Psoriatic arthritis treated by anti-TNFs: a monocentric trial of 102 cases in Auvergne, France.
OBJECTIVE
While several registries have already evaluated the retention of anti-TNF therapy in psoriatic arthritis (PsA), they sometimes reach divergent conclusions. Our study therefore sought to assess therapeutic retention rates and predictive factors of response in a patient cohort from Auvergne, France, followed up in routine clinical practice.


METHODS
Medical records of all PsA patients treated from 2002 to May 2015 were analysed. PsA diagnosis was established based on the CASPAR criteria.


RESULTS
In total, 102 patients were analysed, comprising 62 men (44.6±12.6 years) and 40 women (37.8±13.4). Mean PsA evolution was 2.7 years (0.8-11.2). The most common forms were peripheral (47/102, 45.1%) and mixed (46/102, 46.1%) PsA. The anti-TNF treatment initiated was etanercept in 47 cases (45.2%), adalimumab in 29 (27.9%), infliximab in 20 (19.2%), and golimumab in six [5.8%]. In 28 cases (27.4%), anti-TNF was associated with methotrexate (MTX). Overall, the median duration of anti-TNF retention was 76.5 months. The hazard ratios (HR) for treatment cessation did not significantly differ between the etanercept and monoclonal antibody groups (HR=1.35[0.96-1.93], p=0.08). After 5 years, approximately 30.8% of etanercept patients and 68.8% of monoclonal antibody patients (adalimumab 71.2%; infliximab 67.2%) were still being treated. Combining with MTX did not prolong the overall retention rate (HR=0.85[0.37-1.96], p=0.71). Tobacco use was predictive of discontinuation (p=0.03).


CONCLUSIONS
Our study demonstrates good anti-TNF treatment retention in PsA patients, as well as confirming the deleterious effect of smoking while providing no argument in favour of combined treatment with MTX to improve maintenance.
Department of Rheumatology, CHU Hôpital Gabriel Montpied, Clermont-Ferrand, France. msoubrier@chu-clermontferrand.fr.
Martin
M
Soubrier
Biostatistics and Research Department (DRCI), CHU Hôpital Gabriel Montpied, Clermont-Ferrand, France.
Bruno
B
Pereira
Department of Rheumatology, CHU Hôpital Gabriel Montpied, Clermont-Ferrand, France.
Thomas
T
Frayssac
Department of Rheumatology, CHU Hôpital Gabriel Montpied, Clermont-Ferrand, France.
Dihya
D
Abdi
Department of Rheumatology, CHU Hôpital Gabriel Montpied, Clermont-Ferrand, France.
Marion
M
Couderc
Department of Rheumatology, CHU Hôpital Gabriel Montpied, Clermont-Ferrand, France.
Coline
C
Daron
Department of Rheumatology, CHU Hôpital Gabriel Montpied, Clermont-Ferrand, France.
Sandrine
S
Malochet-Guinamand
Department of Rheumatology, CHU Hôpital Gabriel Montpied, Clermont-Ferrand, France.
Sylvain
S
Mathieu
Department of Rheumatology, CHU Hôpital Gabriel Montpied, Clermont-Ferrand, France.
Zuzana
Z
Tatar
Department of Rheumatology, CHU Hôpital Gabriel Montpied, Clermont-Ferrand, France.
Anne
A
Tournadre
Department of Rheumatology, CHU Hôpital Gabriel Montpied, Clermont-Ferrand, France.
Jean-Jacques
JJ
Dubost
D000068879:Adalimumab / Q000627:therapeutic use*; D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D000068800:Etanercept / Q000627:therapeutic use*; D005260:Female; D005602:France; D006801:Humans; D000069285:Infliximab / Q000627:therapeutic use*; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; C529000:golimumab; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept; D008727:Methotrexate