Biologic disease-modifying antirheumatic drugs in psoriatic arthritis: a real-world cohort of 439 patients

Background: For more than 15 years, severe psoriatic arthritis (PsA) has been treated only by TNF inhibitors. Two new Biologic Disease-modifying Antirheumatic Drugs (bDMARDs) have recently arrived on the market with different targets: IL12–23 for ustekinumab and IL 17 for secukinumab. Few studies exist with a large number of patients and with required hindsight. Objectives: The objective was to assess drug survival in an observational cohort of 630 PsA depending on the line of treatment and to analyse the reasons of discontinuation. Methods: This is a retrospective, multicentric observational study based on the data of the registry RIC Nord de France, from patients suffering from PsA (CASPAR criteria) and treated by bDMARDs from january 2000 to august 2017. Drug survival is defined as the time from initiation to discontinuation (stop/switch) of biologic therapy on the registry. The number of patients who discontinued each treatment and the duration of therapy were recorded. Using Kaplan-Meier survival curves and Cox-regression analyses [hazard ratios (HR) and 95% confidence intervals (CIs)], time to discontinuation was compared across cohorts undergoing first-, second- or third-line treatment. Abstract THU0310 – Figure 1 Drug survival of biotherapies at first-line treatment Results: Out of 630 PsA, 439 were included with a mean follow up greater than or equal to 6 months. The sex ratio was balanced with 47% of women. The mean age was 54.5 years old and the body mass index (BMI) was 28.7 kg/m². The disease duration was 14.25 years. 51.6% of patients did not smoke. The DAS-28 CRP was 3.99 at the initiation of the biotherapy. The drug survival of the TNF inhibitors was similar at first-line treatment (n=439 patients) (figure 1) and at second-line treatment (n=238 patients). The drug survival of infliximab was statistically longer at third-line treatment (n=209) (p<0.0001), as the drug survival of TNF inhibitors compared to non TNF inhibitor biotherapies (ustekinumab and secukinumab) (p0.011). There was no impact of the age, the sex or the BMI on the drug survival. The discontinuation was mainly due to primary and secondary failure at first-line (respectively 33.33% and 33.71%) and to adverse events at second- and third-line (respectively 30.22% and 44.55%). Conclusions: The results of the large observational study confirm those of the clinical trials, especially for the patients with failing initial TNF inhibitor therapy. Disclosure of Interest: None declared DOI: 10.1136/annrheumdis-2018-eular.4980 Citation: Ann Rheum Dis, volume 77, supplement Suppl, year 2018, page A373Session: Psoriatic arthritis