Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2025 Mar 4;27(1):46.
doi: 10.1186/s13075-025-03518-7.

Burden and determinants of multi-b/tsDMARD failure in psoriatic arthritis

Rebecca H Haberman  1 , Kyra Chen  2 , Catherine Howe  2 , Seungha Um  3 , Adamary Felipe  2 , Brianna Fu  2 , Stephanie Eichman  2 , Margaret Coyle  2 , Eileen Lydon  2 , Andrea L Neimann  4 , Soumya M Reddy  2 , Samrachana Adhikari  3 , Jose U Scher  2   5
Affiliations
Observational Study

Burden and determinants of multi-b/tsDMARD failure in psoriatic arthritis

Rebecca H Haberman et al. Arthritis Res Ther. .

Abstract

Objectives: Despite significant therapeutic advances in psoriatic arthritis (PsA), many patients do not achieve remission and cycle through multiple biologic (b)- or targeted synthetic (ts)- DMARDs. Identifying the underlying reasons for repetitive therapeutic failure remains a knowledge gap. Here we describe prescribing patterns and characteristics of PsA patients with multi-b/tsDMARD failure at the NYU Psoriatic Arthritis Center.

Methods: Nine hundred sixty PsA patients were enrolled in an observational, longitudinal registry. Demographics, medical history, medication use, and psoriatic disease phenotype were collected. Multi-b/tsDMARD failure was defined as requiring ≥ 4 b/tsDMARDs.

Results: Seven hundred twenty-five patients (75%) used ≥ 1 b/tsDMARD during their disease course. The initial b/tsDMARDs prescribed were predominately anti-TNF agents. 166 (17%) patients had multi-b/tsDMARD failure. Compared to those requiring 1 b/tsDMARD, female sex (OR 2.3; 95%CI 1.4-3.8), axial disease (OR 2.1; 95% CI 1.2-3.6), depression (OR 2.0; 95%CI 1.1-3.7), and obesity (OR 1.7; 95%CI 1.0-2.8) were risk factors for multi-b/tsDMARD failure disease after adjustment for age, disease duration, sex, depression, smoking, obesity, and skin severity. Patients with multi-b/tsDMARD failure PsA also had increased disease activity at their clinical visit (i.e., swollen joint count, p = 0.005).

Conclusion: In this cohort, 17% patients with PsA experienced multi-b/tsDMARD failure. These patients were more likely to be female, obese, and have higher rates of axial involvement and depression, along with higher active disease activity. This highlights the inflammatory and non-inflammatory drivers of multiple therapeutic failures, underscoring the need for precision medicine strategies and potential non-pharmacologic adjuvant therapies for patients with PsA to improve outcomes and quality of life.

Keywords: Biologics; Difficult to treat; Outcomes; Psoriatic arthritis; Therapeutics.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was approved by the NYU Institutional Review Board (s20-00084) with waived written consent from individual participants as all data was collected in a deidentified manner. Consent for publication: Not applicable. Competing interests: RHH has served as a consultant for Johnson & Johnson and Novartis. SMR has served as a consultant for BMS, Johnson & Johnson, Novartis and UCB. JUS has served as a consultant for BMS, Johnson & Johnson, Pfizer, and UCB. EL has served as a consultant for Amgen, AstraZeneca, and UCB. ALN has served as a consultant for Sun pharma and UCB.

Figures

Fig. 1
Fig. 1
Number of biologic and targeted synthetic disease modifying anti-rheumatic drugs (b/tsDMARDs) exposures
Fig. 2
Fig. 2
b/tsDMARD prescription patterns. A Mechanism of action of by b/tsDMARD exposure. B Mechanism of action of the first b/tsDMARD exposure by time period. Arrows and medications denote the time period where the first medication of that MOA was FDA approved for the indication of either psoriasis or psoriatic arthritis. TNFi denotes tumor necrosis factor inhibitor, IL- 12/23i interleukin 12/23 inhibitor, IL-17i interleukin 17 inhibitor, IL-23i interleukin 23 inhibitor, JAKi janus kinase inhibitor, CTLA-4i cytotoxic T-lymphocyte associated protein 4 inhibitor, Tyk2i tyrosine kinase inhibitor, IL-17AFi interleukin 17AF inhibitor
Fig. 3
Fig. 3
Reason for discontinuing b/tsDMARD by exposure
Fig. 4
Fig. 4
Kaplan–Meier Estimates of b/tsDMARD Persistence by Exposure. Persistence was defined as the time from therapy initiation to discontinuation. Patients exposed to 4 or more treatments were grouped into the 4th+ cohort
Fig. 5
Fig. 5
Risk estimates of multi-b/tsDMARD failure psoriatic arthritis. Odds ratios are unadjusted (A) and adjusted (B) for disease duration, age, sex, depression, smoking status, obesity, and skin severity
See this image and copyright information in PMC

References

    1. Ritchlin CT, Colbert RA, Gladman DD. Psoriatic Arthritis. N Engl J Med. 2017;376(10):957–70. - DOI - PubMed
    1. Mease PJ, Gladman DD, Ritchlin CT, Ruderman EM, Steinfeld SD, Choy EH, et al. Adalimumab for the treatment of patients with moderately to severely active psoriatic arthritis: results of a double-blind, randomized, placebo-controlled trial. Arthritis Rheum. 2005;52(10):3279–89. - DOI - PubMed
    1. Mease PJ, van der Heijde D, Ritchlin CT, Okada M, Cuchacovich RS, Shuler CL, et al. Ixekizumab, an interleukin-17A specific monoclonal antibody, for the treatment of biologic-naive patients with active psoriatic arthritis: results from the 24-week randomised, double-blind, placebo-controlled and active (adalimumab)-controlled period of the phase III trial SPIRIT-P1. Ann Rheum Dis. 2017;76(1):79–87. - DOI - PMC - PubMed
    1. McInnes IB, Behrens F, Mease PJ, Kavanaugh A, Ritchlin C, Nash P, et al. Secukinumab versus adalimumab for treatment of active psoriatic arthritis (EXCEED): a double-blind, parallel-group, randomised, active-controlled, phase 3b trial. Lancet. 2020;395(10235):1496–505. - DOI - PubMed
    1. Glintborg B, Di Giuseppe D, Wallman JK, Nordström DC, Gudbjornsson B, Hetland ML, et al. Uptake and effectiveness of newer biologic and targeted synthetic disease-modifying antirheumatic drugs in psoriatic arthritis: results from five Nordic biologics registries. Ann Rheum Dis. 2023;82(6):820–8. - DOI - PubMed

Publication types