Real-World Long-Term Effectiveness of Switching between Tumor Necrosis Factor Inhibitors in Psoriatic Arthritis Patients from the Rheumatic Diseases Portuguese Register

Elsa Vieira-Sousa^1,2, Mónica Eusébio³, Pedro Ávila-Ribeiro^1,2, Nikita Khmelinskii^1,2, Ana Rita Machado^1,2, Teresa Martins-Rocha^4,5, Miguel Bernardes^4,5, Daniela Santos Faria⁶, Joana Leite Silva⁶, Helena Santos⁷, Cláudia Miguel⁷, Pedro Carvalho^8,9, Tiago Costa¹⁰, Lídia Teixeira¹¹, Tiago Meirinhos¹², Patrícia Nero¹³ and Maria José Santos^11,14, ¹Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal, Lisboa, Portugal, ²Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa, Portugal, Lisboa, Portugal, ³Sociedade Portuguesa de Reumatologia, Lisboa, Portugal, LIsboa, Portugal, ⁴Serviços de Reumatologia do Centro Hospitalar São João do Porto, Porto, Portugal, Porto, Portugal, ⁵Faculdade de Medicina da Universidade do Porto (FMUP), Porto, Portugal, Porto, Portugal, ⁶Serviço de Reumatologia da Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal, Ponte de Lima, Portugal, ⁷Instituto Português de Reumatologia Lisboa, Portugal, Lisboa, Portugal, ⁸Serviço de Reumatologia, Hospitais Universitários de Coimbra, Coimbra, Portugal, Coimbra, Portugal, ⁹Serviço de Reumatologia, Centro Hospitalar e Universitário do Algarve, Faro, Portugal, Faro, Portugal, ¹⁰Serviço de Reumatologia do Hospital Egas Moniz, Lisboa, Portugal, Lisboa, Portugal, ¹¹Serviço de Reumatologia do Hospital Garcia de Orta, Almada, Portugal, Almada, Portugal, ¹²Serviço de Reumatologia, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal, Aveiro, Portugal, ¹³Hospital CUF Descobertas, Lisboa, Portugal, Lisboa, Portugal, ¹⁴Sociedade Portuguesa de Reumatologia, Lisboa, Portugal, Lisboa, Portugal

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Biologic drugs, psoriatic arthritis and registries

Session Information

Date: Tuesday, October 23, 2018

Title: Spondyloarthritis Including Psoriatic Arthritis – Clinical Poster III: Treatment

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Tumor necrosis factor inhibitors (TNFi) lead to a dramatic improvement in the management of psoriatic arthritis (PsA). Nevertheless, a significant proportion of patients do not respond or are intolerant to TNFis, requiring treatment switch for an adequate control of disease activity. The aim of this study is to assess long-term TNFis drug retention and predictors for TNFi discontinuation in PsA patients registered at Rheumatic Diseases Portuguese Registry (Reuma.pt).

Methods: All PsA patients registered at Reuma.pt, with at least one TNFi prescription were included. Drug retention for a 1^st, 2^nd and 3^rd-line TNFi was assessed by Kaplan-Meier survival analysis. Comparative analysis of survival curves was performed using the Wilcox (Breslow) for the equality of survival functions. The reasons for TNFis discontinuation were described as frequencies. Predictors of discontinuation, were studied using a Cox model considering discontinuation of the first TNFi, independently of the indication.

Results: 750 PsA patients were identified, with a mean age of 47.6 years; 50.3% female. 185 patients (26.2%) were treated with adalimumab, 322 (45.7%) etanercept, 100 (14.2%) golimumab and 98 (13.9%) with infliximab as first TNFi. The overall retention of TNFi was 49±40 months when treated with a 1^st TNFi, decreasing to 36±33 months for the 2^nd TNFi, and 23±23 months for the 3^rd TNFi. After being treated with a 1^st TNFi, 35.8% discontinued therapy, 53.5% due to lack or loss of effectiveness and 24.4 % due to adverse events. The rates of discontinuation for the 2^nd and 3^rd TNFi were of 39% and 54%, respectively, with similar proportions for lack/loss of effectiveness and adverse events for the 2^nd (62.3%; 21.6%) and 3^rd TNFi (63.0%; 22.2%). When considering predictors of discontinuation for the first TNFi, independently of the indication, being female increased by 2.1 times the risk of discontinuation (HR=2.1, p-value=0.003). In addition, each increase of one unit in DA28 at baseline, increased the risk of discontinuation by 18% (HR=1.18, p-value=0.039). Finally, being treated with infliximab in comparison with etanercept, increased by 2.0 times the risk of discontinuation, assuming the other variables as constant (HR=2.0, p-value=0.007, global p-value=0.012).

Conclusion: The overall persistence of a 1^st TNFi was high in PsA patients registered at Reuma.pt, decreasing on average 13 months, in those who switched to a 2^nd TNFi or a 3^rd TNFi. Lack or loss of response were the main reasons for TNFi discontinuation, independently of TNFi position. Female gender and higher peripheral disease activity (DAS28) at baseline, were associated with an increased risk of discontinuation of TNFis. Likewise, Infliximab doubled the risk of discontinuation when compared with etanercept.

Financial support for statistics and report writing was provided by Novartis, S.A.

Disclosure: E. Vieira-Sousa, None; M. Eusébio, None; P. Ávila-Ribeiro, None; N. Khmelinskii, None; A. R. Machado, None; T. Martins-Rocha, None; M. Bernardes, Pfizer, Inc., Lilly, Janssen-Cilag, MSD, GSK, 9; D. Santos Faria, None; J. Leite Silva, None; H. Santos, None; C. Miguel, None; P. Carvalho, None; T. Costa, None; L. Teixeira, None; T. Meirinhos, None; P. Nero, None; M. J. Santos, None.

To cite this abstract in AMA style:

Vieira-Sousa E, Eusébio M, Ávila-Ribeiro P, Khmelinskii N, Machado AR, Martins-Rocha T, Bernardes M, Santos Faria D, Leite Silva J, Santos H, Miguel C, Carvalho P, Costa T, Teixeira L, Meirinhos T, Nero P, Santos MJ. Real-World Long-Term Effectiveness of Switching between Tumor Necrosis Factor Inhibitors in Psoriatic Arthritis Patients from the Rheumatic Diseases Portuguese Register [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/real-world-long-term-effectiveness-of-switching-between-tumor-necrosis-factor-inhibitors-in-psoriatic-arthritis-patients-from-the-rheumatic-diseases-portuguese-register/. Accessed .

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