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Psoriatic arthritis treatment regimens, therapy duration and reasons for cessation in the biologics era: a multi‐centre Australian study
Author(s) -
Tymms Kathleen,
Kelly Ayano,
Bird Paul,
Griffiths Hedley,
Jager Julien,
Littlejohn Geoff,
Louw Sandra,
Roberts Lynden,
Youssef Peter,
Zochling Jane,
Nichols Dave
Publication year - 2018
Publication title -
international journal of rheumatic diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.795
H-Index - 41
eISSN - 1756-185X
pISSN - 1756-1841
DOI - 10.1111/1756-185x.13127
Subject(s) - medicine , psoriatic arthritis , combination therapy , rheumatology , cohort , retrospective cohort study , adverse effect , physical therapy , arthritis
Aim To describe the treatment regimens, duration of therapy and reasons for disease‐modifying antirheumatic drug ( DMARD ) cessation in a large psoriatic arthritis (PsA) cohort. Methods A retrospective non‐interventional multi‐centre study using Audit4 electronic medical records, with de‐identified, routinely collected clinical data from rheumatology practices in the OPAL consortium (Optimising Patient outcomes in Australian rheumatoLogy) during November 2015. Baseline characteristics, type and duration of conventional and biologic DMARD s ( cDMARD and bDMARD , respectively), disease activity (Disease Activity Score of 28 joints C‐reactive protein [ DAS 28‐ CRP ]), and reasons for treatment cessation were recorded. Results A total of 3422 rheumatologist‐diagnosed PsA patients were included: 60% female, mean age 54 years and disease duration 10 years. Of patients with treatment recorded ( n = 2948), 46% were on cDMARD monotherapy, 19% bDMARD monotherapy, 13% combination bDMARD and cDMARD s, 11% combination cDMARD s and 10% no DMARD s. Of those with DAS 28‐ CRP results ( n = 494), the highest mean DAS 28‐ CRP was 3.32 on combination cDMARD s, and the lowest was 2.19 on bDMARD monotherapy. Median duration on cDMARD monotherapy was 33.5 months ( n = 2232), on bDMARD monotherapy 110.1 months ( n = 751), on combination bDMARD and cDMARD s 68.5 months ( n = 559). The most common reasons for cessation of cDMARD monotherapy was adverse reactions (41%), for bDMARD monotherapy lack of efficacy (26%), and for combination bDMARD and cDMARD s treatment completed or no longer required (37%). Conclusion Most PsA patients were prescribed DMARD therapies with a large proportion receiving cDMARD s. Patients on combination cDMARD therapies had the highest DAS 28‐ CRP results. Adverse reactions were the most common reason for cessation of cDMARD monotherapy, whereas for bDMARD monotherapy it was lack of efficacy.