How well are biologic and conventional DMARDs tolerated in psoriatic arthritis: A real world study

Abstract

Objective: Even though disease-modifying antirheumatic drugs (DMARDs) are well established in routine clinical practice, longitudinal real-world data for their retention and tolerability are sparse, especially in psoriatic arthritis (PsA) patients. Our objective was to describe the characteristics of our large PsA cohort including the comorbidities and evaluate real-world DMARD tolerability and discontinuation rates with reasons for stopping treatment.

Methods: We retrospectively interrogated the electronic, multipurpose, live setting database at our university hospital to identify 335 patients diagnosed with PsA who had received conventional DMARDs (cDMARDs) and/or biologic DMARDs (bDMARDs) between 1994 up to and including April 2019.

Results: In total, 170 (50.7%) patients had discontinued one or more cDMARDs prior with a mean duration before discontinuation of 9.9 months. In contrast, only 28 (24.8%) patients had stopped a course of bDMARDs at some point. The mean duration before biologic therapy was discontinued was 18.2 months.

Conclusion: To our knowledge, this is the first dedicated retrospective review of a large real-world PsA cohort addressing drug survival and tolerability of DMARDs over a 20-year period. Our study shows that in reality, cDMARDs are not well tolerated. This should encourage review of international guidance allowing earlier employment of biologics in the treatment paradigm.

Keywords: Drug tolerance, psoriatic arthritis, biologic therapy, DMARD Main Points

Longitudinal real-world data for retention and tolerability of DMARDs are sparse, especially in the psoriatic arthritis patient population. cDMARDs are not well tolerated compared to bDMARDs in our large PsA patient cohort. International guidelines that continue to recommend methotrexate and other cDMARDs as the initial choice of therapy for PsA should be revisited.