TY - JOUR
T1 - 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
AU - Lindström, Ulf
AU - Di Giuseppe, Daniela
AU - Delcoigne, Bénédicte
AU - Glintborg, Bente
AU - Möller, Burkhard
AU - Ciurea, Adrian
AU - Pombo-Suarez, Manuel
AU - Sanchez-Piedra, Carlos
AU - Eklund, Kari
AU - Relas, Heikki
AU - Gudbjornsson, Bjorn
AU - Love, Thorvardur Jon
AU - Jones, Gareth T.
AU - Codreanu, Catalin
AU - Ionescu, Ruxandra
AU - Nekvindova, Lucie
AU - Závada, Jakub
AU - Atas, Nuh
AU - Yolbas, Servet
AU - Fagerli, Karen Minde
AU - Michelsen, Brigitte
AU - Rotar, null
AU - Tomšič, Matija
AU - Iannone, Florenzo
AU - Santos, Maria Jose
AU - Avila-Ribeiro, Pedro
AU - Ørnbjerg, Lykke Midtbøll
AU - Østergaard, Mikkel
AU - Jacobsson, Lennart T.H.
AU - Askling, Johan
AU - Nissen, Michael J.
N1 - Funding This work was supported by Novartis. Novartis had no influence on the data collection, statistical analyses, manuscript preparation or decision to submit. The work was also supported by NordForsk
PY - 2021/11
Y1 - 2021/11
N2 - 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.
AB - 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.
KW - arthritis
KW - methotrexate
KW - psoriatic
KW - tumour necrosis factor inhibitors
UR - http://www.scopus.com/inward/record.url?scp=85107521561&partnerID=8YFLogxK
U2 - 10.1136/annrheumdis-2021-220097
DO - 10.1136/annrheumdis-2021-220097
M3 - Article
C2 - 34083206
AN - SCOPUS:85107521561
SN - 0003-4967
VL - 80
SP - 1410
EP - 1418
JO - Annals of the Rheumatic Diseases
JF - Annals of the Rheumatic Diseases
IS - 11
M1 - 220097
ER -