Which Is More Effective in Patients with Psoriatic Arthritis: Biologic Combination or Monotherapy?

JANUARY 13, 2016
Andrew Smith
A new patient registry analysis has found no significant differences in outcome between combination therapy and monotherapy in patients with psoriatic arthritis.
Investigators used the Corrona database to pull records on 318 combination therapy patients and 201 monotherapy patients who were biologically naïve at baseline, who had started on a tumor necrosis factor inhibitor (anti-TNF) while in the database and who had a follow-up visit on record more than 90 days after treatment began. The overwhelming majority of combination therapy patients (91%) used methotrexate with an anti-TNF medication. The rest (9%) used some other conventional synthetic disease-modifying anti-rheumatic drug.
The endpoints of the analysis were anti-TNF persistence and time to Clinical Disease Activity Index (CDAI) remission. To control for channeling bias, all analyses used propensity scoring, which was estimated with CDAI and patient sex. Due to limitations in the data, the investigators were only able to evaluate anti-TNF persistence in 497 patients and time to remission in 380 patients.
Combination therapy patients exhibited an insignificantly higher degree of anti-TNF persistence than monotherapy patients (32 months vs. 31 months; p=0.73). They also achieved remission, on average, over an insignificantly shorter period of time (21 months vs. 25 months; p=0.56).
Multiple regression analysis did find some factors that were associated with duration of anti-TNF use. Significant predictors of longer anti-TNF adherence included Hispanic ethnicity and psoriatic arthritis duration. Significant predictors of shorter adherence included a history of methotrexate use.
Still, the failure to find anything approaching significant differences in the duration or outcomes of combination therapy and monotherapy led the investigators behind the new analysis to call for a different kind of study.

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