Patient-reported Outcomes in PsA at Different Treatment Initiations of TNFi

A new study presented at the American College of Rheumatology/Empowering Rheumatology Professionals Annual Meeting analyzed patient-reported outcomes (PROs) in patients with psoriatic arthritis (PsA) who initiated their first, second, or third tumor necrosis factor inhibitor (TNFi) in routine practice.

The analysis included pooled data from 13 European registries taking part in the EuroSpA Research Collaboration. Eligible patients were those who had been followed in the study cohort since initiating their first TNFi. PROs were reported using visual analog scale (VAS) scores on a 100-mm scale for pain, global disease activity, and fatigue; physical function was measured with the Health Assessment Questionnaire (HAQ). The authors defined PRO remission rates as the proportion of patients who achieved a state of pain score ≤20 mm, global score 20 mm, fatigue score ≤20 mm, and HAQ score ≤0.5.

Data were evaluated for 25,988 axSpA patients who initiated a first TNFi, of whom 8,294 switched to a second TNFi and 2,842 changed to a third TNFi. For the first TNFi, the median PROs after six months ranged from 20 mm to 30 mm. For the second and third TNFis, median six-month PROs ranged from 27 mm to 40 mm and 35 mm to 50 mm, respectively. Median six-month decreases in PROs ranged from 18 mm to 30 mm for the first TNFi, and 8 mm to 18 mm for both the second and third TNFis. Overall LUNDEX-adjusted PRO remission rates in the six-month group ranged from 33% to 41% in the first TNFi group, 23% to 33% in the second TNFi group, and 17% to 24% in the third TNFi group. When evaluated by individual registries, LUNXDEX-adjusted six-month PRO remission rates for the first TNFi ranged from 32% to 51% for pain; 24% to 50% for global; 28% to 48% for Bath Ankylosing Spondylitis Disease Activity Index; 32% to 51% for Bath Ankylosing Spondylitis Functional Index; and 21% to 47% for fatigue scores.

The results were in line with what the researchers predicted, as they noted in their conclusion.

“In this large observational study cohort, one-third of patients achieved a state of PRO remission after six months of treatment with their first TNFi with significant variation between registries,” they said. “As expected, improvements in PROs and PRO remission rates were lower in those who had switched to the second or third TNFi, reflecting selection of non-responders and more severe cases (confounding by indication).”