Haberman Rebecca H, Chen Kyra, Howe Catherine, Um Seungha, Felipe Adamary, Fu Brianna, Eichman Stephanie, Coyle Margaret, Lydon Eileen, Neimann Andrea L, Reddy Soumya M, Adhikari Samrachana, Scher Jose U
Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA.
Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.
Arthritis Res Ther. 2025 Mar 4;27(1):46. doi: 10.1186/s13075-025-03518-7.
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.
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.
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).
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.
尽管银屑病关节炎（PsA）在治疗方面取得了显著进展，但许多患者仍无法实现缓解，需反复更换多种生物制剂（b）或靶向合成改善病情抗风湿药（ts）。目前仍不清楚导致反复治疗失败的根本原因。在此，我们描述了纽约大学银屑病关节炎中心PsA患者使用多种b/tsDMARDs治疗失败后的用药模式和特征。
960例PsA患者纳入一项观察性纵向登记研究。收集患者的人口统计学资料、病史、用药情况和银屑病疾病表型。多种b/tsDMARDs治疗失败定义为需要使用≥4种b/tsDMARDs。
725例患者（75%）在病程中使用过≥1种b/tsDMARDs。最初开具的b/tsDMARDs主要是抗TNF药物。166例（17%）患者出现多种b/tsDMARDs治疗失败。与仅需使用1种b/tsDMARDs的患者相比，在校正年龄、病程、性别、抑郁、吸烟、肥胖和皮肤严重程度后，女性（比值比[OR]2.3；95%置信区间[CI]1.4 - 3.8）、轴向性疾病（OR 2.1；95%CI 1.2 - 3.6）、抑郁（OR 2.0；95%CI 1.1 - 3.7）和肥胖（OR 1.7；95%CI 1.0 - 2.8）是多种b/tsDMARDs治疗失败的危险因素。多种b/tsDMARDs治疗失败的PsA患者在临床就诊时疾病活动度也更高（即肿胀关节计数，p = 0.005）。
在该队列中，17%的PsA患者出现多种b/tsDMARDs治疗失败。这些患者更可能为女性、肥胖，轴向受累和抑郁发生率更高，且疾病活动度更高。这凸显了导致多次治疗失败的炎症和非炎症驱动因素，强调了针对PsA患者采用精准医学策略及潜在非药物辅助治疗以改善治疗效果和生活质量的必要性。
