title: Longterm Clinical Outcomes in 420 Patients with Psoriatic Arthritis Taking Anti-tumor Necrosis Factor Drugs in Real-world Settings.
abstract: An observational study to evaluate the longterm clinical outcomes of adalimumab (ADA), etanercept (ETN), and infliximab (IFX) in patients with psoriatic arthritis (PsA), in real-world settings.
  
  
  
  From a prospective cohort we studied 420 biologic-naive patients with PsA who had peripheral arthritis and were beginning a treatment with ADA, ETN, or IFX. Drug survival was evaluated by Kaplan-Meier life analysis, and baseline predictors of drug discontinuation were assessed by Cox regression analysis. The frequency of concomitant glucocorticoids and the daily mean dosage were compared by chi-square test and ANOVA repeated measures across 4 years.
  
  
  
  After 4 years the overall survival of the first anti-tumor necrosis factor-α (anti-TNF) was 51.0%, but significantly higher for ETN (58.9%) than ADA (43.9%) or IFX (44.0%; p = 0.003). Patients taking ETN also had the lowest HR of drug discontinuation (HR 0.57, 95% CI 0.34-0.93, p = 0.02). The strongest predictor of drug interruption was female sex (HR 2.02, 95% CI 1.28-3.20, p = 0.002). The disease duration was inversely correlated with drug discontinuation (HR 0.96, 95% CI 0.93-0.99, p = 0.02). The average daily dose of prednisone significantly decreased from baseline: 5.6 ± 2.5 to 4.7 ± 1.9 at 1 year (p = 0.01) to 4.0 ± 1.8 at 4 years (p = 0.001). Additionally, compared to baseline (49.6%), a significant reduction of patients taking glucocorticoids was detected at 2 years (36.5%, p < 0.05), 3 years (29.9%, p < 0.01), and 4 years (22.6%, p < 0.01).
  
  
  
