COMPARATIVE EFFECTIVENESS OF BIOLOGIC AND TARGETED SYNTHETIC DMARDS IN PSORIATIC ARTHRITIS ACCORDING TO COMORBIDITIES AT TREATMENT START: A NORDIC COLLABORATIVE STUDY BASED ON ENRICHED CLINICAL REGISTERS
Authors: Di Guiseppe D et al.
Biologic DMARD experienced PsA patients from 5 Nordic registries were included between 2012 and 2020 in this analysis with the objective to compare 1-year treatment retention and 6-month effectiveness in patients with or without comorbidities at treatment start for IL17i versus TNFi, and JAKi versus TNFi.
A total of 10.276 treatment starts among 6.118 patients were analysed. Patients initiating a TNFi were more often male, most often on a concomitant csDMARDs and had a lower pro-portion of patients with comorbidities (43%), compared to IL17i (46%) and JAKi (55%) patients. Patients with comorbidities had a higher chance to remain on IL17i compared to TNFi (HR=0.87, 95%CI 0.77-0.98), no difference was seen for JAKi vs TNFi. Patients without comorbidities had a higher chance to discontinue a JAKi versus TNFi but stayed longer on IL17i. However, patients without comorbidities had a higher chance to achieve LDA after 6 months on TNFi compared to anti-IL17 and JAK inhibitors. Among patients with at least one comorbidity, there was no difference in the chance of reaching LDA after 6 months between TNFi (33%), IL17i (30%) and JAKi (29%).
This registry based analysis confirms that comorbidities impact treatment outcomes. In patients with comorbidities, the data seems to favour anti-IL17 directed bDMARDs with regard to retention after 1 year but not with regard to the chance of achieving LDA. It may be discussed whether this discrepancy reflects a better tolerability of anti-IL17 in this patient population or a secondary loss of efficacy in patients on TNFi. A detailed analysis regarding the number and kind of comorbidities will certainly follow.