PO:02:030 | Retention Rate of Non-anti-TNF Therapies and primary failure in monocentric cohort of patients with Psoriatic Arthritis

Alba Chiara Pozzi¹, Sofia Barezzani², Andrea Galli², Cesare Tomasi¹, Micol Frassi¹, Ilaria Cavazzana¹, Franco Franceschini¹ | ¹Rheumatology and Clinical Immunology Unit ERN-ReCONNECT, ASST Spedali Civili, University of Brescia Brescia, Italy; ²Facoltà di Medicina e Chirurgia, University of Brescia Brescia, Italy

Aim of the study. Psoriatic arthritis (PsA) is a chronic, immune-mediated, inflammatory arthropathy. We conducted a retrospective single-center observational study with the aim of evaluating the retention rate (RR) of non-anti-TNFalpha (bDMARDs and tsDMARDs) and assessing the incidence of primary failure by identifying factors that may influence it. Primary failure was defined as discontinuation of therapy within six months of treatment due to active disease or physician's choice.

Materials and Methods. We included patients fulfilling CASPAR criteria. Demographic, clinical features and treatments were retrieved. Patients with primary failure were identified and compared to responders and to patients who stopped for non-efficacy-related reasons (side effects, pregnancy etc...) Then we considered patients who had anti IL-17 and anti-IL-23/IL-12/23, and we evaluated the RR of the treatments. Descriptive results are presented as median values or as numbers and percentages, as appropriate. Normality was tested with the Kolmogorov-Smirnov test. Between-group differences were analysed with Mann-Whitney U test for continuous variables and chi-square or Fisher’s exact tests for categorical ones. Kaplan-Meier curves were used for survival analysis. Significance was set at p=0.05.

Results. Preliminary data included 113 patients (39M, 74F). Mean age was 56.3 years (SD 12.2), BMI 27.1 (SD 5.67, n=52), and mean age at diagnosis 46.96 years (SD 12.7, n=106). Joint involvement was oligoarticular in 34.2% (38/111), polyarticular in 35.1% (39/111), enthesitis in 25.2% (28/111), dactylitis in 18.0% (20/111), and axial in 19.8% (22/111). Anti-TNF was the most prescribed first-line drug (51.3%), followed by anti-IL-17 (25.7%) and anti-IL-23 (15,9%) (Table2): this finding is likely related to drug availability, guidelines-driven choices, and economic factors. We did not identify any variables associated with primary therapy failure when comparing non-responders to both responders and who discontinued treatment for other reasons. Overall, 68.2% received one therapy line, while 31.8% received two or more. Patients treated with antiIL-17 or antiIL-23 were 110 for a total of 157 cycles of therapy [99 antiIL-17(63,1%)(59 Secukinumab, 39 Ixekizumab, 1Bimekizumab), and 58 (26,9%) antiIL-23 (23 Ustekinumab,33 Guselkumab,2 Risankizumab)], RR at 1,3 and 5 years showed similar overall survival between anti-IL17 and anti-IL23: at 12 months cycles were interrupted 12 antiIL-17 (7 Secukinumab and 5 Ixekizumab), and 7 antiIL-23 (4 Ustekinumab and 6 Guselkumab), at 36 months 23 antiIL-17 (16 Sekukinumab, 6 Ixekizumab and 1 Bimekizumab), and 20 antiIL-23 (9 Ustekinumab, 9 Guselkumab and 2 Risankizumab), at 60 months 10 antiIL-17 (5 Secukinumab, 1 Ixekizumab) and 1 antiIL-23 (1 Ustekinumab). (Table3).

Conclusions. The 12-month RR was 87.8% for anti-IL-17 and 87.9% for anti-IL-23, slightly higher than reported in the literature (1). However, these are preliminary findings, and a collection bias is possible, as data were gathered from patients already treated with these agents. References: 1. Ferrito M. Reumatismo. 2023 Jul 17;75(2)