Department of Medicine II, Rheumatology/Clinical Immunology, University Hospital of Wuerzburg, Würzburg, Germany.
Independent Researcher, Greven, Germany.
Front Immunol. 2024 May 23;15:1395968. doi: 10.3389/fimmu.2024.1395968. eCollection 2024.
Treatment options with disease-modifying antirheumatic drugs (DMARDs) for psoriatic arthritis (PsA) have evolved over recent years. In addition to Janus kinase inhibitors (JAKi), four classes of biologic DMARDs (bDMARDs; interleukin [IL]-23 inhibitors [IL-23i], IL-12/23 inhibitors [IL-12/23i], tumor necrosis factor inhibitors [TNFi], and IL-17 inhibitors [IL-17i]) are currently approved for moderate to severe PsA treatment. There is minimal evidence of the persistence of these drugs among PsA outpatients in a real-world scenario during the period following the approval of JAKi. Therefore, we aimed to analyze the drug survival rates of biologic and JAKi therapies among German PsA outpatients during routine clinical care.
We retrospectively analyzed PsA patients with a new prescription for a biologic or JAKi in the RHADAR database between January 2015 and October 2023. Kaplan-Meier Curves and Cox regression modelling were used to compare drug survival rates.
1352 new prescriptions with bDMARDs (IL-12/23i [n=50], IL-23i [n=31], TNFi [n=774], IL-17i [n=360]) or JAKi (n=137) were identified. The 5-year drug survival rate was 67.8% for IL-17i, 62.3% for TNFi, 53.3% for JAKi, and 46.0% for IL-12/23i. Discontinuation probabilities for JAKi and IL-12/23i were significantly higher compared with TNFi (JAKi hazard ratio [HR] 1.66, [95% CI 1.23-2.24], p=0.001; IL-12/23i HR 1.54, [95% CI 1.02-2.33], p=0.042) and IL-17i (JAKi HR 1.77, [95% CI 1.27-2.47], p=0.001; IL-12/23i HR 1.64, [95% CI 1.06-2.55], p=0.027). JAKi-treated patients had more severe disease and more osteoarthritis (OA) compared to TNFi and more OA compared to IL-17i.
German PsA outpatients might persist longer with TNFi and IL-17i compared with IL-12/23i or JAKi. For TNFi, differences in subgroup characteristics and comorbidities (OA) may have affected drug survival rates. For IL-17i, the longer drug survival might not only be related to less OA compared to JAKi and, therefore, might be affected by other factors.
近年来，治疗银屑病关节炎（PsA）的疾病修饰抗风湿药物（DMARDs）选择有所发展。除了 Janus 激酶抑制剂（JAKi）外，目前有四类生物 DMARDs（bDMARDs；白细胞介素[IL]-23 抑制剂[IL-23i]、IL-12/23 抑制剂[IL-12/23i]、肿瘤坏死因子抑制剂[TNFi]和 IL-17 抑制剂[IL-17i]）被批准用于中度至重度 PsA 的治疗。在 JAKi 获得批准后的真实世界场景中，PsA 门诊患者中这些药物的持续存在证据很少。因此，我们旨在分析德国 PsA 门诊患者在常规临床护理中接受生物制剂和 JAKi 治疗的药物生存率。
我们回顾性分析了 2015 年 1 月至 2023 年 10 月期间 RHADAR 数据库中接受新处方生物制剂或 JAKi 的 PsA 患者。使用 Kaplan-Meier 曲线和 Cox 回归模型比较药物生存率。
共确定了 1352 例新处方 bDMARDs（IL-12/23i [n=50]、IL-23i [n=31]、TNFi [n=774]、IL-17i [n=360]）或 JAKi（n=137）。IL-17i 的 5 年药物生存率为 67.8%，TNFi 为 62.3%，JAKi 为 53.3%，IL-12/23i 为 46.0%。与 TNFi（JAKi 风险比[HR]1.66，[95%CI 1.23-2.24]，p=0.001；IL-12/23i HR 1.54，[95%CI 1.02-2.33]，p=0.042）和 IL-17i（JAKi HR 1.77，[95%CI 1.27-2.47]，p=0.001；IL-12/23i HR 1.64，[95%CI 1.06-2.55]，p=0.027）相比，JAKi 和 IL-12/23i 的停药概率显著更高。与 TNFi 相比，JAKi 治疗的患者疾病更严重，骨关节炎（OA）更多，与 IL-17i 相比，OA 更多。
与 IL-12/23i 或 JAKi 相比，德国 PsA 门诊患者可能会更长时间地使用 TNFi 和 IL-17i。对于 TNFi，亚组特征和合并症（OA）的差异可能影响了药物生存率。对于 IL-17i，较长的药物生存率不仅可能与 JAKi 相比 OA 较少有关，而且可能还与其他因素有关。
