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Predictors of Achieving Remission among Patients with Psoriatic Arthritis Initiating a Tumor Necrosis Factor Inhibitor

Author

Ogdie A1, Palmer JL1, Greenberg J1, Curtis JR1, Harrold LR1, Solomon DH1, Kavanaugh A1, Kremer JM1, Mease PJ1. J Rheumatol. 2019 Jan 15. pii: jrheum.171034. doi: 10.3899/jrheum.171034. [Epub ahead of print]

Author Information

1 From the University of Pennsylvania, Philadelphia, Pennsylvania; Corrona Research Foundation; New York University Hospital for Joint Diseases, New York, New York; University of Alabama at Birmingham, Birmingham, Alabama; University of Massachusetts, Worcester; Brigham and Women's Hospital, Boston, Massachusetts; University of California San Diego, San Diego, California; Albany Medical College, Albany, New York; Swedish Medical Center; University of Washington, Seattle, Washington, USA. This study was supported by the Corrona Research Foundation. Dr. Ogdie is supported by K23 AR063764, R01 AR072363, and the Rheumatology Research Foundation. Dr. Solomon's work on this project was supported by Corrona and NIH-K24AR055989. The authors have reported potential conflicts of interest; we have listed only COI with a value > $10,000 during the past 12 months. Dr. Ogdie has received grants to the University of Pennsylvania from Pfizer (co-investigator) and Novartis (primary investigator). Dr. Palmer is an employee of Corrona. Dr. Greenberg is an employee and shareholder for Corrona LLC. Dr. Curtis has received grants from Pfizer and Lilly. Dr. Harrold has stock from Corrona LLC and is an employee of University of Massachusetts Medical School and Corrona LLC. Dr. Solomon receives salary support through research grants with his institution from Amgen, Bristol Myers Squibb, Genentech, Abbvie, and Ironwood. Dr. Kavanaugh has conducted clinical trials sponsored by and/or consulted for AbbVie, Eli Lilly, and Pfizer. Dr. Kremer is an employee of Corrona. Dr. Mease has received research grants, consulting honoraria, and/or speaker fees from Abbvie, Amgen, Celgene, Lilly, Novartis, and Pfizer. A. Ogdie, MD, MSCE, University of Pennsylvania; J.L. Palmer, PhD, Corrona Research Foundation; J. Greenberg, MD, New York University Hospital for Joint Diseases; J.R. Curtis, MD, MS, MPH, University of Alabama at Birmingham; L.R. Harrold, MD, MPH, Corrona Research Foundation; D.H. Solomon, MD, MPH, Brigham and Women's Hospital; A. Kavanaugh, MD, University of California at San Diego; J.M. Kremer, MD, Corrona Research Foundation, and Albany Medical College; P.J. Mease, MD, Swedish Medical Center, and University of Washington. Address correspondence to Dr. A. Ogdie, Division of Rheumatology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. E-mail: alexis.ogdie@uphs.upenn.edu. Accepted for publication August 9, 2018.

Abstract

To examine predictors of remission among patients with psoriatic arthritis (PsA) initiating a tumor necrosis factor (TNF) inhibitor.

METHODS: 

Patients with PsA enrolled in the Corrona Registry between 2005 and 2013 were followed from initiation of a TNF inhibitor (TNFi; etanercept, adalimumab, infliximab, certolizumab, or golimumab) to the visit closest to 12 months. Additional inclusion criteria included 3 tender or 3 swollen joints. Outcomes of interest were Clinical Disease Activity Index (CDAI) ≤ 2.8 (remission), low disease activity (LDA; CDAI ≤ 10), change in the modified Health Assessment Questionnaire (mHAQ) ≥ 0.35 and achievement of mHAQ < 0.30. Predictors were measured on or before TNFi initiation. Covariates significant in univariable logistic regression models and ≤ 5% missing values were included in a multivariable model and removed individually until all remaining variables were significant (p < 0.05).

RESULTS: 

Among 1832 TNFi initiations, 774 initiations (624 patients) met inclusion criteria. Median age at initiation was 52 years [interquartile range (IQR) 44-60], 56% were female, median PsA duration was 4 years (IQR 2-11), and median CDAI at baseline was 20 (IQR 14.5-28). Remission was achieved by 14% and LDA (or remission) by 37%. Achieving remission was positively associated with college education (OR 1.88, 95% CI 1.11-3.19) but negatively associated with female sex (0.62, 95% CI 0.40-0.97), obese body mass index (0.51, 95% CI 0.32-0.81), hypertension (0.55, 95% CI 0.32-0.95), previous biologic use (0.41, 95% CI 0.26-0.65), and baseline pain (0.80 per 10 mm visual analog scale, 95% CI 0.73-0.87). Predictors for LDA, mHAQ < 0.30, and mHAQ change were similar.

CONCLUSION: 

Few patients with PsA in a US-based registry achieved remission by CDAI criteria. Female sex, obesity, comorbidities, and education influence achievement of remission on a TNFi.