Psoriatic Arthritis: The Influence of Co-morbidities on Drug Choice

Patel, Sneha; Kumthekar, Anand

doi:10.1007/s40744-021-00397-7

Cited by 5 publications

(7 citation statements)

References 191 publications

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“…As expected, we found that the number of comorbid diseases and age ≥60 years were associated with major polypharmacy in patients with PsA. Approximately 40% of patients with PsA have at least 3 comorbid diseases, and the high burden of comorbid conditions affects their therapeutic choices 29,30 . These comorbid conditions may also be treated with drugs that can cause polypharmacy.…”

Section: Discussionsupporting

confidence: 72%

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Associations of Polypharmacy With Clinical Parameters, Function, and Health-Related Quality of Life in Psoriatic Arthritis

Gürsoy¹,

Gezer

Kasman

et al. 2022

J Clin Rheumatol

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ObjectiveThe aim of this study was to assess predictors of polypharmacy and its effect on health-related quality of life in patients with psoriatic arthritis (PsA).MethodsThis cross-sectional study was performed between February and December 2019. The number of medications was grouped into minor (2–4) and major (≥5) polypharmacy. Functional status and quality of life were assessed using the Health Assessment Questionnaire and Short-Form 36, respectively. Clinical and demographic characteristics, physical function, and quality of life of the polypharmacy group were compared. Predictive factors for major polypharmacy were evaluated using a logistic regression analysis.ResultsThe mean age of the 100 patients (70 females and 30 males) with PsA was 48.43 ± 12.94 years. The proportion of patients with major polypharmacy was 19%. The physical function subscale of Short-Form 36 was lower in the major polypharmacy group (p = 0.009). Univariable analysis revealed that sex, body mass index, disease duration, disease activity, psoriasis severity, dactylitis, enthesitis, PsA subtypes, smoking, and Health Assessment Questionnaire were not associated with major polypharmacy (p > 0.10). In the multivariable model, the number of comorbidities (odds ratio, 3.151; 95% confidence interval, 1.828–5.429; p < 0.001) and age ≥60 years (odds ratio, 4.864; 95% confidence interval, 1.159–20.418; p = 0.031) were significantly associated with major polypharmacy.ConclusionsThe number of comorbid diseases and age ≥60 years were the factors associated with major polypharmacy in patients with PsA. Although physical function was not associated with polypharmacy, patients with major polypharmacy had poorer quality of life.

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Section: Discussionsupporting

confidence: 72%

“…Approximately 40% of patients with PsA have at least 3 comorbid diseases, and the high burden of comorbid conditions affects their therapeutic choices. 29,30 These comorbid conditions may also be treated with drugs that can cause polypharmacy. Moreover, age directly increases the risk of comorbidity.…”

Section: Discussionmentioning

confidence: 99%

Associations of Polypharmacy With Clinical Parameters, Function, and Health-Related Quality of Life in Psoriatic Arthritis

Gürsoy¹,

Gezer

Kasman

et al. 2022

J Clin Rheumatol

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“…However, this effect is eliminated with Infliximab since it is dosed based on weight [ 72 , 123 ] Surgery For high-risk procedures, biologic therapy should be withheld 3–5 half-lives before surgeries [ 47 , 88 ] Biologics may be restarted after surgery if there is no evidence of infection and once healing is satisfactory [ 47 , 88 ] IBD Patients with a history of concomitant IBD might benefit from monoclonal TNFi and IL-12/23i since they are effective in IBD. Moreover, IL-23i, and JAKi are suggested to be used in patients with PsA and IBD [ 72 , 122 ] IL-17i are not used in patients with active IBD [ 89 , 128 ] Decisions regarding optimal therapeutic agent should be discussed with a gastroenterologist [ 122 ] Pregnancy and lactation Rheumatologists are expected to be familiar with drug safety during pregnancy and lactation to ensure that the disease is well controlled and to minimize the risks to both the mother and the infant. However, since the data regarding this field are derived from case reports, small series, and observational studies only, this area is still challenging to the treating clinicians The decision to initiate biologic therapy and treatment option should be determined on an individual basis based on risk management plans.…”

Section: Resultsmentioning

confidence: 99%

“…Patients with LTBI should be treated with anti-TB treatment at least 1 month before initiating biologic therapy and are to be monitored every 3 months during the treatment course [ 47 , 88 , 96 – 98 ]…”

Section: Resultsmentioning

confidence: 99%

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The Saudi consensus recommendations for the management of psoriatic arthritis (2023)

