Woodie Brad R, Balachandar Sarayu, Fleischer Alan B
College of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
J Psoriasis Psoriatic Arthritis. 2025 May 10:24755303251342501. doi: 10.1177/24755303251342501.
Traditional oral small molecule disease-modifying antirheumatic drugs (OSMs) have historically been the cornerstone of psoriatic arthritis (PsA) management. However, biologics have gained prominence due to their superior efficacy in patients with an inadequate response to OSMs.
To analyze trends in the use of OSMs, biologics, and combination therapy for PsA management from 1993 to 2019.
We utilized the National Ambulatory Medical Care Survey to examine PsA treatment patterns. Medications were classified as OSMs, biologics, or combination therapy (both an OSM and a biologic). Weighted Rao-Scott χ tests and one-way ANOVA assessed differences in treatment patterns over time and by patient demographics.
Among an estimated 3.7 million visits for PsA (112 unweighted visits) where systemic therapy was prescribed, biologic use significantly increased ( = .006) over time, OSM use declined ( < .001), and combination therapy initially increased but later decreased ( < .001). There were no significant differences in treatment patterns by age, sex, race, ethnicity, or insurance status (all > .2).
Biologics have increasingly replaced traditional OSMs as the primary treatment for PsA. The decline in combination therapy after 2013 likely reflects the improved efficacy of newer biologics, reducing the need for adjunctive OSM use. Limitations include the lack of disease severity data and the absence of visits for newer therapies, such as Janus kinase inhibitors.
传统口服小分子抗风湿药物（OSM）一直是银屑病关节炎（PsA）治疗的基石。然而，生物制剂因其在对OSM反应不佳的患者中具有卓越疗效而日益受到重视。
分析1993年至2019年期间用于PsA治疗的OSM、生物制剂及联合治疗的使用趋势。
我们利用国家门诊医疗调查来研究PsA的治疗模式。药物被分类为OSM、生物制剂或联合治疗（一种OSM和一种生物制剂）。加权Rao-Scott χ检验和单因素方差分析评估了治疗模式随时间以及患者人口统计学特征的差异。
在估计370万次PsA就诊（112次未加权就诊）中，当开具全身治疗药物时，生物制剂的使用随时间显著增加（P = 0.006），OSM的使用下降（P < 0.001），联合治疗最初增加但后来下降（P < 0.001）。在年龄、性别、种族、民族或保险状况方面，治疗模式没有显著差异（所有P > 0.2）。
生物制剂已越来越多地取代传统OSM成为PsA的主要治疗方法。2013年后联合治疗的下降可能反映了新型生物制剂疗效的提高，减少了辅助使用OSM的需求。局限性包括缺乏疾病严重程度数据以及未纳入新型疗法（如Janus激酶抑制剂）的就诊情况。
