title: Comparative effectiveness of biologic monotherapy versus combination therapy for patients with psoriatic arthritis: results from the Corrona registry.
abstract: OBJECTIVE
  To characterise the comparative effectiveness of combination therapy (a tumour necrosis factor inhibitor (TNFi) and a conventional synthetic disease-modifying antirheumatic drug (csDMARD) such as methotrexate) and monotherapy (TNFi only) for psoriatic arthritis (PsA) from a large US registry.
  
  
  METHODS
  The analysis included adult patients with PsA who were enrolled in the Corrona database (ClinicalTrials.gov, NCT01402661), had initiated a TNFi, were biologic naïve, and had a follow-up visit ≥90 days after drug initiation. The endpoints of the analysis were TNFi persistence (drug survival) and time to Clinical Disease Activity Index (CDAI) remission. All analyses were performed using propensity scoring, which were estimated using CDAI and patient sex, to control for channelling bias.
  
  
  RESULTS
  Of 519 patients meeting the inclusion criteria (318 with combination therapy and 201 with monotherapy), the analysis population was 497 for TNFi persistence and 380 for time to remission. The difference between combination therapy (TNFi+methotrexate, 91% of patients; TNFi+other csDMARD, 9%) and monotherapy was not statistically significant for TNFi persistence (32 and 31 months, p=0.73) and time to remission (21 and 25 months, p=0.56). Predictors of TNFi persistence included Hispanic ethnicity (longer persistence), PsA duration (longer persistence), history of methotrexate use (shorter persistence), body mass index (shorter persistence) and disease activity (shorter persistence).
  
  
  CONCLUSIONS
  Patients with PsA from a large US registry experienced similar TNFi persistence on combination therapy and monotherapy. Prospective, randomised clinical trials evaluating the efficacy of combination therapy versus monotherapy would provide much-needed clarity on treatment options for patients with PsA.
  
  
  BACKGROUND
  NCT01402661.
authors.affiliation: Department of Rheumatology , Swedish Medical Center and University of Washington , Seattle, Washington , USA.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Mease
authors.affiliation: Inflammation Global Development , Amgen Inc. , Thousand Oaks, California , USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Collier
authors.affiliation: Epidemiology and Outcomes Research, Corrona, LLC , Southborough, Massachusetts , USA.
authors.forename: Katherine C
authors.initials: KC
authors.lastname: Saunders
authors.affiliation: Department of Biostatistics , Axio Research LLC , Seattle, Washington , USA.
authors.forename: Guo
authors.initials: G
authors.lastname: Li
authors.affiliation: Center for Rheumatology, Albany Medical College and the Center for Rheumatology , Albany, New York , USA.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Kremer
authors.affiliation: Epidemiology and Outcomes Research, Corrona, LLC, Southborough, Massachusetts, USA; Division of Rheumatology, New York University School of Medicine, New York, New York, USA.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Greenberg
keywords: Anti-TNF; DMARDs (biologic); Psoriatic Arthritis
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