Risk Factors Associated with Difficult-to-treat (D2T) Psoriatic Arthritis - A One-year Analysis from the APLAR SpA Registry
Background: Despite the widespread advocacy of the treat-to-target(T2T) strategy for managing psoriatic arthritis (PsA), a significant number of patients fail to achieve minimal disease activity (MDA) even with advanced therapies. While a universal definition of difficult-to-treat(D2T) PsA is absent...
Saved in:
| Main Authors: | , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
World Scientific Publishing
2024-01-01
|
| Series: | Journal of Clinical Rheumatology and Immunology |
| Online Access: | https://www.worldscientific.com/doi/10.1142/S2661341724740274 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| Summary: | Background: Despite the widespread advocacy of the treat-to-target(T2T) strategy for managing psoriatic arthritis (PsA), a significant number of patients fail to achieve minimal disease activity (MDA) even with advanced therapies. While a universal definition of difficult-to-treat(D2T) PsA is absent, investigating the heterogeneity of D2T PsA within a real-life T2T-cohort can offer valuable insights into comprehending this concept. Methods: This analysis included the first 111 PsA patients enrolled in the APLAR SpA registry who underwent 1-year T2T management. They were recruited from 6 Asia-Pacific regions. D2T was defined as the failure to achieve MDA despite receiving [Formula: see text]1 conventional synthetic disease-modifying anti-rheumatic drugs(csDMARDs) and [Formula: see text]1 biologic/targeted synthetic DMARDs(b/tsDMARDs) over 6-months. Results: A total of 111 patients (mean age: 48± 13 years, 59 [53%] male, mean disease duration: 5.3± 7.3 years) were included. At baseline, the patients exhibited moderate disease activity, with only 35% achieving MDA. After 1-year, a significant improvement in Disease Activity in Psoriatic Arthritis (DAPSA) was observed (16.3± 14.0 at baseline vs 10.1± 9.7 at 1-year, p<0.001), with 56% of patients achieving MDA. At one-year, 17(15%) patients fulfilled the definition of D2T-PsA. Compared to the non-D2T group, patients in the D2T group had lower education level, longer disease duration, worse disease activity across domains, and higher functional disability at baseline (Table 1). During the 1-year treatment, the T2T adherence rate was significantly lower in the D2T group (71% vs 90%, p=0.028). Reasons for not escalating treatment in the D2T group included patients’ preference (60%), physician’s decision (20%), and no alternative treatment available (20%). Using multivariate logistic regression, a lower education level (OR:4.64, 95%CI:1.16-16.9, p=0.029) and higher Ankylosing Spondylitis Disease Activity Score (ASDAS) (OR: 1.81, 95%CI:1.07-3.04, p=0.026) were significantly associated with D2T after adjusting for baseline disease duration, number of dactylitic digits, MDA status and protocol adherence. Conclusions: Despite the implementation of the T2T-strategy and increased utilization of b/tsDMARDs, more than 40% of patients were unable to achieve MDA. Factors such as higher axial disease activity and lower education level were associated with D2T PsA. Further studies are required to determine whether a more aggressive treatment approach focusing on the axial domain should be implemented for these individuals. |
|---|---|
| ISSN: | 2661-3417 2661-3425 |