Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose:
Psoriatic arthritis (PsA) is now recognized as a potentially severe form of arthritis which requires aggressive medical therapy. The aim of this study was to determine trends in drug usage among patients with PsA followed longitudinally.
Methods:
1229 patients with PsA were included from an observational cohort from 1978 to 2013. Descriptive statistics at baseline were conducted to characterize the study population. Comparisons of medication use by decade (1970-1980, 1980-1990, 1990-2000, 2000-2010, 2010 onwards) were made for NSAIDS (Non-steroidal anti-inflammatory drugs), DMARDs (Disease Modifying Anti-Rheumatic Drugs) and Biologics were conducted frequencies and trend tests.
Results:
Demographics at baseline: 56% males with mean (s.d.) age of 44 (13.1) years, disease duration 6.8 (8.2) years, PASI of 5.9 (8.1), active joint count of 11.0 (9.9), and 57% with radiographic damage [modified Steinbrocker score 12.7 (25.2)]. Medication use at baseline: 79% of the patients on NSAIDs, 51% on DMARDs and 7% on Biologics. Over follow-up 89% of the patients took NSAIDs with the highest frequency of use on Indomethacin (43%), Naproxen (40%) and Diclofenac (30%). Of the 75% treated with DMARDs, mostly Methotrexate (MTX) 54% orally and 26% parenterally), sulfasalazine (26%) Leflunomide (14%). 29% were on biologics, most commonly Etanercept (20%) adalimumab 9% and golimumab 4%. There was a clear trend towards decreased NSAID use (p-value<0.0001) but increased DMARD and Biologics use by decade (<0.0001) (Table 1 & 2).
Table 1 Frequency of Medication Use at Baseline by Decade
|
MEDICATION |
DECADE |
p-value |
||||
|
1970-1980 |
1980-1990 |
1990-2000 |
2000-2010 |
2010 & on |
||
|
NSAIDs |
41 (71.9%) |
240 (87.0%) |
214 (84.6%) |
375 (73.7%) |
40 (66.7%) |
<0.0001 |
|
DMARDs |
25 (45.6%) |
118 (42.8%) |
129 (52.0%) |
276 (54.2%) |
35 (55.6%) |
0.12 |
|
BIOLOGICs |
0 (0%) |
1 (0.4%) |
0 (0%) |
55 (11.3%) |
16 (25.4%) |
<0.0001 |
Table 2: Combination of Medication use by Decade
|
MEDICATION |
DECADE |
p-value |
||||
|
1970’s |
1980’s |
1990’s |
2000’s |
2010’s |
||
|
None |
12 (21.1%) |
27 (9.5%) |
27 (10.6%) |
80 (15.5%) |
8 (12.7%) |
0.27 |
|
NSAIDs only |
19 (33.3%) |
140 (49.1%) |
98 (38.6%) |
146 (28.3%) |
14 (22.2%) |
<0.0001 |
|
DMARDs +/- NSAIDs |
26 (45.6%) |
117 (41.1%) |
129 (50.8%) |
235 (45.5%) |
25 (39.7%) |
0.73 |
|
BLGs +/-DMARDs +/- NSAIDs |
0 (0%) |
1 (0.4%) |
0 (0%) |
55 (10.7%) |
16 (25.4%) |
<0.0001 |
Conclusion:
Medication use over the past four decades shows reduced NSAID use but increased DMARD and Biologics use as the severity of PsA was recognized.
Disclosure:
A. Thavaneswaran,
None;
G. Kalman-Lamb,
None;
T. Loo,
None;
V. Chandran,
None;
D. D. Gladman,
None.
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