Al-Homood,

Al Ghanim,

Fatani

et al. 2024

Clin Rheumatol

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Psoriatic arthritis (PsA) is a complex inflammatory disease characterized by musculoskeletal and non-musculoskeletal manifestations. It is a distinct disease entity at the interface between rheumatology and dermatology, making it challenging to manage. The diverse clinical presentation and severity of PsA require a multidisciplinary approach for optimal care. Early diagnosis and management are necessary to improving quality of life for patients. In Saudi Arabia, there is currently no unified national consensus on the best practices for managing PsA. This lack of consensus leads to debate and uncertainty in the treatment of the disease, resulting in over or under prescribing of biological agents. To address this issue, a multidisciplinary work group was formed by the Saudi Ministry of Health. This group, consisting of dermatologists, rheumatologists, and pharmacists, aimed to develop evidence-based consensus recommendations for he use and monitoring of biological therapy in PsA management. The work group conducted five consensus workshops between December 2021 to March 2022. Using the nominal group technique, they discussed various aspects of PsA management, including eligibility criteria for biological treatment, monitoring of disease activity, treatment goals, screening, precautions, and management of PsA with biologic therapies. The group also considered special considerations for patients with comorbidities, pregnant and lactating women, as well as pediatric and adolescent populations. The resulting consensus document provides recommendations that are applicable to the Saudi setting, taking into account international guidelines and the specific needs of PsA patients in the country. The consensus document will be regularly updated to incorporate new data and therapeutic agents as they become available. Key Points• In Saudi Arabia, there is a lack of unified national consensus on the optimal management of PsA, therefore, this article aims to provide up-to-date evidence-based consensus recommendations for the optimal use and monitoring of biologic therapy in the management of PsA in Saudi Arabia.• The consensus development process was undertaken by a multidisciplinary work group of 13 experts, including two dermatologists, six rheumatologists, and five pharmacists.• There is more than one disease activity tool used in PsA disease, depending on the disease domain – peripheral arthritis Disease Activity Index in Psoriatic Arthritis (DAPSA) or Minimal Disease Activity (MDA), axial PsA Ankylosing Spondylitis Disease Activity Score (ASDAS), and dactylitis and enthesitis MDA.• The main goal of therapy in all patients with PsA is to achieve the target of remission, or alternatively, low disease activity in all disease domains and improve quality of life (QoL).

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Real-World Drug Survival of Biologics and Targeted Synthetic Disease-Modifying Anti-rheumatic Drugs Among Patients with Psoriatic Arthritis

Rosenberg,

Amital,

Chodick

et al. 2024

Drugs Aging

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Background While the variety of biologics (b) and targeted synthetic (ts) disease-modifying anti-rheumatic drugs (DMARDs) available for patients with psoriatic arthritis (PsA) has proved to be efficacious in randomized clinical trials, there is a growing importance to understand the benefits and potential drawbacks of these different therapies in real-world settings, which includes bio-experienced and older patients as well. Objective To evaluate the real-world adherence, drug survival, and discontinuation risk of bDMARDs and tsDMARDs among patients with PsA, comprising both younger and older patients. Methods A retrospective study using a computerized database. Treatment-naïve and treatment-experiencedpatients with PsA, younger and older than 60 years, who initiated treatment with bDMARDs [TNF-α inhibitors (TNF-αis), IL-17 inhibitors (IL-17is), IL-12/23 inhibitors (IL-12/23i)] or tsDMARDs (the PDE-4 inhibitor apremilast) during 2015–2018 were included. Adherence was assessed using the proportion of days covered (PDC) method. Time to discontinuation was analyzed using Kaplan–Meier estimates. Risk of discontinuation was estimated by Cox proportional hazard model. Results We identified 427 eligible patients (22.2 % were older than 60 years), utilizing 673 treatment lines. The proportion of adherent patients (PDC ≥ 0.8) was similar (62.1–66.5%) across all lines of therapy and across different biologics (70.0–72.0%), while apremilast showed the lowest, in both treatment-naïve and experienced settings (43.6% and 25.5%, respectively). The Kaplan–Meier analysis showed that in the treatment-naïve TNF-αis had higher drug survival compared with apremilast ( P = 0.032). Apremilast also had the lowest drug survival in the treatment-experienced group ( P < 0.0001). Kaplan–Meier analysis by age groups showed similar drug survival rates in older (≥ 60 years) and younger (age < 60 years) patients, regardless of treatment-experience status. The multivariable model showed that apremilast had increased risk for discontinuation compared with TNF-αis. Conclusion Adherence, drug survival and risk for discontinuation were similar for all included bDMARDs, regardless of treatment experience status, while apremilast showed lower rates and increased risk. Adherence and discontinuation rate were similar in older and younger patients. With the variety of drug modes of action available for patients with PsA, these findings may assist caregivers in selecting the appropriate treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-024-01136-7.

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Psoriatic Arthritis: The Influence of Co-morbidities on Drug Choice

Cited by 5 publications

References 191 publications

Associations of Polypharmacy With Clinical Parameters, Function, and Health-Related Quality of Life in Psoriatic Arthritis

Associations of Polypharmacy With Clinical Parameters, Function, and Health-Related Quality of Life in Psoriatic Arthritis

The Saudi consensus recommendations for the management of psoriatic arthritis (2023)

Real-World Drug Survival of Biologics and Targeted Synthetic Disease-Modifying Anti-rheumatic Drugs Among Patients with Psoriatic Arthritis

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