  In real-world settings, TNF inhibitors showed a high rate of drug survival at 4 years. Further, the need for glucocorticoids for controlling active PsA was lowered with time.
authors.affiliation: From the Rheumatology Unit, Medical School, University of Bari, Bari; the Rheumatology Unit, Ospedali Riuniti di Foggia, Foggia; and the Department of Rheumatology, Policlinico Le Scotte, University of Siena, Siena, Italy.F. Iannone, MD, PhD, Associate Professor of Rheumatology, Rheumatology Unit, Medical School, University of Bari; S. Lopriore, MD, Research Assistant of Rheumatology, Rheumatology Unit, Medical School, University of Bari; R. Bucci, MD, Consultant of Rheumatology, Rheumatology Unit, Ospedali Riuniti di Foggia; G. Lopalco, MD, Consultant of Rheumatology, Rheumatology Unit, Medical School, University of Bari; A. Chialà, MD, Consultant of Rheumatology, Rheumatology Unit, Medical School, University of Bari; L. Cantarini, MD, Senior Lecturer of Rheumatology, Policlinico Le Scotte, University of Siena; G. Lapadula, MD, Rheumatology Unit, Medical School, University of Bari. florenzo.iannone@uniba.it.
authors.forename: Florenzo
authors.initials: F
authors.lastname: Iannone
authors.affiliation: From the Rheumatology Unit, Medical School, University of Bari, Bari; the Rheumatology Unit, Ospedali Riuniti di Foggia, Foggia; and the Department of Rheumatology, Policlinico Le Scotte, University of Siena, Siena, Italy.F. Iannone, MD, PhD, Associate Professor of Rheumatology, Rheumatology Unit, Medical School, University of Bari; S. Lopriore, MD, Research Assistant of Rheumatology, Rheumatology Unit, Medical School, University of Bari; R. Bucci, MD, Consultant of Rheumatology, Rheumatology Unit, Ospedali Riuniti di Foggia; G. Lopalco, MD, Consultant of Rheumatology, Rheumatology Unit, Medical School, University of Bari; A. Chialà, MD, Consultant of Rheumatology, Rheumatology Unit, Medical School, University of Bari; L. Cantarini, MD, Senior Lecturer of Rheumatology, Policlinico Le Scotte, University of Siena; G. Lapadula, MD, Rheumatology Unit, Medical School, University of Bari.
authors.forename: Simona
authors.initials: S
authors.lastname: Lopriore
authors.affiliation: From the Rheumatology Unit, Medical School, University of Bari, Bari; the Rheumatology Unit, Ospedali Riuniti di Foggia, Foggia; and the Department of Rheumatology, Policlinico Le Scotte, University of Siena, Siena, Italy.F. Iannone, MD, PhD, Associate Professor of Rheumatology, Rheumatology Unit, Medical School, University of Bari; S. Lopriore, MD, Research Assistant of Rheumatology, Rheumatology Unit, Medical School, University of Bari; R. Bucci, MD, Consultant of Rheumatology, Rheumatology Unit, Ospedali Riuniti di Foggia; G. Lopalco, MD, Consultant of Rheumatology, Rheumatology Unit, Medical School, University of Bari; A. Chialà, MD, Consultant of Rheumatology, Rheumatology Unit, Medical School, University of Bari; L. Cantarini, MD, Senior Lecturer of Rheumatology, Policlinico Le Scotte, University of Siena; G. Lapadula, MD, Rheumatology Unit, Medical School, University of Bari.
authors.forename: Romano
authors.initials: R
authors.lastname: Bucci
authors.affiliation: From the Rheumatology Unit, Medical School, University of Bari, Bari; the Rheumatology Unit, Ospedali Riuniti di Foggia, Foggia; and the Department of Rheumatology, Policlinico Le Scotte, University of Siena, Siena, Italy.F. Iannone, MD, PhD, Associate Professor of Rheumatology, Rheumatology Unit, Medical School, University of Bari; S. Lopriore, MD, Research Assistant of Rheumatology, Rheumatology Unit, Medical School, University of Bari; R. Bucci, MD, Consultant of Rheumatology, Rheumatology Unit, Ospedali Riuniti di Foggia; G. Lopalco, MD, Consultant of Rheumatology, Rheumatology Unit, Medical School, University of Bari; A. Chialà, MD, Consultant of Rheumatology, Rheumatology Unit, Medical School, University of Bari; L. Cantarini, MD, Senior Lecturer of Rheumatology, Policlinico Le Scotte, University of Siena; G. Lapadula, MD, Rheumatology Unit, Medical School, University of Bari.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lopalco
authors.affiliation: From the Rheumatology Unit, Medical School, University of Bari, Bari; the Rheumatology Unit, Ospedali Riuniti di Foggia, Foggia; and the Department of Rheumatology, Policlinico Le Scotte, University of Siena, Siena, Italy.F. Iannone, MD, PhD, Associate Professor of Rheumatology, Rheumatology Unit, Medical School, University of Bari; S. Lopriore, MD, Research Assistant of Rheumatology, Rheumatology Unit, Medical School, University of Bari; R. Bucci, MD, Consultant of Rheumatology, Rheumatology Unit, Ospedali Riuniti di Foggia; G. Lopalco, MD, Consultant of Rheumatology, Rheumatology Unit, Medical School, University of Bari; A. Chialà, MD, Consultant of Rheumatology, Rheumatology Unit, Medical School, University of Bari; L. Cantarini, MD, Senior Lecturer of Rheumatology, Policlinico Le Scotte, University of Siena; G. Lapadula, MD, Rheumatology Unit, Medical School, University of Bari.
authors.forename: Angela
authors.initials: A
authors.lastname: Chialà
authors.affiliation: From the Rheumatology Unit, Medical School, University of Bari, Bari; the Rheumatology Unit, Ospedali Riuniti di Foggia, Foggia; and the Department of Rheumatology, Policlinico Le Scotte, University of Siena, Siena, Italy.F. Iannone, MD, PhD, Associate Professor of Rheumatology, Rheumatology Unit, Medical School, University of Bari; S. Lopriore, MD, Research Assistant of Rheumatology, Rheumatology Unit, Medical School, University of Bari; R. Bucci, MD, Consultant of Rheumatology, Rheumatology Unit, Ospedali Riuniti di Foggia; G. Lopalco, MD, Consultant of Rheumatology, Rheumatology Unit, Medical School, University of Bari; A. Chialà, MD, Consultant of Rheumatology, Rheumatology Unit, Medical School, University of Bari; L. Cantarini, MD, Senior Lecturer of Rheumatology, Policlinico Le Scotte, University of Siena; G. Lapadula, MD, Rheumatology Unit, Medical School, University of Bari.
authors.forename: Luca
authors.initials: L
authors.lastname: Cantarini
authors.affiliation: From the Rheumatology Unit, Medical School, University of Bari, Bari; the Rheumatology Unit, Ospedali Riuniti di Foggia, Foggia; and the Department of Rheumatology, Policlinico Le Scotte, University of Siena, Siena, Italy.F. Iannone, MD, PhD, Associate Professor of Rheumatology, Rheumatology Unit, Medical School, University of Bari; S. Lopriore, MD, Research Assistant of Rheumatology, Rheumatology Unit, Medical School, University of Bari; R. Bucci, MD, Consultant of Rheumatology, Rheumatology Unit, Ospedali Riuniti di Foggia; G. Lopalco, MD, Consultant of Rheumatology, Rheumatology Unit, Medical School, University of Bari; A. Chialà, MD, Consultant of Rheumatology, Rheumatology Unit, Medical School, University of Bari; L. Cantarini, MD, Senior Lecturer of Rheumatology, Policlinico Le Scotte, University of Siena; G. Lapadula, MD, Rheumatology Unit, Medical School, University of Bari.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Lapadula
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D000068800:Etanercept / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D000069285:Infliximab / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010352:Patient Dropouts; D011446:Prospective Studies; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents; D005938:Glucocorticoids; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept
keywords: ADALIMUMAB; DISEASE ACTIVITY; ETANERCEPT; INFLIXIMAB; PSORIATIC ARTHRITIS