Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Psoriatic arthritis (PsA) is a chronic inflammatory disease that benefits from DMARDs, in this regard knowing more about these therapies is a great step forward in the management of these patients in daily clinical practice. Objetives: To evaluate the survival of DMARDs used in recent diagnose PsA patients as well as the causes of discontinuation and to analyze the possible associated factors. Methods: Retrospective longitudinal observational study. Subjects: Inception cohort of patients from January 2010 to December 2014, and followed up to December 2016, diagnosed with PsA according to ICD-10 code. Main outcome: discontinuation of conventional DMARDs (cDMARDs) and biological DMARDs (bDMARDs) due to: Adverse drug reactions (ADRs); Improvement or remission; Inefficacy; Patient`s decision and Physician’s decision. Covariables: sociodemographic and clinical. Statistical analysis: To estimate DMARDs discontinuation rates, survival techniques were used, expressing the incidence rate (IR) per 100 patients*year with their respective CI at 95%. Multivarite Cox regression models were performed to analyze the factors associated with DMARDs discontinuation and the results were expressed in Hazard ratio(HR) and 95%CI. Results: 191 patients with recent diagnosis of PsA were included, with a 379.7 Patients*year follow-up. 50.3% were male, the mean age at diagnosis was 50±14.6 years old. 46.6% of the patients had a history of cutaneous psoriasis. HLA-B27 was positive in 20% of patients. 50% of the patients started a DMARDs at the first visit. Throughout the follow-up, all patients received cDMARDs and 23 used bDMARDs. The median DMARD per patient was 2[1-3]. Methotrexate (MTX) was the most used drug 69.7%. According to the treatment regimen, 30% were on combination therapy, the most frequent was antiTNF+MTX (33%). 103 discontinuations were recorded with a IR 27.1[22.3-32.9] within these, 44 were related with ADRs (IR 11.5[8.6-15.5]), 24 (IR 6.3[3.5-11.1]) were due to inefficiency, 9 (IR 2.3[1.2-4.5]) were registered after remission, 12 (IR 3.1[1.7-5.5]) by decision of the patient and 12 (IR 3.1[1.7-5.5]) by doctor’s decision. The DMARDs median survival was 1.8 years [1.4-2.7]. Table 1 shows the discontinuation rates for each type of DMARDs and the multivariate analysis for the factors associeted with DMARDs discontinuation is in Table 2. Conclusion: In our study, the DMARD discontinuation rate was 27.1, mainly related with ADRs. We have also found some clinical and therapy regimen factors that can modify the DMARDs survival on PsA. We observed that MTX, presented the longest survival independent of the rest of the factors.
|Table 2.||HR||95% CI|
|Age at diagnosis||0.97||0.97-1.01|
|CRP ≥ 1.05gr/dL||1.85||0.99-3.48|
|MTX vs rest DMARDs||0.53||0.31-0.91|
To cite this abstract in AMA style:Freites Núñez D, Rosales Rosado Z, Font Urgelles J, Hernández-Rodríguez I, Leon L, Candelas Rodriguez G, Rodriguez-Rodriguez L, Fernández-Gutiérrez B, Jover Jover JA, Alcazar LA. Survival of Disease-Modifying Drugs in Patients with Recent Diagnosis of Psoriatic Arthritis in Daily Clinical Practice [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/survival-of-disease-modifying-drugs-in-patients-with-recent-diagnosis-of-psoriatic-arthritis-in-daily-clinical-practice/. Accessed August 12, 2020.
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