Psoriatic arthritis had almost no presence on the last day of EULAR 2016. Of the handful of posters on display, two were of note. The two posters have attempted to characterize patients who switch after being prescribed biologic therapy.
The first poster (#SAT0412) investigated a small cohort of patients from Portugal. The investigators aimed to determine differences in baseline clinical and laboratory features between switchers and non-switchers. A retrospective analysis of their cohort of patients followed for at least 24 months was conducted. Of the 58 patients in their cohort, 32 were prescribed biologics after failure of DMARD therapy after a median duration from diagnosis of 26 months. Out of 32 patients prescribed biologics, 15 switched to another biologic agent due to secondary failure (64%), primary failure (18%) or adverse events (14%). Interestingly, switchers were significantly younger at onset of psoriasis as well as PsA, had higher PASI, more prevalent uveitis and axial involvement. Moreover, all patients starting biologic therapy within the first 12 months of disease onset switched to another biologic agent.
Thus, this study suggests that those patients with early onset and more severe disease tend to switch their first prescribed biologic.
The second poster (#SAT0411) investigated the same issue using data from the CORRONA registry from the US. PsA patients enrolled in the registry between 3/2013 and 7/2015 on a biologic at baseline (registry enrollment) and at least two follow-up visits were included. Of the 251 PsA patients meeting the inclusion criteria, 26% (n=65) discontinued/switched the index biologic and 74% (n=186) stayed on the index biologic by the second follow-up visit. 97% had a history of prior biologic use and 55% were on monotherapy. The major reason for discontinuing the index biologic was lack of efficacy (60%) followed by other reasons (16%) and side effects (12%). Factors associated with discontinuation/switching included female sex, higher pain and fatigue scores, greater work impairment, higher disease activity score and enthesitis.
This study suggests that higher disease activity scores and poorer patient-reported outcomes influence switching or discontinuation of biologic therapy in PsA.
Taken together, these studies indicate that clinicians need to be paying attention to patient-reported outcomes and treat disease activity aggressively when managing patients with PsA in order to prevent switching or discontinuation of biologic therapy in PsA.
Dr. Chandran is a rheumatologist and clinician-scientist, an Assistant Professor of Medicine & Laboratory Medicine and Pathobiology at the University of Toronto, an affiliate scientist at the Krembil Research Institute, a staff physician at the University Health Network and Mount Sinai Hospitals, and an associate member of the graduate faculty at the Institute of Medical Science. He co-directs the Psoriatic Arthritis Program at the University Health Network.View Full Bio