Long-term persistence of second-line biologics in psoriatic arthritis patients with prior TNF inhibitor exposure: a nationwide cohort study from the French health insurance database (SNDS)
Introduction Tumour necrosis factor inhibitor (TNFi) agents are most often the first-choice biological treatment for patients with psoriatic arthritis (PsA). When their discontinuation is needed, a switch to another TNFi or to another therapeutic class may be considered. However, data supporting one...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2022-11-01
|
| Series: | RMD Open |
| Online Access: | https://rmdopen.bmj.com/content/8/2/e002681.full |
| _version_ | 1797777479590477824 |
|---|---|
| author | Pascal Claudepierre Léa Bastard Lea Hoisnard Laura Pina Vegas Emilie Sbidian |
| author_facet | Pascal Claudepierre Léa Bastard Lea Hoisnard Laura Pina Vegas Emilie Sbidian |
| author_sort | Pascal Claudepierre |
| collection | DOAJ |
| description | Introduction Tumour necrosis factor inhibitor (TNFi) agents are most often the first-choice biological treatment for patients with psoriatic arthritis (PsA). When their discontinuation is needed, a switch to another TNFi or to another therapeutic class may be considered. However, data supporting one approach over another are lacking.Objective To compare the long-term persistence of classes of biologics in PsA patients with prior TNFi exposure.Methods This nationwide cohort study involved the administrative healthcare database of the French health insurance scheme linked to the hospital discharge database. We included all adults with PsA starting a second-line biological after discontinuing a TNFi during 2015–2020. Persistence was defined as the time from biological initiation to discontinuation and was estimated by the Kaplan-Meier method. Comparison of persistence by biological class was performed with Poisson regression models with time divided into 6-month intervals.Results We included 2975 patients: 1580 (53%) initiating a second TNFi, 426 (14%) an interleukin 12/23 inhibitor (IL-12/23i) and 969 (33%) an IL-17 inhibitor (IL-17i). Overall, 1-year and 3-year persistence rates were 42% and 17%, respectively. After adjustment, persistence was associated with treatment with an IL-17i (adjusted relative risk (RRa) 0.79, 95% CI 0.71 to 0.87) or IL-12/23i (RRa 0.69, 95% CI 0.61 to 0.79) vs a TNFi, with no significant difference between IL-12/23 and IL-17 inhibitors (RRa 0.88, 95% CI 0.76 to 1.02).Conclusions Overall, this real-life study shows low persistence for all biologics at 3 years in PsA patients previously exposed to a TNFi. However, persistence was higher with an IL-17i or IL-12/23i than a TNFi. |
| first_indexed | 2024-03-12T23:04:33Z |
| format | Article |
| id | doaj.art-41fc3a56585b4511a4df1e396eb522ab |
| institution | Directory Open Access Journal |
| issn | 2056-5933 |
| language | English |
| last_indexed | 2024-03-12T23:04:33Z |
| publishDate | 2022-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | RMD Open |
| spelling | doaj.art-41fc3a56585b4511a4df1e396eb522ab2023-07-19T03:30:07ZengBMJ Publishing GroupRMD Open2056-59332022-11-018210.1136/rmdopen-2022-002681Long-term persistence of second-line biologics in psoriatic arthritis patients with prior TNF inhibitor exposure: a nationwide cohort study from the French health insurance database (SNDS)Pascal Claudepierre0Léa Bastard1Lea Hoisnard2Laura Pina Vegas3Emilie Sbidian4Rhumatologie, Hôpital Henri Mondor, Creteil cedex, FranceEpiDermE, Université Paris-Est Créteil Val de Marne, Créteil, France1 Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique - Hôpitaux de Paris (AP-HP), Henri Mondor Hospital, Créteil, Île-de-France, FranceEpiDermE, Université Paris-Est Créteil Val de Marne, Créteil, France1 Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique - Hôpitaux de Paris (AP-HP), Henri Mondor Hospital, Créteil, Île-de-France, FranceIntroduction Tumour necrosis factor inhibitor (TNFi) agents are most often the first-choice biological treatment for patients with psoriatic arthritis (PsA). When their discontinuation