Dual targeted therapy in patients with psoriatic arthritis and spondyloarthritis: a real-world multicenter experience from Spain

Dual targeted therapy (DTT) has emerged as a promising approach in patients with refractory spondyloarthritis (SpA) or psoriatic arthritis (PsA) and extra-musculoskeletal manifestations of both diseases, but its effectiveness/safety ratio still remains unclear. This is a retrospective, real-world multicenter study in refractory SpA and PsA patients with simultaneous use of two biological or synthetic targeted agents. Effectiveness was assessed using Ankylosing Spondylitis Disease Activity Score with C-reactive protein (ASDAS-CRP) and Disease Activity in Psoriatic Arthritis (DAPSA) Score. We identified 39 different DTT combinations in 36 patients (22 SpA; 14 PsA), 25 of them with concomitant inflammatory bowel disease. The most commonly used combinations were TNF inhibitor plus antagonist of the IL12/23 pathway, followed by TNF inhibitor plus IL-17 antagonist. During a median exposure of 14.86 months (IQR 8-20.2), DTT retention rate was 69.4% (n=25/36; 19 SpA, 6 PsA). Major clinical improvement (change in ASDAS-CRP > 2 or improvement > 85% in DAPSA) was achieved in 69.4% of patients (n=25/36 therapeutical combinations; 17/21 SpA, 8/15 PsA), with a 58.3% (n=21/36 combinations; 15/20 SpA, 6/13 PsA) low-activity/remission rate. Of the patients who were receiving glucocorticoids, 55% managed to withdraw them during follow-up. Interestingly, only four serious adverse events in three patients were observed, leading to DTT discontinuation

Gender-specific differences in patients with psoriatic arthritis receiving ustekinumab or tumour necrosis factor inhibitor: real-world data

Objective: Investigate effects of gender on disease characteristics and treatment impact in patients with psoriatic arthritis (PsA). Methods: PsABio is a non-interventional European study in patients with PsA starting a biological disease-modifying anti-rheumatic drug (bDMARD; ustekinumab or tumour necrosis factor inhibitor [TNFi]). This post-hoc analysis compared persistence, disease activity, patient-reported outcomes and safety between male and female patients at baseline and 6 and 12 months of treatment. Results: At baseline, disease duration was 6.7 and 6.9 years for 512 females and 417 males respectively. Mean (95% CI) scores for females versus males were: clinical Disease Activity Index for Psoriatic Arthritis (cDAPSA), 32.3 (30.3;34.2) versus 26.8 (24.8;28.9); Health Assessment Questionnaire-Disability Index (HAQ-DI), 1.3 (1.2;1.4) versus 0.93 (0.86;0.99); total Psoriatic Arthritis Impact of Disease-12 (PsAID-12) score, 6.0 (5.8;6.2) versus 5.1 (4.9;5.3), respectively. Improvements in scores were smaller in female than male patients. At 12 months, 175/303 (57.8%) female and 212/264 (80.3%) male patients achieved cDAPSA low disease activity, 96/285 (33.7%) and 137/247 (55.5%), achieved minimal disease activity (MDA), respectively. HAQ-DI scores were 0.85 (0.77;0.92) versus 0.50 (0.43;0.56), PsAID-12 scores 3.5 (3.3;3.8) versus 2.4 (2.2;2.6), respectively. Treatment persistence was lower in females than males (p = <0.001). Lack of effectiveness was the predominant reason to stop, irrespective of gender and bDMARD. Conclusions: Before starting bDMARDs, females had more severe disease than males and a lower percentage reached favourable disease states, with lower persistence of treatment after 12 months. A better understanding of the mechanisms underlying these differences may improve therapeutic management in females with PsA. Trial registration: ClinicalTrials.gov, https://clinicaltrials.gov, NCT02627768