Background/Purpose: Data on second line biologic patients who have experienced 1st line tumor necrosis factor inhibitor (TNF) failure and associated disease burden among patients (pts) with Psoriatic Arthritis (PsA) in the European Union (EU) is lacking. We assessed the clinical characteristics of pts with PsA on 2nd line biologics after 1st line anti-TNF failure.

Methods: A multi-country medical chart-review study of PsA pts was conducted among physicians (rheumatologists: 96%) in hospitals/private practices to collect de-identified data on pts recently treated with a biologic as part of usual care. Physicians from UK/Germany/France/Italy/Spain (5EU) were screened for practice duration and pt volume and recruited from a large panel to be geographically representative in each country. Eligible pt charts (>2) were randomly selected from a sample of prospective pts visiting each center/practice during the screening period. Physicians abstracted pt diagnosis, treatment patterns/dynamics and pt symptomatology/disease status. EU sites did not require local ethics reviews owing to de-identified retrospective data collection methodology.

Results: Between Jan2011 and Dec2012, 454 PsA pts (mean age:48.8yrs; female:49.6%) on 2nd line biologic after 1st line anti-TNF failure were identified. Mean time-to-1st line anti-TNF from diagnosis was 51.6 months; mean time on 1st line anti-TNF was 18.3months (pts <6:/7-12/13-24/>24months: 33%/21%/19%/27%). Top-3 1st line anti-TNFs observed were: etanercept (38%), adalimumab (32%), and infliximab (27%). The top-5 reasons for 1st line anti-TNF discontinuation were ‘long-term efficacy failure’, ‘disease worsened’, ‘side-effects not tolerated’, ‘insufficient improvement’, and ‘short-term efficacy failure’. Mean time on current 2nd line biologic was 18.5months (pts <6/7-12/13-24/>24months: 28%/21%/25%/27%). Current 2nd line biologics (top-5) included: adalimumab (39%), etanercept (31%), infliximab (14%), golimumab (11%), abatacept (2%). Top-5 reasons for choice of 2nd line biologic were ‘mechanism of action’, ‘prevention of structural damage’, ‘improve signs/symptoms’, ‘disease worsened’, ‘positive personal experience’. Key lab measures documented were: ESR-21.7mm/h and CRP-8.3mg/dl. Among pts with available data, current HAQ was 1.1, Swollen Joint Count was 1.9 and Tender Joint Count was 3.4. Current disease severity per physician judgment (mild:moderate:severe) were: 48%:47%:5%. Current disease severity (mild:moderate:severe) by time on 1st line anti-TNF biologic (<6/7-12/13-24/>24months) were 47%:48%:5% / 55%:42%:3% / 49%:48%:4% / 44%:49%:7% respectively.

Conclusion: Among PsA pts on their 2nd biologic who have experienced prior anti-TNF failure, 54% discontinued their 1st line anti-TNF regimen within 12months of initiation. There was considerable disease burden despite current 2nd line biologic. Further research is warranted to assess the effectiveness of switching in PsA pts and optimize the treatment strategies to alleviate disease burden among 1st line anti-TNF failures.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/disease-burden-among-patients-with-psoriatic-arthritis-who-have-experienced-first-line-tumor-necrosis-factor-inhibitor-regimen-failure-in-the-european-union/