Introduction: Although tumor necrosis factor inhibitors (TNFis) have improved management of psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA); many patients experience suboptimal disease control. We quantified achievement of varying degrees of disease activity in patients with PsA and axSpA who initiated and maintained TNFi treatment for 12 months.
Methods: Patients with PsA or axSpA enrolled in the PPD™ CorEvitas™ PsA/Spondyloarthritis Registry were included in the study. Varying degrees of disease control were quantified based on minimal disease activity (MDA) status for PsA and BASDAI50 (≥ 50% improvement in Bath Ankylosing Spondylitis Disease Activity Index) status for axSpA at 6 and 12 months. Patients were categorized into four groups: sustained (MDA/BASDAI50 at 6 and 12 months), improved (MDA/BASDAI50 at 12 months only), worsened (MDA/BASDAI50 at 6 months only), and never achieved (no MDA/BASDAI50 at 6 or 12 months).
Results: For PsA, 338 patients initiated and persisted on TNFis. At 6 months, the majority (65%, n = 221) did not achieve MDA status; of these, 86% (n = 189) still did not achieve MDA at 12 months. For axSpA, 152 patients initiated and persisted on TNFis. At 6 months, 80% (n = 121) did not achieve BASDAI50; among these patients, 91% (n = 110) still did not achieve BASDAI50 status at 12 months. For both PsA and axSpA initiators, the risk of not achieving clinical or quality of life outcomes was two- to threefold lower in patients who never achieved versus patients who achieved and sustained MDA/BASDAI50.
Conclusion: More than 80% of patients with PsA or axSpA who did not achieve low disease activity at 6 months still did not achieve low disease activity by 12 months even though they persisted on TNFi treatment. These findings underscore the importance for physicians to consider modifying therapy if treatment targets with TNFi have not been achieved in the first 6 months.
Keywords: Axial spondyloarthritis; Back pain; CorEvitas PsA/SpA Registry; Immune-mediated inflammatory disease; Joint pain; Minimal disease activity; Physical function; Psoriatic arthritis; Quality of life; Tumor necrosis factor inhibitors.
Psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) are lifelong inflammatory diseases. Joint pain and stiffness are symptoms of both diseases. Patients with these diseases may experience damage to their joints that can reduce their ability to work and perform daily activities. Tumor necrosis factor inhibitors (TNFis) are medications that treat PsA and axSpA. TNFis can improve pain, swelling, and tenderness of the joints and reduce inflammation and disease activity in patients with these chronic inflammatory diseases. Despite the effectiveness of these drugs, many patients still experience symptoms and do not have low disease activity. This study examined if patients with PsA or axSpA who started and remained on TNFi treatment for 6 and 12 months could achieve low disease activity, which means that symptoms are significantly reduced and risk of long-term joint damage is reduced. We found that at 6 months 70–80% of patients with PsA and axSpA did not have low disease activity, and 90% of those who did not reach low disease activity at 6 months still did not reach low disease activity after 12 months of consistent therapy. Patients with low disease activity were two- to threefold times more likely to have optimal reduction in symptoms and disease activity measures compared with those without low disease activity. These findings suggest a need for more effective treatment strategies to manage these chronic inflammatory diseases and a need for healthcare providers to consider changes in therapy for patients who have not reached treatment goals by 6 months.
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