Background/Purpose: The advent of targeted synthetics and biologics has greatly broadened the options for effective treatment in PsA. Guidelines published in 2018 by the American College of Rheumatology/National Psoriasis Foundation (ACR/NPF) support the use of biologic agents, including as initial therapy. Despite clear directives, there is a paucity of data regarding medication use in real world clinical practice and patient medication preferences.

Methods: This is a cross-sectional survey of Classification Criteria for Psoriatic Arthritis (CASPAR) criteria defined PsA patients recruited from a single academic center PsA registry from June-September 2020. Preferences were ranked on a 5-point Likert scale ranging from ‘not at all important’ to ‘extremely important.’

Results: One hundred thirty-seven(29%) PsA patients responded. Median age was 60 years (IQR 51-70). Median duration of PsA skin symptoms, joint symptoms and PsA diagnosis by a physician was 19 (IQR 10-34), 12 (IQR 8-21) and 8 (IQR 4-17) years, respectively.

Non-steroidal anti-inflammatory drugs were the first medication used for PsA in 62%. The most common initial immunomodulatory medications were anti-TNF-α (35%), followed by methotrexate (19%), anti-phosphodiesterase-4 (anti-PDE4) (12.4%), other conventional synthetic disease modifying anti-rheumatic medications (csDMARDs) (11.7%), anti-IL17 (5.1%), and anti-IL23 (2.9%). At survey administration, the most common immunomodulatory therapies were anti-TNF-α (30%), followed by anti-IL17 (20.4%), methotrexate (10.2%), anti-PDE4 (8.8%), other csDMARDs (8.0%), Janus kinase inhibitors (2.2%), and anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA 4) (1.5%), while 28% of patients were not on any immunomodulatory therapy. After 2018, when updated guidelines from the ACR/NPF were published, a significantly higher percentage of patients’ first medication was an anti-IL17 compared to 2018 or earlier (30% vs 3.5% p< 0.001); a pattern also seen with anti-PDE4 (40% vs 11.5% p< 0.012).

Medication preferences most ranked as “extremely” important were prevention of joint damage, (80%), ability to perform daily activities (71%), prevention of pain (70%), rheumatologist recommendation (63%) and medication side effects (62%).

Conclusion: The significant increase of anti-IL17 and anti-PDE4 medications as initial treatment after 2018 may reflect their inclusion as potential initial therapy in updated guidelines, along with the importance placed by patients on medication side effects. Surprisingly, over a quarter of patients were not on any immunomodulatory therapy. Given the expanding armamentarium of PsA medications, it is increasingly important to align patient preferences and therapeutic options to ensure durable use of effective therapy.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/current-medication-practices-and-preferences-among-patients-with-psoriatic-arthritis-psa/