TNFi plus csDMARD does not improve disease activity, HAQ in psoriatic arthritis

Tumour necrosis factor inhibitor (TNFi) in combination with conventional synthetic disease-modifying antirheumatic drugs (csDMARD) does not appear to be any better than TNFi monotherapy at improving disease activity or Health Assessment Questionnaire (HAQ) in patients with psoriatic arthritis (PsA), reports a study. However, the combination therapy may improve TNFi survival.

The authors examined five PsA biologic cohorts between 2000 and 2015: the ATTRA registry (Czech Republic), the Swiss Clinical Quality Management PsA registry, the Hellenic Registry of Biologics Therapies (Greece), the University of Bari PsA biologics database (Italy), and the Bath PsA cohort (UK).

Kaplan-Meier and log-rank tests were used to analyse drug persistence and equality of survival, respectively. Logistic regression with propensity scores were used to assess comparative effectiveness.

Furthermore, the authors conducted separate analyses on the combined Italian/Swiss cohorts for change in rate of Disease Activity Score in 28 joints (DAS28) and the combined Italian, Swiss, and Bath cohorts for change in rate of HAQ.

Overall, 2,294 patients were included in the drug survival analysis. Patients initiating TNFi in combination with methotrexate had longer drug survival than those on monotherapy in the Swiss (p=0.002), Greek (p=0.021), and Bath (p=0.014) databases. On the other hand, the monotherapy group persisted longer in Italy (p=0.030).

In 1,056 patients from the combined Italian/Swiss dataset, no significant between-group difference was seen in the rate of change of DAS28. When including the Bath cohort (n=1,205), no significant difference was also observed in the rate of change of HAQ.