Abstract：
OBJECTIVE: To assess the potential impact of targeted therapies for psoriatic arthritis (PsA) on symptomatic treatments (non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, opioid analgesics), methotrexate and mood disorder treatments and on hospitalisation and sick leave.
METHODS: Using the French health insurance database, this nationwide cohort study included adults with PsA who were new users (not in the year before the index date) of targeted therapies for ≥9 months during 2015-2021. Main endpoints were difference in proportion of users of associated treatments, hospitalisations and sick leaves between 3 and 9 months after and 6 months before targeted therapy initiation. Logistic regression models adjusted for sex, age, psoriasis, inflammatory bowel disease and Charlson Comorbidity Index compared the impact of biologics initiation (tumour necrosis factor inhibitor (TNFi)/interleukin 17 inhibitor (IL17i)/IL12/23i) on associated treatment discontinuation.
RESULTS: Among 9793 patients initiating targeted therapy for PsA (mean age: 51±13 years, 47% men), 62% initiated TNFi, 14% IL17i, 10% IL12/23i, 1% Janus kinase inhibitor, 12% phosphodiesterase-4 inhibitor. After treatment initiation, the proportion of treatment users was significantly reduced for NSAIDs (-15%), opioid analgesics (-9%), prednisone (-9%), methotrexate (-15%) and mood disorder treatments (-2%), along with decreased hospitalisations (-12%) and sick leaves (-4%). TNFi had a greater sparing effect on NSAIDs and prednisone use than IL17i (ORa=1.04, 95% CI=1.01 to 1.07; 1.04, 1.02 to 1.06) and IL12/23i (1.07, 1.04 to 1.10; 1.06, 1.04 to 1.09). Odds of methotrexate discontinuation was reduced with TNFi versus IL17i (0.96, 0.94 to 0.98) and IL12/23i (0.94, 0.92 to 0.97).
CONCLUSIONS: Targeted therapy initiation for PsA reduced the use of associated treatment and healthcare, with TNFi having a slightly greater effect than IL17i and IL12/23i, except for methotrexate discontinuation.
METHODS: Using the French health insurance database, this nationwide cohort study included adults with PsA who were new users (not in the year before the index date) of targeted therapies for ≥9 months during 2015-2021. Main endpoints were difference in proportion of users of associated treatments, hospitalisations and sick leaves between 3 and 9 months after and 6 months before targeted therapy initiation. Logistic regression models adjusted for sex, age, psoriasis, inflammatory bowel disease and Charlson Comorbidity Index compared the impact of biologics initiation (tumour necrosis factor inhibitor (TNFi)/interleukin 17 inhibitor (IL17i)/IL12/23i) on associated treatment discontinuation.
RESULTS: Among 9793 patients initiating targeted therapy for PsA (mean age: 51±13 years, 47% men), 62% initiated TNFi, 14% IL17i, 10% IL12/23i, 1% Janus kinase inhibitor, 12% phosphodiesterase-4 inhibitor. After treatment initiation, the proportion of treatment users was significantly reduced for NSAIDs (-15%), opioid analgesics (-9%), prednisone (-9%), methotrexate (-15%) and mood disorder treatments (-2%), along with decreased hospitalisations (-12%) and sick leaves (-4%). TNFi had a greater sparing effect on NSAIDs and prednisone use than IL17i (ORa=1.04, 95% CI=1.01 to 1.07; 1.04, 1.02 to 1.06) and IL12/23i (1.07, 1.04 to 1.10; 1.06, 1.04 to 1.09). Odds of methotrexate discontinuation was reduced with TNFi versus IL17i (0.96, 0.94 to 0.98) and IL12/23i (0.94, 0.92 to 0.97).
CONCLUSIONS: Targeted therapy initiation for PsA reduced the use of associated treatment and healthcare, with TNFi having a slightly greater effect than IL17i and IL12/23i, except for methotrexate discontinuation.
摘要：
目的：评估银屑病关节炎（PsA）靶向治疗对症治疗的潜在影响（非甾体抗炎药（NSAIDs），皮质类固醇,阿片类镇痛药），甲氨蝶呤和情绪障碍治疗以及住院和病假。
方法：使用法国健康保险数据库，这项全国性队列研究纳入了2015-2021年期间新使用靶向治疗≥9个月的PsA成人患者(不在指标日期前一年).主要终点是相关治疗使用者比例的差异，在靶向治疗开始后3-9个月和6个月前住院和病假。经性别调整的Logistic回归模型，年龄,牛皮癣,炎症性肠病和Charlson合并症指数比较了开始使用生物制剂(肿瘤坏死因子抑制剂(TNFi)/白介素17抑制剂(IL17i)/IL12/23i)对相关治疗中止的影响.
结果：在开始PsA靶向治疗的9793例患者中（平均年龄：51±13岁，47%的男性），62%的人启动了TNFi，14%IL17i，10%IL12/23i，1%Janus激酶抑制剂，12%磷酸二酯酶-4抑制剂。治疗开始后，NSAIDs的治疗使用者比例显着降低（-15%），阿片类镇痛药（-9%），泼尼松（-9%），甲氨蝶呤（-15％）和情绪障碍治疗（-2％），住院人数减少（-12％）和病假（-4％）。与IL17i(ORa=1.04,95%CI=1.01至1.07;1.04,1.02至1.06)和IL12/23i(1.07,1.04至1.10;1.06,1.04至1.09)相比,TNFi对NSAIDs和泼尼松的使用具有更大的节约作用。与IL17i（0.96，0.94至0.98）和IL12/23i（0.94，0.92至0.97）相比，TNFi降低了甲氨蝶呤停药的几率。
结论：PsA的靶向治疗开始减少了相关治疗和医疗保健的使用，TNFi的影响比IL17i和IL12/23i略大，除了甲氨蝶呤停药.
方法：使用法国健康保险数据库，这项全国性队列研究纳入了2015-2021年期间新使用靶向治疗≥9个月的PsA成人患者(不在指标日期前一年).主要终点是相关治疗使用者比例的差异，在靶向治疗开始后3-9个月和6个月前住院和病假。经性别调整的Logistic回归模型，年龄,牛皮癣,炎症性肠病和Charlson合并症指数比较了开始使用生物制剂(肿瘤坏死因子抑制剂(TNFi)/白介素17抑制剂(IL17i)/IL12/23i)对相关治疗中止的影响.
结果：在开始PsA靶向治疗的9793例患者中（平均年龄：51±13岁，47%的男性），62%的人启动了TNFi，14%IL17i，10%IL12/23i，1%Janus激酶抑制剂，12%磷酸二酯酶-4抑制剂。治疗开始后，NSAIDs的治疗使用者比例显着降低（-15%），阿片类镇痛药（-9%），泼尼松（-9%），甲氨蝶呤（-15％）和情绪障碍治疗（-2％），住院人数减少（-12％）和病假（-4％）。与IL17i(ORa=1.04,95%CI=1.01至1.07;1.04,1.02至1.06)和IL12/23i(1.07,1.04至1.10;1.06,1.04至1.09)相比,TNFi对NSAIDs和泼尼松的使用具有更大的节约作用。与IL17i（0.96，0.94至0.98）和IL12/23i（0.94，0.92至0.97）相比，TNFi降低了甲氨蝶呤停药的几率。
结论：PsA的靶向治疗开始减少了相关治疗和医疗保健的使用，TNFi的影响比IL17i和IL12/23i略大，除了甲氨蝶呤停药.
