近年来,治疗银屑病关节炎(PsA)的疾病缓解性抗风湿药(DMARDs)的治疗方案不断发展。除了Janus激酶抑制剂(JAKI),四类生物DMARDs(bDMARDs;白细胞介素[IL]-23抑制剂[IL-23i],IL-12/23抑制剂[IL-12/23i],肿瘤坏死因子抑制剂[TNFi],和IL-17抑制剂[IL-17i])目前被批准用于中度至重度PsA治疗。在JAKI批准后的这段时间内,在现实世界的情况下,这些药物在PsA门诊患者中的持久性存在的证据很少。因此,我们旨在分析德国PsA门诊患者在常规临床护理期间接受生物疗法和JAKi疗法的药物存活率.
■我们回顾性分析了2015年1月至2023年10月期间RHADAR数据库中使用生物制剂或JAKI新处方的PsA患者。使用Kaplan-Meier曲线和Cox回归模型比较药物生存率。
■1352种带有bDMARDs的新处方(IL-12/23i[n=50],IL-23i[n=31],TNFi[n=774],鉴定了IL-17i[n=360])或JAKi(n=137)。IL-17i的5年生存率为67.8%,TNFi为62.3%,JAKI占53.3%,IL-12/23i为46.0%。与TNFi相比,JAKI和IL-12/23i的停药概率明显更高(JAKI风险比[HR]1.66,[95%CI1.23-2.24],p=0.001;IL-12/23iHR1.54,[95%CI1.02-2.33],p=0.042)和IL-17i(JAkiHR1.77,[95%CI1.27-2.47],p=0.001;IL-12/23iHR1.64,[95%CI1.06-2.55],p=0.027)。与TNFi相比,JAKI治疗的患者患有更严重的疾病和更多的骨关节炎(OA),与IL-17i相比,OA更多。
■与IL-12/23i或JAKi相比,德国PsA门诊患者使用TNFi和IL-17i的持续时间可能更长。对于TNFi,亚组特征和合并症(OA)的差异可能影响药物生存率.对于IL-17i,与JAKI相比,更长的药物生存期可能不仅与更少的OA有关,而且,因此,可能会受到其他因素的影响。
UNASSIGNED: Treatment options with disease-modifying antirheumatic drugs (DMARDs) for psoriatic arthritis (PsA) have evolved over recent years. In addition to Janus kinase inhibitors (JAKi), four classes of biologic DMARDs (bDMARDs; interleukin [IL]-23 inhibitors [IL-23i], IL-12/23 inhibitors [IL-12/23i], tumor necrosis factor inhibitors [TNFi], and IL-17 inhibitors [IL-17i]) are currently approved for moderate to severe PsA treatment. There is minimal evidence of the persistence of these drugs among PsA outpatients in a real-world scenario during the period following the approval of JAKi. Therefore, we aimed to analyze the drug survival rates of biologic and JAKi therapies among German PsA outpatients during routine clinical care.
UNASSIGNED: We retrospectively analyzed PsA patients with a new prescription for a biologic or JAKi in the RHADAR database between January 2015 and October 2023. Kaplan-Meier Curves and Cox regression modelling were used to compare drug survival rates.
UNASSIGNED: 1352 new prescriptions with bDMARDs (IL-12/23i [n=50], IL-23i [n=31], TNFi [n=774], IL-17i [n=360]) or JAKi (n=137) were identified. The 5-year drug survival rate was 67.8% for IL-17i, 62.3% for TNFi, 53.3% for JAKi, and 46.0% for IL-12/23i. Discontinuation probabilities for JAKi and IL-12/23i were significantly higher compared with TNFi (JAKi hazard ratio [HR] 1.66, [95% CI 1.23-2.24], p=0.001; IL-12/23i HR 1.54, [95% CI 1.02-2.33], p=0.042) and IL-17i (JAKi HR 1.77, [95% CI 1.27-2.47], p=0.001; IL-12/23i HR 1.64, [95% CI 1.06-2.55], p=0.027). JAKi-treated patients had more severe disease and more osteoarthritis (OA) compared to TNFi and more OA compared to IL-17i.
UNASSIGNED: German PsA outpatients might persist longer with TNFi and IL-17i compared with IL-12/23i or JAKi. For TNFi, differences in subgroup characteristics and comorbidities (OA) may have affected drug survival rates. For IL-17i, the longer drug survival might not only be related to less OA compared to JAKi and, therefore, might be affected by other factors.