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Walsh JA, Lin I, Zhao R, Shiff NJ, Morrison L, Emond B, Yu LH, Schwartzbein S, Lefebvre P, Pilon D, Chakravarty SD, Mease P. Comparison of Real-World On-Label Treatment Persistence in Patients with Psoriatic Arthritis Receiving Guselkumab Versus Subcutaneous Tumor Necrosis Factor Inhibitors. Drugs Real World Outcomes 2024; 11:487-499. [PMID: 39083163 PMCID: PMC11365907 DOI: 10.1007/s40801-024-00428-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2024] [Indexed: 09/02/2024] Open
Abstract
BACKGROUND Treatment persistence among patients with psoriatic arthritis (PsA) is essential for achieving optimal treatment outcomes. Guselkumab, a fully human interleukin-23p19-subunit inhibitor, was approved by the United States (US) Food and Drug Administration for the treatment of active PsA in July 2020, with a dosing regimen of 100 mg at week 0, week 4, then every 8 weeks. In the Phase 3 DISCOVER-1 and DISCOVER-2 studies of patients with active PsA, 94% of guselkumab-randomized patients completed treatment through 1 year and 90% did so through 2 years (DISCOVER-2). Real-world evidence is needed to compare treatment persistence while following US prescribing guidelines (i.e., on-label persistence) for guselkumab versus subcutaneous (SC) tumor necrosis factor inhibitors (TNFis). METHODS Adults with PsA receiving guselkumab or their first SC TNFi (i.e., adalimumab, certolizumab pegol, etanercept, or golimumab) between 14 July 2020 and 31 March 2022 were identified in the IQVIA PharMetrics® Plus database (first claim defined the treatment start date [index date]). Baseline characteristics and biologic use (biologic-naïve/biologic-experienced) were assessed during the 12-month period preceding the index date. Baseline characteristics were balanced between cohorts using propensity-score weighting based on the standardized mortality ratio approach. The follow-up period spanned from the index date until the earlier of the end of continuous insurance eligibility or end of data availability. On-label persistence, defined as the absence of treatment discontinuation (based on a gap of 112 days for guselkumab or 56 days for SC TNFi) or any dose escalation/reduction during follow-up, was assessed in the weighted treatment cohorts using Kaplan-Meier (KM) curves. A Cox proportional hazards model, further adjusted for baseline biologic use, was used to compare on-label persistence between the weighted cohorts. RESULTS The guselkumab cohort included 526 patients (mean age 49.8 years; 61.2% female) and the SC TNFi cohort included 1953 patients (mean age: 48.5 years; 60.2% female). After weighting, baseline characteristics were well balanced with a mean follow-up of 12.3-12.4 months across cohorts; 51.5% of patients in the guselkumab cohort and 16.7% in the SC TNFi cohort received biologics in the 12-month baseline period. Respective rates of treatment persistence at 3, 6, 9, and 12 months were 91.2%, 84.1%, 75.9%, and 71.5% for the guselkumab cohort versus 77.3%, 61.6%, 50.0%, and 43.7% for the SC TNFi cohort (all log-rank p < 0.001). At 12 months, patients in the guselkumab cohort were 3.0 times more likely than patients in the SC TNFi cohort to remain persistent on treatment (p < 0.001). Median time to discontinuation was not reached for the guselkumab cohort and was 8.9 months for the SC TNFi cohort. CONCLUSION This real-world study employing US commercial health-plan claims data to assess on-label treatment persistence in PsA demonstrated that, at 12 months, guselkumab was associated with a 3 times greater likelihood of persistence compared with SC TNFi.
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Affiliation(s)
- Jessica A Walsh
- University of Utah School of Medicine, 50 North Medical Drive, Salt Lake City, UT, 84132, US.
- Salt Lake City Veterans Affairs Health, Salt Lake City, Utah, US.
