Targeted Therapy for PsA Decreases Healthcare Consumption in French Cohort

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Initiating targeted therapy for psoriatic arthritis (PsA) reduced the use of associated symptomatic treatment and healthcare consumption in a cohort of French patients.¹

“The efficacy of these therapies is widely acknowledged, but is often contrasted by their safety profile and cost. Nonetheless, some emerging evidence suggests that they may reduce the consumption of other drugs, particularly symptomatic treatments, which are frequently poorly tolerated... Thus, as part of comprehensive patient management, a decrease or even discontinuation of those treatments can be considered as an objective in itself,” first author Laura Pina Vegas, MD, PhD, Leiden University Medical Center, formerly at Hôpital Henri Mondor, and coauthors wrote.¹

The investigators analyzed data from 9793 patients from the French health insurance database with PsA who were new users (within 1 year) of targeted therapies for at least 9 months during 2015–2021. They adjusted for sex, age, psoriasis, inflammatory bowel disease and Charlson Comorbidity Index and looked at the impact of initiating biologics such as tumor necrosis factor inhibitors (TNFi), interleukin 17 inhibitors (IL17i)/ and IL12/23i on associated treatments, hospitalizations and sick leaves between 3 and 9 months after starting compared with 6 months before initiation.The included patients had a mean age of 51 years (standard deviation [SD], 13) and 47% were men. Most initiated TNFi (62%), followed by IL17i (14%), phosphodiesterase-4 inhibitor (12%), IL12/23i (10%), and Janus kinase inhibitor (1%).¹

Vegas and coauthors found that initiating targeted therapies, the use of non-steroidal anti-inflammatory drugs (NSAIDs; -15%), opioid analgesics (−9%), prednisone (−9%), methotrexate (−15%) and mood disorder treatments (−2%) was decreased. Hospitalizations (−12%) and sick leaves (−4%) also decreased. Patients receiving TNFi were slightly more likely to discontinue NSAID (odds ratio [OR], 1.04 [95% CI, 1.01-1.07]) and prednisone use (OR, 1.04 [95% CI, 1.02-1.06]) than those receiving IL17i. On the other hand, those receiving TNFi were slightly less likely to discontinue methotrexate than those receiving IL17i (OR, 0.96 [95% 0.94-0.98]) or IL12/23i (OR, 0.94 [95% CI, 0.92-0.97]).¹

In another paper, Vegas and coauthors also conducted a similar analysis on associations of serious infection and new use of targeted therapies in 12,071 patients with PsA from the database. These patients had a mean age of 48.7 years (SD, 12.7) and 57.7% were women.²

Altogether, the investigators identified367 serious infections (3.0%), with a crude incidence rate of 17.0 per 1000 person-years (95% CI, 15.2-18.7). After weighting inverse propensity scores and adjusting for time-dependent covariates and calendar year, they found that patients initiating etanercept (weighted hazard ratio [wHR],0.72 [95% CI, 0.53-0.97) or ustekinumab (wHR, 0.57 [95% CI, 0.35-0.93) were at a significantly lower risk of serious infection than those initiating adalimumab. Use of other targeted therapies- certolizumab pegol, golimumab, infliximab, ixekizumab, secukinumab, or tofacitinib - did not statistically modify this risk.²

Patients with concomitant use of systemic corticosteroids (prednisone) had a significantly higher risk of serious infection (wHR, 1.90 [95% CI, 1.47-2.46]). Concomitant use of conventional disease-modifying antirheumatic drugs or NSAIDs did not modify serious infection risk.²

“This study found an overall low risk of serious infection among new users of targeted therapies for moderate to severe PsA...Considering the number of current treatment options for PsA, further studies, especially of other large-scale cohorts in real-world settings, are needed to confirm these results and evaluate the most recent treatments to help physicians optimize their therapeutic choice for each patient,” Vegas and coauthors wrote.²

REFERENCES

1. Vegas LP, Iggui S, Sbidian E, Claudepierre. Impact of initiation of targeted therapy on the use of psoriatic arthritis-related treatments and healthcare consumption: a cohort study of 9793 patients from the French health insurance database (SNDS). RMD Open 2024;10(3):e004631. doi: 10.1136/rmdopen-2024-004631
2. Bastard L, Claudepierre P, Penso L, Sbidian E, Vegas LP. Risk of serious infection associated with different classes of targeted therapies used in psoriatic arthritis: a nationwide cohort study from the French Health Insurance Database (SNDS). RMD Open 2024;10(1):e003865. doi: 10.1136/rmdopen-2023-003865