Probability of Biologic Persistence Differs With Order of Use in PsA

Depression and anxiety, higher tender joint count, and older age were associated with biologic discontinuation in patients with psoriatic arthritis at a specialized treatment center, according to study findings published online ahead of print in Arthritis Care & Research.

“These findings are expected, as these comorbidities indicate a more severe disease that is unlikely to be treated easily,” wrote corresponding author Dafna D. Gladman, MD, FRCPC, of the University of Toronto in Canada, and coauthors.

The retrospective analysis included 571 patients from a psoriatic arthritis clinic at a Toronto Western Hospital who initiated biologic therapy between January 1, 2000, and July 7, 2020. Researchers were interested in trends in biologic persistence in the patient population.

Persistence in taking a biologic depended on the order of its use, according to the findings. Certolizumab had the highest probability of 3-year persistence when it was a patient’s first biologic but had the lowest probability of persistence when it was used as a second biologic treatment. As a first biologic, interleukin-17 inhibitors had the lowest probability of 3-year persistence.

Relative risks of biologic discontinuation were 1.68 in patients with depression and anxiety, 1.02 in patients with a higher tender joint count, and 1.03 in older patients, the study found. On the other hand, higher education and obesity were each associated with a lower rate of discontinuation. Relative risks of biologic discontinuation were 0.65 with higher education and 0.56 with obesity.

“While it is not clear why our study demonstrated that obesity was associated with persistence in taking a drug, it is possible that these patients were afraid to stop taking the drug out of fear that other drugs may not work,” wrote researchers, who cited previous studies linking obesity with a lower likelihood of achieving psoriatic arthritis minimal disease activity and remission.

—Jolynn Tumolo

Reference

Rida MA, Lee KA, Chandran V, Cook RJ, Gladman DD. Persistence of biologics in the treatment of psoriatic arthritis: data from a large hospital-based longitudinal cohort. Arthritis Care Res. Published online March 13, 2023. doi:10.1002/acr.25112