Effectiveness and treatment retention of TNF inhibitors when used as

Abstract

Background Comedication with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) during treatment with tumour necrosis factor inhibitors (TNFi) is extensively used in psoriatic arthritis (PsA), although the additive benefit remains unclear. We aimed to compare treatment outcomes in patients with PsA treated with TNFi and csDMARD comedication versus TNFi monotherapy. Methods Patients with PsA from 13 European countries who initiated a first TNFi in 2006-2017 were included. Country-specific comparisons of 1 year TNFi retention were performed by csDMARD comedication status, together with HRs for TNFi discontinuation (comedication vs monotherapy), adjusted for age, sex, calendar year, disease duration and Disease Activity Score with 28 joints (DAS28). Adjusted ORs of clinical remission (based on DAS28) at 12 months were calculated. Between-country heterogeneity was assessed using random-effect meta-analyses, combined results were presented when heterogeneity was not significant. Secondary analyses stratified according to TNFi subtype (adalimumab/infliximab/etanercept) and restricted to methotrexate as comedication were performed. Results In total, 15 332 patients were included (62% comedication, 38% monotherapy). TNFi retention varied across countries, with significant heterogeneity precluding a combined estimate. Comedication was associated with better remission rates, pooled OR 1.25 (1.12-1.41). Methotrexate comedication was associated with improved remission for adalimumab (OR 1.45 (1.23-1.72)) and infliximab (OR 1.55 (1.21-1.98)) and improved retention for infliximab. No effect of comedication was demonstrated for etanercept. Conclusion This large observational study suggests that, as used in clinical practice, csDMARD and TNFi comedication are associated with improved remission rates, and specifically, comedication with methotrexate increases remission rates for both adalimumab and infliximab.

C1 [Lindstrom, Ulf; Jacobsson, Lennart T. H.] Univ Gothenburg, Sahlgrenska Acad, Dept Rheumatol & Inflammat Res, Gothenburg, Sweden.

[Di Giuseppe, Daniela; Delcoigne, Benedicte; Askling, Johan] Karolinska Inst, Dept Med Solna, Clin Epidemiol Div, Stockholm, Sweden.

[Glintborg, Bente] Rigshosp, DANBIO, Copenhagen, Denmark.

[Glintborg, Bente] Rigshosp, Copenhagen Ctr Arthrit Res COPECARE, Ctr Rheumatol & Spine Dis, Ctr Head & Orthoped, Copenhagen, Denmark.

[Glintborg, Bente] Univ Copenhagen, Fac Hlth & Med Sci, Dept Clin Med, Copenhagen, Denmark.

[Moller, Burkhard] Univ Hosp Bern, Inselspital, Dept Rheumatol & Immunol, Bern, Switzerland.

[Ciurea, Adrian] Univ Zurich, Univ Hosp Zurich, Dept Rheumatol, Zurich, Switzerland.

[Pombo-Suarez, Manuel] Hosp Clin Univ, Rheumatol Serv, Santiago De Compostela, Spain.

[Sanchez-Piedra, Carlos] Spanish Soc Rheumatol, Res Unit, Madrid, Spain.

[Eklund, Kari; Relas, Heikki] Helsinki Univ Hosp, Dept Rheumatol, Inflammat Ctr, Helsinki, Finland.

[Eklund, Kari] Orton Orthopaed Hosp, Helsinki, Finland.

[Gudbjornsson, Bjorn] Univ Hosp, Ctr Rheumatol Res, Reykjavik, Iceland.

[Gudbjornsson, Bjorn; Love, Thorvardur Jon] Univ Iceland, Fac Med, Reykjavik, Iceland.

[Love, Thorvardur Jon] Landspitali Univ Hosp, Dept Sci & Res, Reykjavik, Iceland.

[Jones, Gareth T.] Univ Aberdeen, Aberdeen Ctr Arthrit & Musculoskeletal Hlth, Epidemiol Grp, Aberdeen, Scotland.

[Codreanu, Catalin; Ionescu, Ruxandra] Univ Med & Pharm Carol Davila, Romanian Registry Rheumat Dis, Bucharest, Romania.

[Nekvindova, Lucie] Charles Univ Prague, Fac Med 1, Prague, Czech Republic.

[Nekvindova, Lucie] Inst Biostat & Anal Ltd, Brno, Czech Republic.

[Zavada, Jakub] Charles Univ Prague, Fac Med 1, Dept Rheumatol, Prague, Czech Republic.

[Zavada, Jakub] Inst Rheumatol, Prague, Czech Republic.

[Atas, Nuh] Gazi Univ, Univ Hosp, Dept Internal Med, Div Rheumatol, Ankara, Turkey.

[Atas, Nuh] Gazi Univ, Fac Med, Ankara, Turkey.

[Yolbas, Servet] Inonu Univ, Univ Hosp, Dept Internal Med, Div Rheumatol, Malatya, Turkey.

[Yolbas, Servet] Inonu Univ, Fac Med, Malatya, Turkey.

[Fagerli, Karen Minde; Michelsen, Brigitte] Diakonhjemmet Hosp, Dept Rheumatol & Res, Oslo, Norway.

[Michelsen, Brigitte] Sorlandet Hosp, Dept Med, Div Rheumatol, Kristiansand, Norway.

[Rotar, Ziga; Tomsic, Matija] Univ Med Ctr Ljubljana, Dept Rheumatol, Ljubljana, Slovenia.

[Rotar, Ziga; Tomsic, Matija] Univ Ljubljana, Fac Med, Ljubljana, Slovenia.

[Iannone, Florenzo] Univ Bari, DETO, Rheumatol Unit, Bari, Italy.

[Santos, Maria Jose] Hosp Garcia Orta, Reuma Pt Registry, Almada, Portugal.

[Santos, Maria Jose] Hosp Garcia Orta, Dept Rheumatol, Almada, Portugal.

[Avila-Ribeiro, Pedro] Univ Lisbon, Fac Med, Inst Mol Med, Rheumatol Res Unit, Lisbon, Portugal.

[Avila-Ribeiro, Pedro] Hosp Santa Maria, Dept Rheumatol, Lisbon, Portugal.

[Ornbjerg, Lykke Midtboll; Ostergaard, Mikkel] Rigshosp Glostrup, Copenhagen Ctr Arthrit Res COPECARE, Ctr Rheumatol & Spine Dis, Ctr Head & Orthopaed, Glostrup, Denmark.

[Ostergaard, Mikkel] Univ Copenhagen, Dept Clin Med, Copenhagen, Denmark.

[Nissen, Michael J.] Geneva Univ Hosp, Dept Rheumatol, Geneva, Switzerland.