Background:Switching between therapies is a recommended strategy for psoriatic arthritis (PsA) patients who experience treatment failure; however, studies including real-life data are scarce.Objectives:To assess the incidence rate (IR) of switching between biologics and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) due to inefficacy in PsA, and to compare the risk of switching due to inefficacy across different b/tsDMARDs groups.Design:A longitudinal retrospective study, spanning from 2007 to 2022, was conducted on patients with PsA treated with b/tsDMARDs at an outpatient rheumatology clinic.Methods:The primary outcome was switching between b/tsDMARDs due to inefficacy. The independent variable was the exposure to b/tsDMARDs during follow-up. As covariates, clinical, treatment-related, and sociodemographic variables were considered. Survival techniques were run to estimate the IR of switching due to inefficacy per 100 patients*year and confidence interval at 95% (95% CI). Cox multivariate regression analyses were run to assess the risk of b/tsDMARDs switching due to inefficacy, expressed as hazard ratio (HR) and 95% CI.Results:In all, 141 patients were included, with 893.09 patients*year follow-ups. 52.48% of them were females in their fifties. In total, 262 courses of treatment were recorded. During the study period, 56 patients presented 121 switches and 103 related to inefficacy (IR: 11.53 (9.51–13.98)). Tumor necrosis factor-alpha inhibitors (TNFi) showed the lowest IR. In the bivariate analysis, all b/tsDMARDs had more risk of switching compared to TNFi (HR: anti-lL-17 vs TNFi: 2.26 (1.17–4.36); others vs TNFi: 3.21 (1.59–6.45)); however, this statistical significance was no longer present in the multivariate analysis once adjustments were made for the covariates. Still, the final model achieved statistical significance in the following variables: gender, clinical symptoms, prescription year, therapy courses, glucocorticoids, and sulfasalazine.Conclusion:In this study, we did not find differences in the rate of switching due to inefficacy among different groups of b/tsDMARDs. Other concomitant treatments, sociodemographic, and clinical variables were identified as risk factors for switching due to inefficacy.

中文翻译：

---

与银屑病关节炎生物制剂和靶向合成疗法无效相关的转换：一项比较现实研究


背景：对于治疗失败的银屑病关节炎 (PsA) 患者，推荐采用不同疗法的策略；然而，包括现实生活数据的研究很少。 目的：评估由于 PsA 无效而在生物制剂和靶向合成缓解病情抗风湿药物 (b/tsDMARD) 之间转换的发生率 (IR)，并比较不同 b/tsDMARD 组之间因无效而导致转换的风险。设计：一项从 2007 年到 2022 年的纵向回顾性研究，对风湿病门诊接受 b/tsDMARD 治疗的 PsA 患者进行。方法：主要结果是转换由于无效而在 b/tsDMARD 之间进行。自变量是随访期间接触 b/tsDMARD 的情况。作为协变量，考虑了临床、治疗相关和社会人口统计学变量。使用生存技术来估计每 100 名患者*年因无效而转换的 IR，置信区间为 95% (95% CI)。进行 Cox 多变量回归分析来评估由于无效而导致 b/tsDMARD 转换的风险，以风险比 (HR) 和 95% CI 表示。 结果：总共纳入 141 名患者，其中 893.09 名患者*年随访。其中50多岁的女性占52.48%。总共记录了262个疗程。在研究期间，56 名患者出现了 121 次转换，其中 103 次与无效相关（IR：11.53（9.51-13.98））。肿瘤坏死因子-α 抑制剂 (TNFi) 的 IR 最低。在双变量分析中，与 TNFi 相比，所有 b/tsDMARD 的转换风险更高（HR：抗 IL-17 与 TNFi：2.26 (1.17–4.36)；其他与 TNFi：3.21 (1.59–6.36)。45））；然而，一旦对协变量进行调整，这种统计显着性就不再存在于多变量分析中。尽管如此，最终模型在以下变量中取得了统计学显着性：性别、临床症状、处方年份、治疗疗程、糖皮质激素和柳氮磺吡啶。 结论：在这项研究中，我们没有发现不同药物之间因无效而导致的转换率存在差异。 b/tsDMARD 组。其他伴随治疗、社会人口统计学和临床​​变量被确定为因无效而转换的危险因素。