Treatment patterns, unmet need, and impact on patient-reported outcomes of psoriatic arthritis in the United States and Europe

Abstract

Psoriatic arthritis (PsA) is a chronic, inflammatory disease. The effects of PsA real-world treatment patterns on patient-reported outcomes in the US and 5 European countries (EU5; France, Germany, Italy, Spain, UK) were evaluated. Respondents from the 2016 National Health and Wellness Survey received advanced therapies (e.g., biologic disease-modifying antirheumatic drugs [DMARDs]), other therapies, (e.g., conventional synthetic DMARDs), or no treatment. Assessments included demographics, disease severity (patient-reported), comorbidities (Charlson Comorbidity Index), health status (Short Form-36 Health Survey), depression (Patient Health Questionnaire-9), work productivity (Work Productivity and Activity Index), and treatment adherence (Morisky Medication Adherence Scale-8). Overall, 1037 respondents from the US and 947 respondents from the EU5 were included. Of these, 21.7% US and 7.3% EU5 respondents received advanced therapies; 16.6% and 28.5%, other therapies; and 61.7% and 64.2%, no treatment, respectively. During treatment with advanced or other therapies, 40.8–54.7% US and 57.7–58.9% EU5 respondents self-reported moderate or severe PsA. Respondents receiving advanced therapies had the highest Charlson Comorbidity Index score (US, 1.25; EU5, 1.42); the lowest scores were with no treatment (0.52 and 0.49, respectively). Employment was lowest with other therapies (US, 47.7%; EU5, 41.1%). Overall work impairment was reported by 57.9% US and 62.6% EU5 respondents receiving advanced therapies. Medication adherence was generally low in the US and medium in the EU5 (Morisky Medication Adherence Scale-8: low, US 40.1–46.7%, EU5, 29.0–35.2%; medium, US 29.3–36.1%, EU5 37.8–49.3%; high, US 23.8–24.0%; EU5, 21.7–27.0%). Advanced and other therapies reduced PsA severity; however, > 40% of respondents reported moderate or severe PsA during treatment. Better management and adherence may reduce unmet need and disease burden. Further work is required to improve PsA diagnosis and time to treatment initiation.Electronic supplementary materialThe online version of this article (10.1007/s00296-018-4195-x) contains supplementary material, which is available to authorized users.

Relationship of pain and fatigue with health-related quality of life and work in patients with psoriatic arthritis on TNFi: results of a multi-national real-world study

“…This finding is consistent with a report that overall employment rates are significantly lower in patients with rheumatic diseases than in the general population, especially in those with ankylosing spondylitis and PsA. [33][34][35] Unemployment and work impairment, including time away from work (absenteeism) or reduced effectiveness at work (presenteeism), affects up to 50% of people with PsA. 6 A National Psoriasis Foundation (US) survey found that 49% of respondents routinely missed work due to psoriasis or PsA, with more than 10 workdays per month missed by 31% of those respondents.…”

Clinical Characteristics, Disease Activity, Functional Status, and Quality of Life Results of Patients With Psoriatic Arthritis Using Biological and Conventional Synthetic Disease-Modifying Antirheumatic Drugs

“…37 Our analysis showed that patients with PsA have lower SF-36 physical and mental scores and lower health-related QoL scores compared with the general population. 38 In a study conducted by Gottlieb et al, 39 SF-36 PCSs in patients with PsA were similar to the ones reported in the literature, while the SF-36 MCSs were lower. In a study conducted in the general population in Norway, a comparison of patients with PsA using bDMARD with those using csDMARD revealed that the scores for the bodily pain, vitality, physical role, and general health perception subscales of SF-36 showed greater improvement.…”

Real-world 2-year treatment patterns among patients with psoriatic arthritis treated with injectable biologic therapies

“…switching or adding therapies for patients with inadequately controlled symptoms). Treatment adherence and persistence to biologic therapies is an important determinant of patient outcomes in rheumatic diseases, including PsA 7,8 . A recent administrative claims database study of patients with PsA found that less than half of patients who newly initiated a biologic were persistent with their index TNF or IL-12/23 inhibitor during a 1-year follow-up period 9 .…”