Treatment response, drug survival and safety of anti-tumour necrosis factor α therapy in 193 patients with psoriatic arthritis: A twelve-year “real life” experience

ObjectiveTo evaluate the performance of anti-TNFα therapy in psoriatic arthritis (PsA) in a routine care setting.MethodsInclusion criteria were patients with PsA who initiated anti-TNFα therapy between April 2001 and April 2013 with a follow-up of at least 6 months. For peripheral forms, treatment was considered to be effective for patients with a favourable expert opinion or > 30% clinical improvement of swollen and tender joint counts. For axial forms, efficacy criteria were: improvement of BASDAI by at least 2 points on a scale from 0 to 10 or 50% improvement (BASDAI 50) or expert opinion. Drug survival of first anti-TNFα therapy was also investigated.ResultsThe study included 193 patients (107/86 M/F, mean age: 46.8 years, mean disease duration: 6.7 years, 171/22 peripheral/axial forms). Only 48 (25%) patients received concomitant DMARD therapy (65% were treated with methotrexate). The majority of patients started with first-line etanercept (n = 102), followed by adalimumab (n = 46), infliximab (n = 44) and golimumab (n = 1). At 3 months, 90% of patients had obtained an adequate response, 7% had discontinued due to lack of efficacy and 3% due to adverse events. Median drug survival was 2 years. One-year and 2-year drug survival rates were 77% and 67%, respectively. Seventy-nine (41%) patients switched to a second anti-TNFα and 29 to a third anti-TNFα; 82% of switchers responded to second-line therapy and 83% responded to third-line therapy.ConclusionHigh drug survival and high response rates were observed in these patients with PsA receiving their first anti-TNFα therapy in routine clinical practice.