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. 2023 Jun;82(6):820-828.
doi: 10.1136/ard-2022-223650. Epub 2023 Feb 22.

Uptake and effectiveness of newer biologic and targeted synthetic disease-modifying antirheumatic drugs in psoriatic arthritis: results from five Nordic biologics registries

Bente Glintborg #  1   2 , Daniela Di Giuseppe #  3 , Johan Karlsson Wallman  4   5 , Dan C Nordström  6 , Bjorn Gudbjornsson  7   8 , Merete Lund Hetland  9   2 , Johan Askling  10 , Gerdur Grondal  8   11 , Tuulikki Sokka  12   13 , Sella A Provan  14 , Brigitte Michelsen  15   16 , Eirik Klami Kristianslund  15 , Lene Dreyer  17   18 , Thorvardur Jon Love  19 , Ulf Lindström  20
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Free article

Uptake and effectiveness of newer biologic and targeted synthetic disease-modifying antirheumatic drugs in psoriatic arthritis: results from five Nordic biologics registries

Bente Glintborg et al. Ann Rheum Dis. 2023 Jun.
Free article

Abstract

Background: We aimed to describe the uptake of newer biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) in psoriatic arthritis (PsA) in the Nordic countries and to compare their retention and effectiveness.

Methods: Patients with PsA starting a b/tsDMARD in 2012-2020 in five Nordic rheumatology registers were included. Uptake and patient characteristics were described, with comorbidities identified from linkages to national patient registries. One-year retention and 6-month effectiveness (proportions achieving low disease activity (LDA) on the Disease Activity Index for PSoriatic Arthritis based on 28-joint evaluation) for the newer b/tsDMARDs (abatacept/apremilast/ixekizumab/secukinumab/tofacitinib/ustekinumab) were compared with adalimumab through adjusted regression models stratified by treatment course (first, second/third, and fourth or more).

Results: In total, 5659 treatment courses with adalimumab (56% biologic-naïve) and 4767 courses with a newer b/tsDMARD (21% biologic-naïve) were included. The uptake of newer b/tsDMARDs increased from 2014 and plateaued in 2018. Patient characteristics appeared similar across treatments at treatment start. Adalimumab was more often used as the first course and newer b/tsDMARDs more often in biologic-experienced patients. Used as a second/third b/tsDMARD, the retention rate and the proportion achieving LDA were significantly better for adalimumab (rate 65%, proportion 59%) compared with abatacept (45%, 37%), apremilast (43%, 35%), ixekizumab (LDA only, 40%) and ustekinumab (LDA only, 40%), but not significantly different from other b/tsDMARDs.

Conclusion: Uptake of newer b/tsDMARDs occurred mainly in biologic-experienced patients. Regardless of mode of action, only a minority of patients starting a second or later b/tsDMARD course remained on drug and achieved LDA. Superior outcomes for adalimumab indicate that the positioning of newer b/tsDMARDs in the PsA treatment algorithm remains to be established.

Keywords: biological therapy; epidemiology; spondylitis, ankylosing; tumor necrosis factor inhibitors.

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Conflict of interest statement

Competing interests: BG: Pfizer, BMS, Sandoz and chairs the steering committee of the Danish Rheumatology Registry (DANBIO), which receives public funding from hospital owners and funding from pharmaceutical companies. JKW: AbbVie, Amgen, Eli Lilly, Novartis and Pfizer. DCN: AbbVie, BMS, Lilly, MSD, Novartis, Pfizer, Roche and UCB. MLH: AbbVie, Biogen, BMS, Celltrion, Eli Lilly, Janssen Biologics BV, Lundbeckfonden, MSD, Pfizer, Roche, Samsung Bioepis, Sandoz and Novartis. JA: AbbVie, BMS, Eli Lilly, Galapagos, MSD, Pfizer, Roche, Samsung Bioepis and Sanofi. Agreements between Karolinska Institutet (with JA as PI) and the listed entities, mainly for the national safety monitoring of rheumatology immunomodulators in Sweden (ARTIS). TS: AbbVie, BMS, Celgene, Medac, Merck, Novartis, Orion Pharma, Pfizer, Roche, Sandoz, UCB and Boehringer Ingelheim. SAP: Boehringer Ingelheim. BM: Novartis. EKK: Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY) funded as a Centre for Clinical Treatment Research by the Research Council of Norway (project 328657). LD: BMS, Janssen, UCB and Boehringer Ingelheim.

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