pharmaceutical companies, including AbbVie, Celltrion, Hospira, MSD, Pfizer, SOBI, Samsung, UCB and Roche. This income finances a wholly separate contract between the BSR and the University of Manchester. The principal investigator and the BSRBR-RA team at the University of Manchester have full academic freedom and are able to work independently of pharmaceutical industry influence. All decisions concerning analyses, interpretation and publication are made autonomously of any industrial contribution. Members of the BSRBR-RA University of Manchester team, BSR trustees, committee members and staff complete an annual declaration in relation to conflicts of interest. All relevant information regarding serious adverse events outlined in the manuscript have been reported to the appropriate pharmaceutical company as per the contractual agreements/standard operating procedures. KMF was supported through a grant from the South-Eastern Norway Regional Health Authority.

    • Competing interests KLH received research grants from AbbVie and Pfizer.

    • Ethics approval The study was approved by the North West Multicentre Research Ethics Committee (reference number MREC 00/08/053), and all subjects provided written consent.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.

    • Collaborators see www.bsrbr.org for full list of contributors.