Biologic therapy survival in patients with psoriatic arthritis
K.A. Lytkina1, G.V. Lukina2, E.N. Koltsova3, E.I. Shmidt4, E.V. Zhilyaev5
1City Clinical Hospital No.4, Moscow
2V.A. Nasonova Scientific Research Institute of Rheumatology, Moscow
3Scientific Research Institute of Health Organization and Medical Management, Moscow
4N.I. Pirogov City Clinical Hospital No.1, Moscow
5Russian Medical Academy of Continuing Professional Education, Moscow
Aim: to study the retention duration of patients with psoriatic arthritis (PA) prescribed with genetically engineered biologic drugs (GIBD) and to search for possible predictors of therapy survival.
Patients and Methods: patients with PA, included in the Moscow Unified Register of Arthritis (MURA), receiving GIBD. Non-adjusted retention analysis of GIBD therapy was carried out by estimating the average treatment time until discontinuation for any reason using the Kaplan-Meier method. The search for independent risk predictors of therapy discontinuation was carried out by the direct step-wise selection of variables in the framework of a multivariate stratified Cox proportional regression model. An adjusted comparison of the GIBD cancellation risk was made in a multivariate stratified Cox proportional regression model with identified predictors inclusion as confounders. Since some drugs are used for the PA treatment only for the last 2–3 years, and mainly when the effectiveness of other drugs is insufficient, amendments have also been made to the model for the year of treatment initiation and to the serial number of the drug in targeted therapy.
Results: 236 episodes of GIBD treatment were analyzed in 141 patients (43.4% of men, 56.7% of women; average age 50.1±11.4 years). The analyzed GIBD were adalimumab (50), golimumab (11), infliximab (51), etanercept (71), certolizumab pegol (7), ustekinumab (55). In the initial analysis of the GIBD survival with PA (non-adjusted analysis), the best therapy retention was obtained for etanercept, adalimumab and ifliximab, while the indicators for ustekinumab, golimumab and certolizumab pegol were slightly worse. In the context of multivariate analysis (multivariate stratified Cox proportional regression model), independent significant predictors of GIBD cancellation (confounders) were identified — manifestation level, pain in the calcaneal region, swelling of the shoulder joints in the disease onset, PA clinical form, neck pain. In the analysis, adjusted for the identified confounders, no significant differences between the drugs (risk of their cancellation) were found.
Conclusion: factors associated with the risk of GIBD cancellation in patients with PA were identified in real clinical practice.
Keywords: psoriatic arthritis, registers, therapy survival, GIBD, cancellation predictors.
For citation: Lytkina K.A., Lukina G.V., Koltsova E.N. et al. Biologic therapy survival in patients with psoriatic arthritis. RMJ. Medical Review. 2019;11(II):86–89.
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