Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: In rheumatoid arthritis, it has been shown that anti-TNF therapy (TNFi) in combination with a conventional synthetic disease-modifying antirheumatic drug (csDMARD), often methotrexate (MTX), is more effective than anti-TNF monotherapy to improve clinical outcomes and TNFi retention. A recent article on psoriatic arthritis (PsA) has observed a trend towards better retention of TNFi in combination with MTX vs monotherapy. We assessed the long-term retention of TNFi with and without csDMARDs in the first-line treatment of PsA in the real world Rhumadata® clinical database.
Methods: The data of all PsA patients treated with a first biological agent was extracted from Rhumadata®. The data included age, gender, clinical variables, patient and physician specific assessments, and laboratory measures. Composite assessment of disease activity including the DAS28-CRP and the simplified and clinical disease activity indices (SDAI and CDAI) were calculated using readily available formulas. Concomitant use of csDMARDs (MTX, hydroxychloroquine, leflunomide, and sulfasalazine) was collected. Patients were classified into four groups: TNFi alone, TNFi+MTX alone, TNFi+non-MTX csDNMARDs and TNFi+MTX+other csDMARDs. Kaplan-Meier methods were used to compute the cumulative incidence of biologic agent discontinuation in those groups and differences in discontinuation rates were tested using the log-rank tests. Potential predictors of biologic retention were entered in univariate and multivariate proportional hazard regression models. Statistical analysis was performed using SAS version 9.4.
Results: Our cohort included 398 patients, 102 receiving anti-TNF monotherapy, 165 concomitant MTX only, 90 MTX + other csDMARDs and 41 concomitant non-MTX csDMARDs . Men represent 55% of our cohort with a mean disease duration of 6 years (SD=8). Mean baseline disease activity measured using DAS28-ESR or CRP are respectively, 4.1 and 4.0. Drugs survival analysis showed no significant difference between groups: Anti-TNF monotherapy versus combination with MTX only, or with MTX + other csDMARDs or with a non-MTX csDMARDs (p=0.09). Drugs survival analysis for each of the anti-TNF (adalimumab, etanercept or golimumab) did not demonstrate a significant difference when adding MTX +/- other csDMARDs. As for infliximab (IFX) used in combination with MTX +/- other csDMARDs showed a trend towards better retention (p=0.07). Multivariate analysis showed that anti-TNF in combination with MTX and at least one other csDMARDs was a predictor of improved retention (HR 0.49, 95% CI 0.31-0.78, p=0.003). Smoking, female gender and higher DAS28 (CRP) were associated with increased drug discontinuation. Main reason for treatment discontinuation in all groups was lack of efficacy.
Conclusion: In this real world analysis, anti-TNF therapy in combination with csDMARDs vs monotherapy, did not significantly influence the biologic long-term retention, except for IFX, where a tendency was observed. Combination therapy with MTX and at least another csDMARDs is a predictor of better retention whereas smokers, women and patients with higher DAS28 (CRP) were more likely to discontinue therapy.
To cite this abstract in AMA style:Ferdinand I, Bessette L, Bourré-Tessier J, Haraoui B, Brown J, Massicotte F, Pelletier JP, Raynauld JP, Rémillard MA, Sauvageau D, Turcotte A, Villeneuve É, Coupal L. Does Combination of Conventional Synthetic Disease Modifying Antirheumatic Drug with Anti-TNF Influence the Long Term Retention Compared to Anti-TNF Monotherapy in Psoriatic Arthritis? an Analysis from Rhumadata® over 12 Years [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/does-combination-of-conventional-synthetic-disease-modifying-antirheumatic-drug-with-anti-tnf-influence-the-long-term-retention-compared-to-anti-tnf-monotherapy-in-psoriatic-arthritis-an-analysis-fro/. Accessed January 15, 2021.
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