Even After Pretreatment with up to Three Biologics, Anti-TNFs Shows Effectiveness in Active Psoriatic Arthritis Patients

Frank Behrens¹, Michaela Koehm¹, Diamant Thaci², Brigitte Krummel-Lorenz³, Gerd Greger⁴, Bianca Wittig⁴ and Harald Burkhardt⁵, ¹CIRI/Div. Rheumatology, J.W. Goethe-University, Frankfurt/Main, Germany, ²Klinik für Dermatologie, Venerologie und Allergologie, J.W. Goethe University, Frankfurt/Main, Germany, ³CIRI/Endokrinologikum, Frankfurt/Main, Germany, ⁴Abbott GmbH & Co KG, Wiesbaden, Germany, ⁵CIRI /Div. of Rheumatology, Goethe-University, Frankfurt/Main, Frankfurt/Main, Germany

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: Adalimumab, anti-TNF therapy, disease-modifying antirheumatic drugs and psoriatic arthritis

Session Information

Title: Spondylarthropathies and Psoriatic Arthritis: Clinical Aspects and Treatment

Session Type: Abstract Submissions (ACR)

Background/Purpose: For the treatment of patients with psoriatic arthritis (PsA) only antiTNF biologics are licensed. Therefore, failures to anti-TNF are often switched to a different antiTNF treatment, despite the fact that only little evidence of effectiveness is available for anti TNF switch.

Methods: A multicentre, prospective observational study included patients (n=3320) with moderate to severe PsA treated with Adalimumab (ADA). Treatment response of ADA therapy when used as first-, second- or third/fourth line antiTNF-therapy regimen in patients with active psoriatic arthritis in clinical routine care in Germany was measured. Besides documentation of demographic data, disease activity assessments such as number of swollen (SJC) and tender joints (TJC), disease activity score 28 (DAS28), enthesitis, dactylitis as well as target lesion score (TLS) and body surface area (BSA) for skin involvement were calculated at baseline, month 3, 6, 12 and 24.

Results: Treatment with ADA is effective in patients with active PsA. The reduction of disease activity is clinical meaningful independently from the number of previous used antiTNF agents (0, 1, ≥ 2). The swollen joint count (SJC) was reduced from 8.7 at baseline to 1.4 after 24 months (TNFnaive). A comparable reduction was seen in patients pretreated with one (7.7 to 2.8) or two and more (8.5 to 1.9) antiTNF agents.

A higher reduction in DAS28 was seen in the group of biologic naive patients (-2.22) than in those with pretreatment of at least one TNF (-1.79). This leads to a mean DAS after two years of treatment with ADA near to remission (DAS28 2.62) while those switching to ADA from another TNF achieved a mean DAS of 2.89 (failed one antiTNF) and 3.12 (failed two or more antiTNF) respectively. Comparable reduction of percentages of patients with dactylitis was seen in all groups while enthesitis responses better in TNF naïve versus those who faile one or more antiTNF. Additionally, skin response in all groups was comparable measured by reduction in TLS.

Conclusion: ADA treatment is effective in patients with active PsA on all facets of the disease (arthritis, enthesitis, dactylitis and skin involvement). A switch from another antiTNF results in a meaningful reduction of disease activity. In contrast to rheumatoid arthritis in which previous antiTNF use leads to a significant decrease of response, in PsA the reduction in SJC is independent from a pretreatment with antiTNF agents. Nevertheless, the mean DAS after two years of treatment was significant lower in antiTNF naive patients than in those with up to 3 previous biologics.

Disclosure:

F. Behrens,