| | - Iris Lin
- Janssen Scientific Affairs, LLC, a Johnson & Johnson company, Horsham, PA, US
| | - Ruizhi Zhao
- Janssen Scientific Affairs, LLC, a Johnson & Johnson company, Horsham, PA, US
| | - Natalie J Shiff
- Janssen Scientific Affairs, LLC, a Johnson & Johnson company, Horsham, PA, US
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
| | | | | | | | | | | | | | - Soumya D Chakravarty
- Janssen Scientific Affairs, LLC, a Johnson & Johnson company, Horsham, PA, US
- Drexel University College of Medicine, Philadelphia, PA, US
| | - Philip Mease
- University of Washington, Seattle, WA, US
- Swedish Medical Center and Providence St. Joseph Health, Seattle, WA, US
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Fragoulis GE, Papagoras C, Gazi S, Mole E, Krikelis M, Voulgari PV, Kaltsonoudis E, Koletsos N, Katsimpri P, Boumpas D, Katsifis D, Kougkas N, Dimitroulas T, Sfikakis PP, Tektonidou MG, Gialouri C, Bogdanos DP, Simopoulou T, Koutsianas C, Mavrea E, Katsifis G, Kottas K, Konsta M, Tziafalia M, Kataxaki E, Kalavri E, Klavdianou K, Grika EP, Sfontouris C, Daoussis D, Iliopoulos G, Bournazos I, Karokis D, Georganas K, Patrikos D, Vassilopoulos D. Disease Profile and Achievement of Therapeutic Goals in a Modern, Nationwide Cohort of 923 Patients with Psoriatic Arthritis. Mediterr J Rheumatol 2023; 34:418-426. [PMID: 38282940 PMCID: PMC10815515 DOI: 10.31138/mjr.301223.dpa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 12/11/2023] [Indexed: 01/30/2024] Open
Abstract
Background Psoriatic arthritis (PsA) is a heterogenous chronic inflammatory disease affecting skin, joints, entheses, and spine with various extra-musculoskeletal manifestations and comorbidities. The reported patient, disease and treatment characteristics in the modern therapeutic era are limited. Methods In this cross-sectional, multi-centre, nationwide study, we recorded the demographic, clinical, and therapeutic characteristics as well as the comorbidities of patients with PsA seen for 1 year (1/1/2022-31/12/2022). Results 923 patients (55% females) with a median (IQR) age of 57 (48-65) years and a mean disease duration of 9.5 years were enrolled. Family history of psoriasis and PsA was noted in 28.3% and 6.3%, respectively. Most patients had limited psoriasis (BSA<3: 83%) while enthesitis, dactylitis, nail and axial involvement reported in 48.3%, 33.2%, 43% and 25.9% of patients, respectively. Regarding comorbidities, approximately half of patients had dyslipidaemia (42%) or hypertension (45.4%), 36.8% were obese and 17% had diabetes while 22.7% had a depressive disorder. Overall, 60.1% received biologics and among them more patients treated with anti-IL-17 or -12/23 agents were on monotherapy (64.2%) compared to those on TNFi monotherapy (49.4%, p=0.0001). The median PsA activity as assessed by the DAPSA score was 6 (IQR: 2.3 - 13.1) with 46% of patients reaching minimal disease activity status (MDA). Conclusion In this large, real life, modern cohort of patients with PsA with frequent comorbidities who were treated mainly with biologics, almost half achieved minimal disease activity. These results show the value of existing therapeutic approaches while at the same time highlight the existing unmet needs.
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Affiliation(s)
- George E. Fragoulis
- Joint Academic Rheumatology Program, First Department of Propaedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Charalampos Papagoras
- First Department of Internal Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Sousana Gazi
- Department of Rheumatology, KAT Hospital, Athens, Greece
| | - Evangelia Mole
- Department of Rheumatology, KAT Hospital, Athens, Greece
| | | | - Paraskevi V. Voulgari
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Evripidis Kaltsonoudis
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Nikolaos Koletsos
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Pelagia Katsimpri
- Joint Academic Rheumatology Program, 4 Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Dimitrios Boumpas
- Joint Academic Rheumatology Program, 4 Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Dimitrios Katsifis
- Joint Academic Rheumatology Program, 4 Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Nikolaos Kougkas
- 4 Department of Medicine, Aristotle University, Thessaloniki, Greece
| | | | - Petros P. Sfikakis
- Joint Academic Rheumatology Program, First Department of Propaedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria G. Tektonidou
- Joint Academic Rheumatology Program, First Department of Propaedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Chrysoula Gialouri
- Joint Academic Rheumatology Program, First Department of Propaedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios P. Bogdanos
- Department of Rheumatology and Clinical Immunology, University of Thessaly, Larissa, Greece
| | - Theodora Simopoulou
- Department of Rheumatology and Clinical Immunology, University of Thessaly, Larissa, Greece
| | - Christos Koutsianas
- Joint Academic Rheumatology Program, Clinical Immunology, Rheumatology Unit, 2 Department of Medicine and Laboratory, National and Kapodistrian University of Athens Medical School, General Hospital of Athens “Hippokration”, Athens, Greece
| | - Eugenia Mavrea
- Joint Academic Rheumatology Program, Clinical Immunology, Rheumatology Unit, 2 Department of Medicine and Laboratory, National and Kapodistrian University of Athens Medical School, General Hospital of Athens “Hippokration”, Athens, Greece
| | - Gkikas Katsifis
- Rheumatology Clinic, Naval Hospital of Athens, Athens, Greece
| | | | - Maria Konsta
- Rheumatology Unit, Sismanoglio Hospital, Athens, Greece
| | | | - Evangelia Kataxaki
- Rheumatology Department, General Hospital Elefsinas Thriaseio, Athens, Greece
| | - Eleni Kalavri
- Department of Rheumatology, “Asklepieion” General Hospital, Athens, Greece
| | | | - Eleftheria P. Grika
- Department of Rheumatology, Evaggelismos Athens General Hospital, Athens, Greece
| | | | - Dimitrios Daoussis
- Department of Rheumatology, Patras University Hospital, University of Patras Medical School, Patras, Greece
| | - George Iliopoulos
- Department of Rheumatology, Patras University Hospital, University of Patras Medical School, Patras, Greece
| | | | | | | | | | - Dimitrios Vassilopoulos
- Joint Academic Rheumatology Program, Clinical Immunology, Rheumatology Unit, 2 Department of Medicine and Laboratory, National and Kapodistrian University of Athens Medical School, General Hospital of Athens “Hippokration”, Athens, Greece
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