Background/Purpose: Psoriatic arthritis (PsA) treatment options are based on the use of DMARDs and NSAID but their use may vary widely, despite international recommendations and guidelines. We aimed at determining the prevalence of comorbidities and prescription patterns of synthetic DMARDs, NSAIDs, and other drugs in a real-life cohort of patients and to determine if sex influences the use and retention rates of therapeutic options.

Methods: We performed a retrospective cohort analysis of administrative health databases of Lombardia region (>10 million population) through the RECORD study of the Italian Society of Rheumatology. PsA and comorbidities were identified using specific copayment exemptions (045.696.0 for PsA) from January 1st 2005 to December 31st 2015 and then linked to DMARD, NSAID, steroid, and other prescriptions. The influence of sex on prescriptions and retention rates was evaluated using Cox regression analyses and the results presented as hazard ratios (HR) and 95% confidence intervals (95%CI).

Results: We identified 8,981 PsA cases (Table 1) and the prescribed DMARDs, NSAIDs and steroids are reported in Table 2. Among clinical features, most comorbidities were found in significantly different proportions in men and women. Of note, 0.8% of patients had a diagnosis of depression while 20.5% received anti-depressants (both being more frequent in women). Methotrexate (MTX) was used in 59% of patients, almost equally in its oral and parenteral formulation, with the latter most commonly prescribed at 10 mg weekly dose. MTX was most frequently prescribed to men, while sulfasalazine and hydroxychloroquine (HCQ) to women. Of note, women received more steroids while men received more NSAIDs. A higher risk for MTX discontinuation was found in women (HR1.06,95%CI1-1.1,p-value0.047), who retained HCQ more commonly (HR0.83,95%CI0.72-0.96, p-value0.012); no differences were observed for other DMARDs retention rates.

Conclusion: In our real-life cohort of patients with PsA anti-depressants are largely used, especially in women. Among DMARDs, MTX is most frequently prescribed but appears to be largely used in its oral formulation and at low dose. Off-label treatments for PsA such as HCQ and steroids are used more frequently in women. In general terms, women and men with PsA have different comorbidities and may underlie different treatment choices. Table 1.

Table 2.