Real-world Persistence of Initial Targeted Therapy Strategy in Monotherapy versus Combination Therapy in Patients with Rheumatoid Arthritis, Psoriatic Arthritis, and Ankylosing Spondylitis

Carlos Sánchez-Piedra¹, Lorena Expósito², PALOMA VELA³, Manuel José Moreno Ramos⁴, Cristina Campos⁵, Cristina Bohorquez⁶, Jerusalem Calvo⁷, Zulema Plaza⁸, Marta Domínguez⁹ and Jose Federico Diaz-Gonzalez¹⁰, ¹Health Technology Assessment Agency (AETS), Instituto de Salud Carlos III, Madrid, Spain, ²Rheumatology Unit, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Spain, ³Rheumatology, Hospital General Universitario Alicante, Alicante, Spain, ⁴Rheumatology Department Hospital Virgen de la Arrixaca, El Palmar Murcia, Spain, ⁵Rheumatology Unit, Hospital General Universitario de Valencia, Valencia, Spain, ⁶Rheumatology Unit, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain, ⁷Reina Sofia University Hospital, Córdoba, Spain, ⁸Universidad Autónoma de Madrid, Madrid, Spain, ⁹Sociedad Española de Reumatología, Madrid, Spain, ¹⁰Hospital Universitario de Canarias, La Laguna, Spain

Meeting: ACR Convergence 2023

Keywords: Ankylosing spondylitis (AS), Biologicals, Disease-Modifying Antirheumatic Drugs (Dmards), Psoriatic arthritis, rheumatoid arthritis

Session Information

Date: Tuesday, November 14, 2023

Title: (2141–2176) RA – Treatments Poster III

Session Type: Poster Session C

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

Background/Purpose: Clinical practice guidelines, based on information from clinical trials, provide different recommendations for the use of combination therapies for the treatment of rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA). Few studies have evaluated the persistence of different treatment strategies (combination vs. monotherapy) as a primary endpoint based on data from real-world settings. The aim of this study was to evaluate the persistence of the initial strategy with or without conventional synthetic (cs) disease-modifying antirheumatic drugs (DMARDs) (combination and monotherapy strategies, respectively) of targeted therapy in patients with RA, AS and PsA under real-life conditions. Factors associated with maintenance of the initial strategy were also analyzed.

Methods: Nested cohort study within BIOBADASER III, a prospective Spanish registry of patients with rheumatic diseases treated with targeted therapy, including biologic(b) and targeted synthetic(ts) DMARDs. Bivariate comparisons and multivariate Cox proportional hazards models were used for the analyses.

Results: A total of 2,521 patients were included in the study. Baseline demographics and disease characteristics, disease activity, type of targeted therapy, and concomitant medications are shown in Table 1. In the multivariate model, the initial strategy of combination therapy was associated with shorter persistence in patients with RA (hazard ratio [HR] 1.58;95% confidence interval [CI] 1.00 to 2.50; p=0.049), PsA (HR 2.48; 95%CI 1.65 to 3.72) and AS (HR 16.77; 95%CI 7.37 to 38.16; p< 0.001). 48; 95%CI 1.65 to 3.72; p< 0.001) and AS (HR 16.77; 95%CI 7.37 to 38.16; p< 0.001), regardless of age, sex, time of disease progression, baseline disease activity or type of b/tsDMARD. Figure 1 shows the analyses of persistence by disease using Kaplan-Meier curves. Overall, the combination strategy was associated with an increased incidence of adverse events (incidence rate ratio [IRR] 1.13; 95%CI 1.05-1.21).

Conclusion: Analysis of a large database collected under real-world conditions shows that initiation of targeted therapy in monotherapy has a significantly better persistence and safety profile than in combination with csDMARD(s) in patients with PsA and AS. In patients with RA, the results also suggest that monotherapy should be considered as a therapeutic option as it offers a higher chance of persistence.

Table 1. Baseline characteristics of the patients included in the analysis.

Figure 1. Persistence of biologic disease-modifying antirheumatic drug treatment strategy (Kaplan-Meier plots).

Disclosures: C. Sánchez-Piedra: None; L. Expósito: None; P. VELA: AbbVie/Abbott, 5, AstraZeneca, 5, Eli Lilly, 5, 6, GlaxoSmithKlein(GSK), 6, Novartis, 5, Pfizer, 5; M. Moreno Ramos: None; C. Campos: None; C. Bohorquez: None; J. Calvo: None; Z. Plaza: None; M. Domínguez: None; J. Diaz-Gonzalez: None.

To cite this abstract in AMA style:

Sánchez-Piedra C, Expósito L, VELA P, Moreno Ramos M, Campos C, Bohorquez C, Calvo J, Plaza Z, Domínguez M, Diaz-Gonzalez J. Real-world Persistence of Initial Targeted Therapy Strategy in Monotherapy versus Combination Therapy in Patients with Rheumatoid Arthritis, Psoriatic Arthritis, and Ankylosing Spondylitis [abstract]. Arthritis Rheumatol. 2023; 75 (suppl 9). https://acrabstracts.org/abstract/real-world-persistence-of-initial-targeted-therapy-strategy-in-monotherapy-versus-combination-therapy-in-patients-with-rheumatoid-arthritis-psoriatic-arthritis-and-ankylosing-spondylitis/. Accessed .

« Back to ACR Convergence 2023

ACR Meeting Abstracts - https://acrabstracts.org/abstract/real-world-persistence-of-initial-targeted-therapy-strategy-in-monotherapy-versus-combination-therapy-in-patients-with-rheumatoid-arthritis-psoriatic-arthritis-and-ankylosing-spondylitis/