Long-term remission and biologic persistence rates: 12-year real-world data
Abstract Background Biologic therapies have greatly improved outcomes in rheumatoid arthritis (RA) and psoriatic arthritis (PsA). Yet, our ability to predict long-term remission and persistence or continuation of therapy remains limited. This study explores predictors of remission and persistence of...
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doaj-6300f7fa7db14cc0b3710f5ce94f54ac2021-01-17T12:57:59ZengBMCArthritis Research & Therapy1478-63622021-01-0123111010.1186/s13075-020-02380-zLong-term remission and biologic persistence rates: 12-year real-world dataKieran Murray0Matthew Turk1Yousef Alammari2Francis Young3Phil Gallagher4Tajvur Saber5Ursula Fearon6Douglas J. Veale7Department of Rheumatology, St Vincent’s University HospitalDepartment of Rheumatology, St Vincent’s University HospitalDepartment of Rheumatology, St Vincent’s University HospitalDepartment of Rheumatology, St Vincent’s University HospitalDepartment of Rheumatology, St Vincent’s University HospitalLady Reading HospitalMolecular Rheumatology, School of Medicine, Trinity Biomedical Sciences Institute, Trinity College DublinDepartment of Rheumatology, St Vincent’s University HospitalAbstract Background Biologic therapies have greatly improved outcomes in rheumatoid arthritis (RA) and psoriatic arthritis (PsA). Yet, our ability to predict long-term remission and persistence or continuation of therapy remains limited. This study explores predictors of remission and persistence of the initial biologic therapy in patients after 12 years. Furthermore, outcomes with adalimumab and etanercept are compared. Patients and methods RA and PsA patients were prospectively recruited from a biologic clinic. Outcomes on commencing therapy, at 1 year and 12 years were reviewed. Demographics, medications, morning stiffness, patient global health score, tender and swollen joint counts, antibody status, CRP and HAQ were collected. Outcomes at 1 year and 12 years are reported and predictors of biologic persistence and EULAR-defined remission (DAS28-CRP < 2.6) are examined with univariate and multivariate analysis. Results A total of 403 patients (274 RA and 129 PsA) were analysed. PsA patients were more likely to be male, in full-time employment and have completed higher education. PsA had higher remission rates than RA at both 1 year (60.3% versus 34.5%, p < 0.001) and 12 years (91.3% versus 60.6%, p < 0.001). This difference persisted when patients were matched for baseline disease activity (p < 0.001). Biologic continuation rates were high for RA and PsA at 1 year (49.6% versus 58.9%) and 12 years (38.2% versus 52.3%). In PsA, patients starting on etanercept had lower CRP at 12 years (p = 0.041). Multivariate analysis showed 1-year continuation [OR 4.28 (1.28–14.38)] and 1-year low-disease activity [OR 3.90 (95% CI 1.05–14.53)] was predictive of a 12-year persistence. Persistence with initial biologic at 12 years [OR 4.98 (95% CI 1.83–13.56)] and male gender [OR 4.48 (95% CI 1.25–16.01)] predicted 12 year remission. Conclusions This is the first study to show better response to biologic therapy in PsA compared to RA at 12 years. Long-term persistence with initial biologic agent was high and was predicted by biologic persistence and low-disease activity at 1 year. Interestingly, PsA patients had higher levels of employment, educational attainment, and long-term remission rates compared to RA patients.https://doi.org/10.1186/s13075-020-02380-zRheumatoid arthritisPsoriatic arthritisBiologicsRemission |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Kieran Murray Matthew Turk Yousef Alammari Francis Young Phil Gallagher Tajvur Saber Ursula Fearon Douglas J. Veale |
spellingShingle |
Kieran Murray Matthew Turk Yousef Alammari Francis Young Phil Gallagher Tajvur Saber Ursula Fearon Douglas J. Veale Long-term remission and biologic persistence rates: 12-year real-world data Arthritis Research & Therapy Rheumatoid arthritis Psoriatic arthritis Biologics Remission |
author_facet |
Kieran Murray Matthew Turk Yousef Alammari Francis Young Phil Gallagher Tajvur Saber Ursula Fearon Douglas J. Veale |
author_sort |
Kieran Murray |
title |
Long-term remission and biologic persistence rates: 12-year real-world data |
title_short |
Long-term remission and biologic persistence rates: 12-year real-world data |
title_full |
Long-term remission and biologic persistence rates: 12-year real-world data |
title_fullStr |
Long-term remission and biologic persistence rates: 12-year real-world data |
title_full_unstemmed |
Long-term remission and biologic persistence rates: 12-year real-world data |
title_sort |
long-term remission and biologic persistence rates: 12-year real-world data |
publisher |
BMC |
series |
Arthritis Research & Therapy |
issn |
1478-6362 |
publishDate |
2021-01-01 |
description |
Abstract Background Biologic therapies have greatly improved outcomes in rheumatoid arthritis (RA) and psoriatic arthritis (PsA). Yet, our ability to predict long-term remission and persistence or continuation of therapy remains limited. This study explores predictors of remission and persistence of the initial biologic therapy in patients after 12 years. Furthermore, outcomes with adalimumab and etanercept are compared. Patients and methods RA and PsA patients were prospectively recruited from a biologic clinic. Outcomes on commencing therapy, at 1 year and 12 years were reviewed. Demographics, medications, morning stiffness, patient global health score, tender and swollen joint counts, antibody status, CRP and HAQ were collected. Outcomes at 1 year and 12 years are reported and predictors of biologic persistence and EULAR-defined remission (DAS28-CRP < 2.6) are examined with univariate and multivariate analysis. Results A total of 403 patients (274 RA and 129 PsA) were analysed. PsA patients were more likely to be male, in full-time employment and have completed higher education. PsA had higher remission rates than RA at both 1 year (60.3% versus 34.5%, p < 0.001) and 12 years (91.3% versus 60.6%, p < 0.001). This difference persisted when patients were matched for baseline disease activity (p < 0.001). Biologic continuation rates were high for RA and PsA at 1 year (49.6% versus 58.9%) and 12 years (38.2% versus 52.3%). In PsA, patients starting on etanercept had lower CRP at 12 years (p = 0.041). Multivariate analysis showed 1-year continuation [OR 4.28 (1.28–14.38)] and 1-year low-disease activity [OR 3.90 (95% CI 1.05–14.53)] was predictive of a 12-year persistence. Persistence with initial biologic at 12 years [OR 4.98 (95% CI 1.83–13.56)] and male gender [OR 4.48 (95% CI 1.25–16.01)] predicted 12 year remission. Conclusions This is the first study to show better response to biologic therapy in PsA compared to RA at 12 years. Long-term persistence with initial biologic agent was high and was predicted by biologic persistence and low-disease activity at 1 year. Interestingly, PsA patients had higher levels of employment, educational attainment, and long-term remission rates compared to RA patients. |
topic |
Rheumatoid arthritis Psoriatic arthritis Biologics Remission |
url |
https://doi.org/10.1186/s13075-020-02380-z |
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