Conventional Synthetic Dmards in Psoriatic Arthritis: Changing Practice in Biologic Era; Real-Life Results from HURBIO-PsA Registry

Objectives: Psoriatic arthritis is a chronic musculoskeletal disorder which may affect skin, joints, bone and enthesis. Conventional synthetic disease modifying anti-rheumatic drugs are first-line treatment options and biologic disease modifying anti-rheumatic drugs are recommended in psoriatic arthritis patients who are intolerant/not controlled well with conventional synthetic disease modifying anti-rheumatic drugs. Although survival data of the conventional synthetic disease modifying anti-rheumatic drugs without concomitant biologic disease modifying anti-rheumatic drugs are available, the effect of biologic disease modifying anti-rheumatic drugs on the retention of conventional synthetic disease modifying anti-rheumatic drugs is still a question of interest. Materials and Methods: Psoriatic arthritis patients who received at least 1 dose of biologic disease modifying anti-rheumatic drugs, using at least 1 conventional synthetic disease modifying anti-rheumatic drugs (methotrexate, leflunomide, hydroxychloroquine and sulfasalazine) at the time of biologic disease modifying anti-rheumatic drugs starting visit and registered in the Hacettepe University BIOlogical Database- Psoriatic Arthritis were included in this retrospective longitudinal analysis. Demographic and disease-specific data at first and last followup visit were collected. Unadjusted retention rate of each conventional synthetic disease modifying anti-rheumatic drugs was assessed. Overall prescription of conventional synthetic disease modifying anti-rheumatic drugs at first and last follow-up visit were compared. Results: A total of 266 (191(71.8%) female) patients was included. Median follow-up duration under biologic treatment was 43.4 (19.4- 80.1) months. Median retention duration of each conventional synthetic disease modifying anti-rheumatic drugs were similar. Between the first and last visit; there was a 29.3% decrease in methotrexate use (61.7% vs. 43.6%; p

PDF

___

[1] Gladman DD, Antoni C, Mease P et al. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis 2005; 64 (Suppl 2): ii14-17.

[2] Coates LC, Corp N, van der Windt DA et al. GRAPPA Treatment Recommendations: An Update From the 2020 GRAPPA Annual Meeting. J Rheumatol 2021; jrheum.201681.

[3] Gossec L, Baraliakos X, Kerschbaumer A et al. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update. Ann Rheum Dis 2020; 79(6):700-12.

[4] Kalyoncu U, Bayindir O, Ferhat Oksuz M et al. The Psoriatic Arthritis Registry of Turkey: results of a multicentre registry on 1081 patients. Rheumatology (Oxford) 2017; 56(2):279- 86.

[5] Jacobs ME, Pouw JN, Welsing P et al. First-line csDMARD monotherapy drug retention in psoriatic arthritis: methotrexate outperforms sulfasalazine. Rheumatology (Oxford) 2021; 60(2):780-84.

[6] Xie Y, Liu Y, Liu Y. Are biologics combined with methotrexate better than biologics monotherapy in psoriasis and psoriatic arthritis: A meta-analysis of randomized controlled trials. Dermatol Ther 2021:e14926.

[7] Wilsdon TD, Whittle SL, Thynne TR et al.Methotrexate for psoriatic arthritis. Cochrane Database Syst Rev 2019; 1:CD012722.

[8] Landi M, Zaffarana CA, Cerda O et al. Methotrexate and leflunomide survival in patients with psoriatic arthritis. International Journal of Clinical Rheumatology 2018; 13(2):102-07.

[9] Lie E, van der Heijde D, Uhlig T et al. Effectiveness and retention rates of methotrexate in psoriatic arthritis in comparison with methotrexate-treated patients with rheumatoid arthritis. Ann Rheum Dis 2010; 69(4):671-76.

[10] Kaltwasser JP, Nash P, Gladman D et al. Treatment of Psoriatic Arthritis Study G: Efficacy and safety of leflunomide in the treatment of psoriatic arthritis and psoriasis: a multinational, double-blind, randomized, placebo-controlled clinical trial. Arthritis Rheum 2004; 50(6):1939-50.

[11] Malesci D, Tirri R, Buono R et al. Leflunomide in psoriatic arthritis: a retrospective study of discontinuation rate in daily clinical practice compared with methotrexate. Clin Exp Rheumatol 2007; 25(6):881-4.

[12] Luzar MJ. Hydroxychloroquine in psoriatic arthropathy: exacerbations of psoriatic skin lesions. J Rheumatol 1982; 9(3):462-4.

[13] Karmacharya P, Ogdie A, Eder L. Psoriatic arthritis and the association with cardiometabolic disease: a narrative review. Ther Adv Musculoskelet Dis 2021; 13:1759720X21998279.