Tuesday, 22 Oct 2019

You are here

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

Add new comment

More Like This

Comorbidity Worsens Axial Spondyloarthritis

Comorbidities are common in patients with axial spondyloarthropathy (axSpA), and a recent study has shown that multimorbidity, the coexistence of 2 or more conditions, is associated with more severe disease than those without comorbidities.

One-Third of Psoriatic Arthritis Patients Will Need Joint Surgery

Dannish study has shown that one-third of psoriatic arthritis (PsA) will have joint surgery that that PsA patients have twice the rate of joint surgery when compared with the general population.

The Danish National Patient Registry was used in this cohort study of incident PsA patients and their future risk of joint surgery compared to a general population cohort (GPC) between 1995-2012).

FUTURE 5 - Secukinumab and Less Radiographic Progression in Psoriatic Arthritis

The FUTURE 5 trial studied the effect of secukinumab (SEC) on radiographic progression through 52 weeks in patients with active psoriatic arthritis (PsA) and found that SEC was clinically and radiographically superior to placebo (PBO). Patients received s.c. secukinumab 300 mg load (300 mg), 150 mg load (150 mg), 150 mg no load regimens or placebo at baseline, at weeks 1, 2 and 3 and every 4 weeks starting at week 4. The majority (87%) of patients enrolled at baseline remained in the study for 52 weeks.

Ixekizumab vs. Adalimumab in Psoriatic Arthritis

The Annals of Rheumatic Disease reports a psoriatic arthritis study where in ixekizumab was non-inferior to adalimumab for achievement of ACR50 responses but was superior to adalimumab for achievement of PASI100 by week 24.

NSAID Use Linked With Hypertension in Ankylosing Spondylitis

Continuous use of nonsteroidal anti-inflammatory drugs (NSAIDs) among patients with ankylosing spondylitis (AS) was associated with the development of incident hypertension, a prospective cohort study found.