Cycling versus swapping strategies in psoriatic arthritis: results from the rheumatic diseases Portuguese register
Authors
Francisca Guimarães; Maria Ferreira; Catarina Soares; Hugo Parente; Carolina Ochôa Matos; Roberto Costa; Daniela Oliveira; Catarina Abreu; Rafaela Teixeira; Sofia Azevedo; João Madruga Dias; Filipe Araújo; Carla Campinho Ferreira; Filipe Cunha Santos; Tomás Fontes; Margarida Faria; Lígia Silva; Ana Chícharo; Patrícia Nero; Helena Santos; Alexandre Sepriano; Daniela Santos-Faria; José Tavares-Costa;
Keywords
Objective: To compare the 2-year retention rate between a second tumor necrosis factor alpha inhibitor (TNFi) and secukinumab (SEK) or ustekinumab (UST), in Psoriatic Arthritis (PsA) patients with previous inadequate response to their first TNFi. Methods: Prospective longitudinal cohort study with a follow-up period of 2 years using the Nationwide Portuguese Reuma.pt database. Patients with a clinical diagnosis of PsA who also fulfill the CASPAR classification criteria, with previous treatment failure to a first-line TNFi and having started a second biotechnological drug (TNFi, SEK or UST) were included. The Cycling group was defined as switching from a first TNFi to a second TNFi, and the Swapping group as switching from a first TNFi to SEK or UST. Sociodemographic data, disease characteristics, disease activity scores and physical function at baseline and after 6, 12 and 24 months were recorded. Cox-proportional hazards regression was used to compare retention rates between Cycling and Swapping groups. To obtain a predictor model of 2-year discontinuation, a multivariable Cox regression model was performed. Results: In total, 439 patients were included, 58% were female, with a mean age (standard deviation) of 49 (12) years. Globally, 75.6% initiated a second TNFi (Cycling group), and 24.4% started SEK/UST (Swapping group). The retention rates after 6, 12 and 24 months were 72%/66%/59% in the Cycling group; and 77%/66%/59% in the Swapping group. There were no significant differences in retention rates between both strategies (HR: 1.06, 95% CI 0.72-1.16). After 2 years of follow-up, 34.4% of patients discontinued their second biologic, mainly due to inefficacy (72.8%), with no differences found between groups. Baseline treatment with glucocorticoids was the only predictor of discontinuation after 2 years of follow-up (HR:1.668, 95% CI 1.154-2.409). Conclusions: After failure of a first TNF inhibitor, Cycling and Swapping strategies result in similar retention rates suggesting that both are acceptable in the management of patients with psoriatic arthritis.
Francisca Guimarães
Unidade Local de Saúde do Alto Minho
Maria Ferreira
Unidade Local de Saúde do Alto Minho
Catarina Soares
Unidade Local de Saúde do Alto Minho
Hugo Parente
Unidade Local de Saúde do Alto Minho
Carolina Ochôa Matos
Centro Hospitalar Universitário Lisboa Norte
Roberto Costa
Centro Hospitalar Universitário Lisboa Norte
Daniela Oliveira
Centro Hospitalar Universitário São João
Catarina Abreu
Hospital Garcia de Orta
Rafaela Teixeira
Centro Hospitalar Tondela-Viseu
Sofia Azevedo
Centro Hospitalar do Baixo Vouga
João Madruga Dias
Centro Hospitalar Médio Tejo
Filipe Araújo
Hospital Ortopédico de Sant’Ana
Carla Campinho Ferreira
Hospital de Braga
Filipe Cunha Santos
Unidade Local de Saúde da Guarda
Tomás Fontes
Hospital do Divino Espírito Santo
Margarida Faria
Hospital Central do Funchal
Lígia Silva
Centro Hospitalar Trás-os-Montes e Alto Douro
Ana Chícharo
Centro Hospitalar Lisboa Ocidental
Patrícia Nero
Hospital CUF Descobertas
Helena Santos
Instituto Português de Reumatologia
Alexandre Sepriano
Centro Hospitalar Lisboa Ocidental
Daniela Santos-Faria
Unidade Local de Saúde do Alto Minho
José Tavares-Costa
Unidade Local de Saúde do Alto Minho
Unidade Local de Saúde do Alto Minho
Maria Ferreira
Unidade Local de Saúde do Alto Minho
Catarina Soares
Unidade Local de Saúde do Alto Minho
Hugo Parente
Unidade Local de Saúde do Alto Minho
Carolina Ochôa Matos
Centro Hospitalar Universitário Lisboa Norte
Roberto Costa
Centro Hospitalar Universitário Lisboa Norte
Daniela Oliveira
Centro Hospitalar Universitário São João
Catarina Abreu
Hospital Garcia de Orta
Rafaela Teixeira
Centro Hospitalar Tondela-Viseu
Sofia Azevedo
Centro Hospitalar do Baixo Vouga
João Madruga Dias
Centro Hospitalar Médio Tejo
Filipe Araújo
Hospital Ortopédico de Sant’Ana
Carla Campinho Ferreira
Hospital de Braga
Filipe Cunha Santos
Unidade Local de Saúde da Guarda
Tomás Fontes
Hospital do Divino Espírito Santo
Margarida Faria
Hospital Central do Funchal
Lígia Silva
Centro Hospitalar Trás-os-Montes e Alto Douro
Ana Chícharo
Centro Hospitalar Lisboa Ocidental
Patrícia Nero
Hospital CUF Descobertas
Helena Santos
Instituto Português de Reumatologia
Alexandre Sepriano
Centro Hospitalar Lisboa Ocidental
Daniela Santos-Faria
Unidade Local de Saúde do Alto Minho
José Tavares-Costa
Unidade Local de Saúde do Alto Minho