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4CPS-127 Persistence of biological disease-modifying drugs and phosphodiesterase-4- inhibitors in patients with Psoriatic Arthrithis
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  1. L Rubio-Ruiz1,
  2. A Onteniente-González1,
  3. L Martin-Zaragoza1,
  4. J Sánchez-Rubio-Ferrández1,
  5. N Herranz-Muñoz1,
  6. S Solís-Cuñado1,
  7. Á Aragón-Díez2,
  8. T Molina-García1
  1. 1Hospital Universitario De Getafe, Pharmacy, Getafe, Spain
  2. 2Hospital Universitario De Getafe, Reumatology, Getafe, Spain

Abstract

Background and Importance Persistence provides information on treatment effectiveness, durability, and tolerance in real-world patient populations. Little is known about the persistence of treatments used in Psoriatic Arthrithis (PsA).

Aim and Objectives This work compares the persistence of biological disease-modifying drugs (bDMARDs) and phosphodiesterase-4-inhibitors (PD-4-Is) in PsA patients and investigate the reasons for treatment discontinuation.

Material and Methods Longitudinal, retrospective, and observational study. It included PsA patients who initiated bDMARDs (anti-TNF, anti-IL12/23, anti-IL17 and anti-IL23) and PD-4-Is treatment between January 2014 and June 2022, with follow-up until December 2023.

Persistence is the period from initiation to discontinuation. Persistence was also calculated as a dichotomous variable at 6 months from the treatment initiation. The permissible gap (threshold of a period without treatment) was 60 days.

The variables analysed include age, gender, treatment line, treatment start and end dates, reasons for discontinuation, treatment-naive and adherence (medication possession ratio >90%).

Persistence after six months was compared using the χ2 test. Kaplan-Meier survival analysis was performed, and differences were evaluated using the log-rank test. Adjusted risk of discontinuation was assessed with Cox Proportional Hazard models. Statistical analysis was conducted with SPSS®V27.0.

Results 206 patients were included, 47.6% were men. The mean age±SD was 53.2±11.6 years. A total of 354 treatment lines were recorded (37.3% anti-TNF; 25.2% PD-4-Is; 20.3% anti-IL17; 9.0% anti-IL12/23; 8.2% anti-IL23).

Overall treatment persistence rate at 6 months was 86.4% (96.8% anti-IL12/23; 95.2% anti-IL23; 91.2% anti-TNF; 83.8% anti-IL17; 75.9% PD-4-Is).

Mean overall persistence duration was 1542 days (CI 95% 1376–1707). According to Cox regression, the mean persistence was 1626 (CI 95% 1436–1815) days for bDMARDs and 1086 days (CI95% 863–1310) for PD-4-Is. Men were more persistent [HR 1.41 (CI95% 1.04–1.93), p<0.05]. bDMARDs were more persistent [HR 1.11 (CI95% 1.02–1.21) p<0.05].

13.6% (n=46) PsA patients treated with bDMARDs or PD-4-Is discontinued treatment before 6 months. The reasons were: 55.5% lack of effectiveness (37.5% anti-TNF; 37.5% anti-IL17; 20.8% PD-4-Is; 4.2% anti-IL12/23); 39.5% adverse effects associated with PD-4-Is and 5.0% unknown reason.

Conclusion and Relevance Patients with greater treatment persistence are those treated with bDMARDs and are predominantly male. Lack of effectiveness were the main reason for early discontinuation of treatment. All patients who discontinued treatment for adverse effects were treated with PD-4-Is.

Conflict of Interest No conflict of interest.

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