Predictors of Biologic Drug Survival Time in Patients with Psoriatic Arthritis in a Community-Based Practice
Bibliographic record
Abstract
Objectives First, to compare the duration of drug survival of biologic drugs used in the treatment of psoriatic arthritis in a community-based practice. Second, to assess the influence of sex, smoking status, HLA-B27 status, and concomitant disease-modifying anti-rheumatic drug (DMARD) use on biologic drug survival. Methods This single-center, retrospective chart review identified patients diagnosed with psoriatic arthritis who were treated with 1 or more biologics prior to June 2024. Follow-up continued to June 30, 2024 or until treatment was stopped. Drug survival time was recorded, alongside patient sex, smoking status, HLA-B27 status, and concomitant DMARD use. Median biologic drug survival was assessed using the Kruskal-Wallis test, with posthoc Dunn’s multiple comparisons. A Cox multivariate regression model evaluated the effects of age, sex, smoking status, concomitant DMARD use, and HLA-B27 status on biologic survival. Results We identified 302 patients diagnosed with psoriatic arthritis who had received 1 or more biologics. The median age was 61 years, with 48% being female. Overall, drug survival data exhibited a right-skewed distribution. Median (IQR) drug survival times (in months) for adalimumab, golimumab, etanercept, ustekinumab, certolizumab, secukinumab, infliximab, upadacitinib, and ixekizumab were 22 (8-77.5), 28 (8.25-79.75), 35 (10-97), 24.5 (8.75-69.25), 27 (4.5-75), 16 (7-42), 30.5 (11-50.25), 8 (5-14), and 17 (9-35), respectively. In first-line use, the median (IQR) survival time for adalimumab, golimumab, etanercept, and infliximab were 30 (10.5-81), 79.5 (34-110), 67 (25-126), and 38.5 (16-60.75) months, respectively. Etanercept demonstrated significantly longer survival time compared to adalimumab (p = 0.0162) and infliximab (p = 0.0267). Loss of efficacy was the reason for discontinuation in 70.97% of etanercept cases, 60.27% of adalimumab cases, and 63.64% of infliximab cases. Smoking history and female sex were associated with higher rates of biologic discontinuation, with HRs of 1.268 (95% CI, 1.033-1.556) and 1.281 (95% CI, 1.050-1.566), respectively. Concomitant DMARD use and HLA-B27 positivity did not significantly impact biologic survival, with HRs of 1.004 (95% CI, 0.821-1.230) and 0.738 (95% CI, 0.497-1.066), respectively. Conclusion Etanercept demonstrated a longer median drug survival time as a first-line treatment compared to adalimumab and infliximab. Smoking history and female sex were associated with an increased risk of biologic discontinuation. Concomitant DMARD use and HLA-B27 status did not significantly influence biologic survival. These results underscore the importance of individual patient factors in the management of psoriatic arthritis.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".