Long-term remission and biologic persistence rates: 12-year real-world data

Abstract

Background: Biologic therapies have greatly improved outcomes in rheumatoid arthritis (RA) and psoriatic arthritis (PsA). Yet, our ability to predict long-term remission and persistence or continuation of therapy remains limited. This study explores predictors of remission and persistence of the initial biologic therapy in patients after 12 years. Furthermore, outcomes with adalimumab and etanercept are compared.

Patients and methods: RA and PsA patients were prospectively recruited from a biologic clinic. Outcomes on commencing therapy, at 1 year and 12 years were reviewed. Demographics, medications, morning stiffness, patient global health score, tender and swollen joint counts, antibody status, CRP and HAQ were collected. Outcomes at 1 year and 12 years are reported and predictors of biologic persistence and EULAR-defined remission (DAS28-CRP < 2.6) are examined with univariate and multivariate analysis.

Results: A total of 403 patients (274 RA and 129 PsA) were analysed. PsA patients were more likely to be male, in full-time employment and have completed higher education. PsA had higher remission rates than RA at both 1 year (60.3% versus 34.5%, p < 0.001) and 12 years (91.3% versus 60.6%, p < 0.001). This difference persisted when patients were matched for baseline disease activity (p < 0.001). Biologic continuation rates were high for RA and PsA at 1 year (49.6% versus 58.9%) and 12 years (38.2% versus 52.3%). In PsA, patients starting on etanercept had lower CRP at 12 years (p = 0.041). Multivariate analysis showed 1-year continuation [OR 4.28 (1.28-14.38)] and 1-year low-disease activity [OR 3.90 (95% CI 1.05-14.53)] was predictive of a 12-year persistence. Persistence with initial biologic at 12 years [OR 4.98 (95% CI 1.83-13.56)] and male gender [OR 4.48 (95% CI 1.25-16.01)] predicted 12 year remission.

Conclusions: This is the first study to show better response to biologic therapy in PsA compared to RA at 12 years. Long-term persistence with initial biologic agent was high and was predicted by biologic persistence and low-disease activity at 1 year. Interestingly, PsA patients had higher levels of employment, educational attainment, and long-term remission rates compared to RA patients.

Keywords: Biologics; Psoriatic arthritis; Remission; Rheumatoid arthritis.

Fig. 1

A comparison of persistence with initial biologic agent over time in rheumatoid and psoriatic arthritis. Persistence rates with original biologic agent in rheumatoid arthritis is represented by the solid line (n = 274) and psoriatic arthritis (n = 129) by the dotted line

Fig. 2

A comparison of DAS28-CRP in RA and PsA across 12 years. a Line graph representing DAS28-CRP responses to biologic therapy at 1 year and 12 years in RA [solid line (n = 274)] and PsA [dotted black line (n = 129)]. Remission is represented by the dotted grey line at DAS28-CRP value of 2.6. DAS28-CRP is significantly lower in PsA at all time points. b Line graph representing DAS28-CRP responses to biologic therapy at 1 year and 12 years in a cohort matched for baseline DAS28-CRP (moderate disease activity) in RA [solid line (n = 89)] and PsA [dotted black line (n = 65)]. Remission is represented by the dotted grey line at DAS28-CRP value of 2.6. Values are expressed as mean +/− SEM; **p < 0.001 between RA and PsA at that timepoint

Fig. 3

A comparison of rates of DAS28-CRP remission over time. a PsA represented by the dotted line (n = 129) has higher remission rates at all time points when compared to RA (n = 274), represented by solid black line. b In patients matched for baseline disease activity [moderate disease activity (n = 154)], remission rates are higher in PsA at both 1 year and 12 years *p < 0.05, **p < 0.001 between RA and PsA at that timepoint