title: Effectiveness and drug survival of TNF-inhibitors in the treatment of psoriatic arthritis: A prospective cohort study.
abstract: Tumor necrosis factor (TNF)-inhibitors are used to treat psoriatic arthritis (PsA), but only a limited number of observational studies on this subject have been published thus far. The aim of this research was to analyze the effectiveness and drug survival of TNF-inhibitors in the treatment of PsA.
  
  
  
  PsA patients identified from the National Register for Biologic Treatment in Finland (ROB-FIN) starting their first, second, or third TNF-inhibitor treatment between 2004 and 2014 were included. Effectiveness was measured using ACR and EULAR response criteria and modeled using ordinal logistic regression. Treatment persistence was analyzed using Kaplan-Meier survival analysis and Cox proportional hazards model.
  
  
  
  The study comprised 765 patients and 990 TNF-inhibitor treatment courses. EULAR moderate treatment responses at 6 months were achieved by 68% and 37% of the users of the first and the second or the third biologic, respectively. The probabilities of discontinuing the treatment within 12 and 24 months were 20% and 28%, respectively. Adjusted treatment responses to all TNF-inhibitors were similar; however, co-therapy with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) was not associated with better effectiveness. Adalimumab [hazard ratio (HR) = 0.62; 95% confidence interval (CI): 0.44-0.88] was superior to infliximab in drug survival while etanercept (HR = 0.77, 95% CI: 0.55-1.1) and golimumab (HR = 0.75, 95% CI: 0.46-1.2) did not differ from it. Co-medication with csDMARDs did not statistically improve drug survival.
  
  
  
  All available TNF-inhibitors showed similar treatment responses with or without csDMARDs. Adalimumab was associated with better drug survival when compared to infliximab.
authors.affiliation: Department of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, P.O. Box 56, 00014 Helsinki, Finland. Electronic address: kalle.jm.aaltonen@helsinki.fi.
authors.forename: Kalle
authors.initials: K
authors.lastname: Aaltonen
authors.affiliation: Department of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, P.O. Box 56, 00014 Helsinki, Finland.
authors.forename: Arto
authors.initials: A
authors.lastname: Heinonen
authors.affiliation: Department of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, P.O. Box 56, 00014 Helsinki, Finland.
authors.forename: Jaana
authors.initials: J
authors.lastname: Joensuu
authors.affiliation: Department of Internal Medicine, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Pinja
authors.initials: P
authors.lastname: Parmanne
authors.affiliation: Department of Medicine, Oulu University Hospital, Oulu, Finland; Institute of Clinical Medicine, Faculty of Medicine, University of Oulu, Oulu, Finland.
authors.forename: Anna
authors.initials: A
authors.lastname: Karjalainen
authors.affiliation: Department of Medicine, Tampere City Hospital, Tampere, Finland.
authors.forename: Tuire
authors.initials: T
authors.lastname: Varjolahti-Lehtinen
authors.affiliation: Department of Medicine, Lapland Central Hospital, Rovaniemi, Finland.
authors.forename: Toini
authors.initials: T
authors.lastname: Uutela
authors.affiliation: Department of Medicine, Turku University Hospital, Turku, Finland.
authors.forename: Maija
authors.initials: M
authors.lastname: Puurtinen-Vilkki
authors.affiliation: Department of Medicine, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Leena
authors.initials: L
authors.lastname: Arstila
authors.affiliation: Department of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, P.O. Box 56, 00014 Helsinki, Finland.
authors.forename: Marja
authors.initials: M
authors.lastname: Blom
authors.affiliation: Department of Medicine, Jyväskylä Central Hospital, Jyväskylä, Finland; School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
authors.forename: Tuulikki
authors.initials: T
authors.lastname: Sokka
authors.affiliation: Department of Internal Medicine, Helsinki University Central Hospital, Helsinki, Finland; Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
authors.forename: Dan
authors.initials: D
authors.lastname: Nordström
mesh_terms: 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*; D000068800:Etanercept / Q000627:therapeutic use*; D005260:Female; D005387:Finland; D006801:Humans; D000069285:Infliximab / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; C529000:golimumab; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept
keywords: Cohort study; Drug survival; Methotrexate; Psoriatic arthritis; TNF-inhibitor; Treatment response