is needed, a switch to another TNFi or to another therapeutic class may be considered. However, data supporting one approach over another are lacking.Objective To compare the long-term persistence of classes of biologics in PsA patients with prior TNFi exposure.Methods This nationwide cohort study involved the administrative healthcare database of the French health insurance scheme linked to the hospital discharge database. We included all adults with PsA starting a second-line biological after discontinuing a TNFi during 2015–2020. Persistence was defined as the time from biological initiation to discontinuation and was estimated by the Kaplan-Meier method. Comparison of persistence by biological class was performed with Poisson regression models with time divided into 6-month intervals.Results We included 2975 patients: 1580 (53%) initiating a second TNFi, 426 (14%) an interleukin 12/23 inhibitor (IL-12/23i) and 969 (33%) an IL-17 inhibitor (IL-17i). Overall, 1-year and 3-year persistence rates were 42% and 17%, respectively. After adjustment, persistence was associated with treatment with an IL-17i (adjusted relative risk (RRa) 0.79, 95% CI 0.71 to 0.87) or IL-12/23i (RRa 0.69, 95% CI 0.61 to 0.79) vs a TNFi, with no significant difference between IL-12/23 and IL-17 inhibitors (RRa 0.88, 95% CI 0.76 to 1.02).Conclusions Overall, this real-life study shows low persistence for all biologics at 3 years in PsA patients previously exposed to a TNFi. However, persistence was higher with an IL-17i or IL-12/23i than a TNFi.https://rmdopen.bmj.com/content/8/2/e002681.full |
| spellingShingle | Pascal Claudepierre Léa Bastard Lea Hoisnard Laura Pina Vegas Emilie Sbidian Long-term persistence of second-line biologics in psoriatic arthritis patients with prior TNF inhibitor exposure: a nationwide cohort study from the French health insurance database (SNDS) RMD Open |
| title | Long-term persistence of second-line biologics in psoriatic arthritis patients with prior TNF inhibitor exposure: a nationwide cohort study from the French health insurance database (SNDS) |
| title_full | Long-term persistence of second-line biologics in psoriatic arthritis patients with prior TNF inhibitor exposure: a nationwide cohort study from the French health insurance database (SNDS) |
| title_fullStr | Long-term persistence of second-line biologics in psoriatic arthritis patients with prior TNF inhibitor exposure: a nationwide cohort study from the French health insurance database (SNDS) |
| title_full_unstemmed | Long-term persistence of second-line biologics in psoriatic arthritis patients with prior TNF inhibitor exposure: a nationwide cohort study from the French health insurance database (SNDS) |
| title_short | Long-term persistence of second-line biologics in psoriatic arthritis patients with prior TNF inhibitor exposure: a nationwide cohort study from the French health insurance database (SNDS) |
| title_sort | long term persistence of second line biologics in psoriatic arthritis patients with prior tnf inhibitor exposure a nationwide cohort study from the french health insurance database snds |
| url | https://rmdopen.bmj.com/content/8/2/e002681.full |
| work_keys_str_mv | AT pascalclaudepierre longtermpersistenceofsecondlinebiologicsinpsoriaticarthritispatientswithpriortnfinhibitorexposureanationwidecohortstudyfromthefrenchhealthinsurancedatabasesnds AT leabastard longtermpersistenceofsecondlinebiologicsinpsoriaticarthritispatientswithpriortnfinhibitorexposureanationwidecohortstudyfromthefrenchhealthinsurancedatabasesnds AT leahoisnard longtermpersistenceofsecondlinebiologicsinpsoriaticarthritispatientswithpriortnfinhibitorexposureanationwidecohortstudyfromthefrenchhealthinsurancedatabasesnds AT laurapinavegas longtermpersistenceofsecondlinebiologicsinpsoriaticarthritispatientswithpriortnfinhibitorexposureanationwidecohortstudyfromthefrenchhealthinsurancedatabasesnds AT emiliesbidian longtermpersistenceofsecondlinebiologicsinpsoriaticarthritispatientswithpriortnfinhibitorexposureanationwidecohortstudyfromthefrenchhealthinsurancedatabasesnds |