Psoriatic Arthritis Treatment Failure Tied to Key Factors

TOPLINE:

Failure to respond to targeted disease-modifying antirheumatic drugs (tsDMARDs) for psoriatic arthritis occurs at an incident rate of about 0.35 per person-year.

METHODOLOGY:

• An observational cohort of 591 individuals at the University of Toronto, Toronto, Ontario, Canada, with psoriatic arthritis (mean age, 48.2 years) who started advanced therapy between 2000 and 2023 was followed prospectively.
• Primary failure was defined as inefficacy during treatment or failure to meet response criteria (≥ 40% reduction in swollen joint count and ≥ 50% reduction in Psoriasis Area and Severity Index scores) after 1 year.
• The researchers grouped patients into responders, treatment failures, and individuals who discontinued therapy for other reasons.

TAKEAWAY:

• Therapies involved tumor necrosis factor (TNF) inhibitors (82.2%), etanercept (39.3%), IL-17 inhibitors (8.3%), IL-23 or IL-12/IL-23 inhibitors (4.4%), and tsDMARDs (4.4%).
• Treatment response occurred in 49.9% of participants, treatment failure in 35.4%, and therapy stoppage for other reasons in 14.7%. Treatment failure rates were 32.5% for TNF inhibitors, 50.7% for non-TNF inhibitor biologics, and 43.3% for tsDMARDs.
• Greater risk for primary failure was linked to daily alcohol consumption (odds ratio [OR], 3.52; 95% CI, 1.33-9.31), higher body mass index (OR, 1.04; 95% CI, 1.01-1.08), and fibromyalgia (OR, 2.07; 95% CI, 1.03-4.16).
• Higher educational level (OR, 0.51; 95% CI, 0.38-0.87), higher damaged joint count (OR, 0.95; 95% CI, 0.93-0.99), and HLA-B27 positivity (OR, 0.40; 95% CI, 0.17, 0.97) conferred lower risk for primary failure. 

IN PRACTICE:

“We always try to look for clinical profiling of patients to know how a patient will respond to therapy. This helps in that,” said presenting author Fadi Kharouf, MD, a clinical fellow at Toronto Western Hospital, Toronto, in an interview.

SOURCE:

Dr Kharouf and coauthors presented the study as a poster at the GRAPPA 2024 annual meeting.

LIMITATIONS:

The study was a retrospective analysis and cannot demonstrate causality. The study was conducted at a single center in Canada, which may limit generalizability.

DISCLOSURES:

The study received funding from the Krembil Foundation.