Biologic disease-modifying antirheumatic drugs (DMARDs) have significantly improved outcomes for patients with psoriatic arthritis (PsA). During a Monday presentation at the 2017 annual meeting of the American College of Rheumatology (ACR) and the Association of Rheumatology Health Professionals (ARHP), Marina Natalia Fornaro of the Instituto de Rehabilitación Psicofísica in Buenos Aires, Argentina, outlined an evaluation of biologic DMARD patterns, drug survival rates, and long-term efficacy in PsA. She and coauthors used the Lund Efficacy Index (LUNDEX), an index of drug efficacy in clinical practice, to perform a retrospective multicenter study of medical record data.
Records were included if patients were aged ≥ 18 years, had PsA, and had started therapy with a biologic DMARD. The total sample included 72 patients with PsA (54.2% men). Median age was 54.5 years, and median disease duration was 11 years. Among the sample, 71.2% of patients had comorbidities.
First biological agent was as follows:
- Adalimumab 45.8%
- Etanercept 36.1%
- Certolizumab 5.6%
- Infliximab and ustekinumab 4.2%
- Golimumab 1.4%
Overall, 25.4% of the patients received the biologic DMARD as monotherapy. Concomitant treatments included nonsteroidal anti-inflammatory drugs, methotrexate, prednisone, leflunomide and sulfasalazine. Nineteen (35.8%) patients stopped taking the first biologic due to inefficacy (43%), lack of provision (28.6%), side effects (14.3%) or other reasons.
The mean drug survival (i.e., time to drug discontinuation) of biologic DMARDs was 82 months (standard deviation ± 7.4). Adalimumab had the highest mean drug survival rate (90 months, standard deviation ± 10.4), followed by etanercept (79 months, standard deviation ± 12).
The analysis found that patients older than 55 years and those with body mass index of 30 or higher had less drug survival. After adjusting for different confounders, the researchers identified older age as the main variable associated with less drug survival.