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Comorbidities Undermine Clinical Outcomes in Psoriatic Arthritis

Analysis of data from the DANBIO registry of psoriatic arthritis (PsA) patients treated with tumor necrosis factor inhibitor (TNFi) therapy shows that comorbidities were associated with higher baseline disease activity, shorter TNFi persistence, and reduced clinical response rates to TNFi.

Investigators studied 1,750 PsA patients and assessed comorbidities using the Charlson Comorbidity Index (CCI). Patients with higher CCI scores were generally older and female, had a longer PsA disease duration, and had a higher BMI compared with patients without comorbidities. Those with higher CCI scores were more likely to have PsA‐related diseases (psoriasis, inflammatory bowel disease, uveitis, and urethritis). A CCI of 2 or higher was seen in 191 patients (9.6%).

Higher levels of comorbidity (higher CCI scores) were associated with: 

  • higher disease activity measures at baseline
  • increased occurrence of depression and/or anxiety
  • shorter TNFi persistence with CCI score ≥2 

These findings are novel and support the importance of monitoring and treating comorbidities in patients with PsA.

Comorbidities are common, but are not commonly dealt with in rheumatology daily practice. The impact of comorbidity has been seen in other recent studies.

Strober and colleagues have also recently reported that PsA patients with metabolic syndrome-related co-morbidities have lower TNFi persistence. (Citation source: http://bit.ly/2Fz9zi7). Switching to a second TNFi was effective in some, but these too had lower TNFi persistence, suggesting the validity of switching to a second TNFi.

Lastly, it is well known that obesity and decreased therapeutic responses are linked. Holgard et al studied 2 different registries and demonstrated that TNFI adherence was shorter in obese patients, especially among men who were obese (P < 0.01 vs non-obese). In multivariable analyses, obesity increased the risk of TNFI withdrawal [hazard ratio 1.6 (95% CI 1.3, 2.0)] and reduced odds for EULAR good or moderate responses [odds ratio 0.47 (95% CI 0.29, 0.72)]. Obesity was associated with higher disease activity and seemed to diminish response and adherence to TNFIs in PsA.

 

Disclosures: 
The author has received compensation as an advisor or consultant on this subject

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