Background/Purpose: Few real-world studies have characterized the use of first- vs second-line tumor necrosis factor inhibitors (TNFis) in US patients with psoriatic arthritis (PsA). This study examined disease characteristics and described patterns of TNFi use through the first follow-up visit (≈ 6 months) in patients with PsA who initiated a first- vs second-line TNFi in the US Corrona PsA/SpA Registry.

Methods: This study included adult patients with PsA enrolled in the Corrona PsA/SpA Registry who initiated first- or second-line TNFi therapy between March 2013 and September 2016 with ≥ 1 follow-up visit. Patient demographics, disease characteristics and patient-reported outcomes were assessed at the time of TNFi initiation (baseline) and compared between cohorts using two-sample t-tests for continuous variables and chi-square or Fisher’s exact tests for categorical variables. The proportions of patients who continued their index TNFi, discontinued without switching, or switched to another biologic at the time of the first follow-up visit was examined and compared between cohorts.

Results: Of the 230 patients with PsA who had ≥ 1 follow-up visit (median [IQR] time to first follow-up, 6.8 [6.0, 9.7] months), 139 patients initiated a first-line TNFi and 91 patients initiated a second-line TNFi. At baseline, patients who initiated a second-line TNFi had higher enthesitis and dactylitis counts, were less likely to be in minimal disease activity and had worse pain and fatigue compared with patients who initiated a first-line TNFi; however, these differences were not statistically significant (Table 1). A higher proportion of patients initiating a first-line TNFi continued their TNFi at the first follow-up visit than those initiating a second-line TNFi (76.3% vs 59.3%; P = 0.001). Among first-line initiators, 19.4% and 4.3% discontinued their index TNFi without switching, or switched to another biologic, respectively, compared with 22.0% and 18.7% of patients initiating a second-line TNFi (Figure 1; both P = 0.001). Of the 17 first- and 19 second-line TNFi initiators with provider-reported reasons for discontinuing or switching TNFis, the most common reasons were lack of effect (44.4% and 60.0%, respectively) and adverse effects (27.8% and 10.0%, respectively).

Conclusion: Patients with PsA initiating a second-line TNFi were more likely to discontinue or switch therapies compared with patients initiating a first-line TNFi, with the most common reason for discontinuation/switch due to lack of effect. These findings from a US registry suggest potential unmet needs for patients with PsA when using TNFis as a second-line therapy in a real-world setting.