Background/Purpose: Several treatment options are available for psoriatic arthritis (PsA) patients (pts). Oral disease modifying anti-rheumatic drugs (DMARDs) are often used as a first-line treatment when non-steroidal anti-inflammatory drugs (NSAIDs) failed to control the PsA symptoms. Few studies have reported the treatment patterns in current PsA management in real-world settings. The objective of this study was to describe treatment changes (i.e., discontinuations and therapy modifications) following the initiation of a non-biologic DMARD in PsA pts.

Methods: Adult pts with ≥2 PsA diagnoses from physician office visits were selected from the MarketScan Commercial Claims database (2005-2009). All pts were required to have continuous insurance coverage ≥6-month prior to and ≥12-month post index date. First prescription date of a non-biologic DMARD was the index date and the preceding 6 months defined the ‘baseline’. Pts who used any biologic/non-biologic DMARDs or had a diagnosis of ankylosing spondylitis during the baseline were excluded. Treatment discontinuation was defined as a treatment interruption of ≥60 consecutive days between the end of days’ supply of one prescription and the start of the next prescription for the index drug. Switch in therapy was defined as the initiation of a biologic/non-biologic DMARD (not used at the index date or during the baseline) within 60 days of the discontinuation date of the index DMARD. Therapy augmentation was defined as the use of a non-biologic or biologic DMARD (not used at the index date or during the baseline) concomitantly with the index non-biologic DMARD for ≥28 consecutive days after the index date. A treatment change was defined as either a switch in therapy or an augmentation to the index therapy. Treatment patterns were captured over the one-year study period following the index date.  Since pts might have used different DMARDs during the study period, the 4 most frequent treatment sequences (excluding treatment interruption) were also reported.

Results: A total of 1,698 PsA pts met the selection criteria; 71.7% initiated on methotrexate, 17.5% on sulfasalazine. Over the 12-month study period, 72.5% of the pts had ≥ 1 therapy change (median time: 86 days). More specifically, 57.7% of pts discontinued the index non-biologic DMARD (median time: 89 days), 13.1% switched to a biologic DMARD (median time: 141 days), 9.3% switched to another non-biologic DMARD (median time: 111 days), 21.4% had a therapy augmentation with a biologic DMARD (median time: 119) and 7.4% had a therapy augmentation with another non-biologic DMARD (median time: 94).  The most common treatment sequences observed were 1) pts used MTX only during the study period (42.5%), 2) pts used MTX and a biologic (22.0%), 3) pts used sulfasalazine only (9.8%), and 4) pts used MTX and sulfasalazine (4.2%). Among pts who initiated a biologic during the study period (N=513), 90.8% did not use other oral DMARDs, while 9.2% also initiated another oral DMARD either in combination or sequentially.

Conclusion: This study suggests that PsA pts newly initiated on a non-biologic DMARD do not remain on the index therapy for a long period of time. Most pts switched to or added on biologics quickly without using a second oral DMARD.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/treatment-patterns-in-psoriatic-arthritis-patients-newly-initiated-on-non-biologic-disease-modifying-anti-rheumatic-drugs/