Real‐world persistence of initial targeted therapy strategy in monotherapy versus combination therapy in patients with chronic inflammatory arthritis

• Published in: European journal of clinical investigation Vol. 54; no. 2; pp. e14095 - n/a
• Main Authors: Exposito, Lorena, Sánchez‐Piedra, Carlos, Vela‐Casasempere, Paloma, Moreno‐Ramos, Manuel José, Campos, Cristina, Bohorquez, Cristina, Manero, Javier, Calvo‐Gutiérrez, Jerusalem, Rodríguez‐Lozano, Carlos, Ruiz‐Montesino, Dolores, Busquets, Noemí, García‐González, Javier, Castrejón, Isabel, Alonso, Fernando, Bustabad, Sagrario, Díaz‐González, Federico
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.02.2024
• Subjects: Ankylosing spondylitis; antirheumatic agents; Antirheumatic Agents - therapeutic use; Arthritis; Arthritis, Psoriatic - drug therapy; Arthritis, Rheumatoid - drug therapy; biologic therapy; Bivariate analysis; Cohort Studies; Disease; Drug Therapy, Combination; Glucocorticoids; Humans; Inflammation; Multivariate analysis; Psoriatic arthritis; Rheumatic diseases; Rheumatoid arthritis; Spondylitis, Ankylosing - drug therapy; Statistical models; Therapy; biologic therapy; psoriatic arthritis; rheumatoid arthritis; antirheumatic agents; ankylosing spondylitis
• ISSN: 0014-2972; 1365-2362
• DOI: 10.1111/eci.14095

Objective The persistence of biologic (b) and targeted synthetic (ts) disease‐modifying antirheumatic drugs(DMARDs) in monotherapy versus in combination with conventional synthetic (cs) DMARDs is still a controversial topic in rheumatic diseases. To clarify this issue, the retention of the initial treatment strategy of b/tsDMARD in combination with csDMARD versus monotherapy in rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) patients under real‐life conditions was evaluated. Factors associated with maintenance of the initial strategy were analysed. Methods Nested cohort study within the Spanish BIOBADASER III registry. Bivariate comparisons and multivariate Cox proportional hazards models were used for the analyses. Results A total of 2521 patients were included in the study. In the multivariate model, the initial strategy of combination therapy was associated with shorter persistence in patients with RA (hazard ratio [HR] 1.58;95% confidence interval [CI] 1.00–2.50; p = .049), PsA (HR 2.48; 95% CI 1.65–3.72) and AS (HR 16.77; 95% CI 7.37–38.16; p < .001), regardless of sex, time of disease progression, baseline disease activity, glucocorticoid use or type of b/tsDMARD. Overall, the combination strategy was associated with an increased incidence of adverse events (incidence rate ratio [IRR] 1.13; 95% CI 1.05–1.21). Conclusions In this real‐life study, the strategy of combining a b/tsDMARD with a csDMARD is associated with lower persistence and worse safety profile compared to monotherapy in RA and especially in PsA and AS, suggesting that combination therapy should be rethought as first choice in RA patients, but especially in PsA and AS patients.