Difficult-To-Treat Psoriatic Arthritis Is Uncommon in a Real-World Registry

Objectives The increasing availability of advanced therapies for psoriatic arthritis (PsA) offers more opportunities for patients to achieve low disease activity or remission. This real-world analysis examines a cohort of PsA patients in Alberta, Canada, to assess the use of biologic/targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) over 2 decades and identifies the proportion of patients with b/tsDMARD-refractory disease. Methods The RAPPORT (Rheumatoid Arthritis Pharmacovigilance Program and Outcomes Research in Therapeutics) cohort, based in Northern Alberta, Canada, includes PsA patients from 2003 to 2024. Participants undergo baseline and follow-up assessments every 3-12 months for disease activity, patient-reported outcomes (eg, Health Assessment Questionnaire), and comorbidities, particularly after initiating b/tsDMARDs following failure of conventional synthetic DMARDs. This analysis included 546 PsA patients with at least 1 year of follow-up. Refractory b/tsDMARD disease was defined as the failure of 3 or more classes of b/tsDMARDs, following the criteria used for treatment-refractory rheumatoid arthritis.[1] Baseline demographic and disease-related characteristics of refractory and non-refractory patients were compared. Results Of the 546 PsA patients, 517 (95%) were non-refractory, while 29 (5%) met the criteria for b/tsDMARD-refractory disease. Sixty percent of the cohort initiated advanced therapies from 2011 onwards, including 72% of refractory patients and 60% of non-refractory patients. The majority were treated with TNF inhibitors, with 85% of non-refractory and 76% of refractory patients using this class of drugs. Apremilast was used by 16 non-refractory and 2 refractory patients, with no other advanced therapies reported. Refractory patients were more likely than non-refractory patients to be female (72% vs 57%), current smokers (21% vs 17%), and had a shorter disease duration (6.8 vs 7.7 years). Time to switch between b/tsDMARDs was shorter in the refractory group (1.37 vs 5.23 years), with more frequent cycling through b/tsDMARDs compared to non-refractory patients (Table 1). Table 1. Characteristics of Non-refractory vs Refractory PsA Patients Conclusion Refractory PsA patients cycled through TNF inhibitors more rapidly than non-refractory patients. Further real-world data are needed to assess the impact of patient and disease characteristics on drug survival and to optimize treatment algorithms with the introduction of newer therapies such as JAK and IL-17 and 23 inhibitors. [1.] Kearsley-Fleet L. Ann Rheum Dis 2018;77(10):1405-12.

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