Drug Survival Differences in RA, PsA, SpA and PsO Save

Drug survival may be the best measure of efficacy and safety. A new study of novel therapy durability (survival) in patients with rheumatoid arthritis (RA), axial spondyloarthritis (AxSpA), psoriatic arthritis (PsA), and psoriasis (PsO) shows that while all these drugs are approved for said conditions, drug survival varies by condition, suggesting an ongoing need for individualized treatment.

Data from the Danish national registries DANBIO and DERMBIO, was analyzed for the use of biologics (bDMARDs) or novel small-molecule therapies (tsDMARDS) among patients with RA, AxSpA, PsA, and psoriasis between January 2015 through May 2021 (DANBIO) and November 2009 to November 2019 (DERMBIO). Drug survival was displayed as Kaplan-Meier curves.

The included 12,089 patients, including 5,104 RA patients, 2,157 AxSpA patients, 2,551 PsA patients, and 2,577 psoriasis patients.  Drug survival differed for each condition, with confounder-adjusted models showing (in order of best to least survival): 

• RA - highest with rituximab:  followed by baricitinib, etanercept and tocilizumab 
• AxSpA - highest for golimumab; followed by secukinumab and etanercept and lowest for infliximab.
• PsA -  tofacitinib and infliximab had the lowest drug survival. All other drugs performed equally well with a trend for drug survival with golimumab, followed by secukinumab and ixekizumab.
• PsO - highest for guselkumab

The authors point out, "Novel JAK inhibitors such as baricitinib had very high persistence in RA, whereas the JAK inhibitor tofacitinib had very low persistence in PsA. In AxSpA, golimumab and secukinumab had highest persistence, whereas the novel IL-23 inhibitor guselkumab appeared to have very high performance in psoriasis".

While all of these are inflammatory conditions with some mechanistic similarities, the differential responses seen with agents of distinctly different modes of action shows that one can not generalize the treatment approach for these 4 different clinical entities -across RA, AxSpA, PsA and psoriasis.