Our study provides some evidence that anti-TNF-α drugs may perform differently in PsA, and that the analysis of clinical disease subsets may improve our knowledge and promote better management of PsA.

In real-world settings, TNF inhibitors showed a high rate of drug survival at 4 years. Further, the need for glucocorticoids for controlling active PsA was lowered with time.

No abstract

Objective To investigate whether tumour necrosis factor inhibitor (TNFi) combination therapy with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) is more effective for psoriatic arthritis (PsA) and/or improves TNFi drug survival compared to TNFi monotherapy. Methods Five PsA biologics cohorts were investigated between 2000 and 2015; the ATTRA registry (Czech Republic), the Swiss Clinical Quality Management PsA registry, the Hellenic Registry of Biologics Therapies (Greece), the University of Bari PsA biologics database (Italy) and the Bath PsA cohort (UK). Drug persistence was analysed using Kaplan-Meier and equality of survival using Log-Rank tests. Comparative effectiveness was investigated using logistic regression with propensity scores. Separate analyses were performed on: (a) the combined Italian/Swiss cohorts for change in rate of DAS-28; and (b) the combined Italian, Swiss and Bath cohorts for change in rate of HAQ. Results In total, 2294 patients were eligible for the drug survival analysis. In the Swiss (p=0.002), Greek (p=0.021) and Bath (p=0.014) databases patients starting TNFi in combination with MTX had longer drug survival compared to monotherapy, whilst in Italy the monotherapy group persisted longer (p=0.030). In patients from the combined Italian/Swiss dataset (n=1066) there was no significant difference between treatment arms in rate of change of DAS28. Similarly, when also including the Bath cohort (n=1205) there was no significant difference in rate of change of HAQ. Conclusion Combination therapy of a TNFi with a csDMARD does not appear to affect improvement of disease activity or HAQ versus TNFi monotherapy but may improve TNFi drug survival.

Objectives To compare the efficacy of adalimumab, etanercept, and infliximab therapy in psoriatic arthritis (PsA) patients with oligoarticular or polyarticular subset Methods We enrolled in a prospective, not-randomized, open-label study 349 PsA patients with peripheral disease, 234 with polyarticular and 115 with oligoarticular subset, beginning a treatment with adalimumab, etanercept, or infliximab. At baseline, 6 months, and 12 months, disease activity indices, (DAS28, Disease Activity Score on 28 joints, SDAI, simplified disease activity index, sum of TJC tender joint count, SJC swollen joint count, CRP C-reactive protein, and PzGA Patient Global Assessment), and disability HAQ (Health Assessment Questionnaire) were calculated. The rates of disease remission were compared among the three TNF-ablockers at 6 and 12 months. Baseline predictors of disease remission and functional improvement (reduction of HAQ ≥0.5) were analyzed by multivariate regression models Results After 12 months the percentage of patients on clinical remission (SDAI ≤3.3) was significantly higher in infliximab or etanercept than adalimumab group (p<0.05), both in oligoarticular and polyarticular subset. Infliximab induced the widest decrease of TJC and the best “good” EULAR response in polyarthritis and oligoarthritis patients, respectively. Baseline predictors of disease remission were low DAS28, low HAQ, sex male, and glucocorticoids therapy in polyarthritis. The best predictor of functional improvement (ΔHAQ ≥0.5) was high HAQ in both subsets. Conclusions Our study provides evidence that anti-TNFa drugs may differently perform in PsA and that separate analysis of the clinical subsets of the disease may improve our knowledge of the management of PsA Disclosure of Interest None Declared