Monitoring and treatment of comorbidities warranted in PsA patients
medwireNews: Among individuals receiving tumor necrosis factor (TNF) inhibitors for psoriatic arthritis (PsA), the presence of comorbid conditions is associated with reduced adherence and response to treatment, Danish research shows.
“These findings […] support the importance of monitoring and treating comorbidities in patients with PsA,” say the study authors who found that those with comorbidities also had higher baseline disease activity and increased incidence of depression and/or anxiety.
Using data from the DANBIO registry and the Danish National Patient Register, they identified 1750 patients who initiated TNF inhibitor therapy between 2000 and 2015. Of these, the majority (61%) had a Charlson Comorbidity Index (CCI) score of 0, indicating the absence of any somatic or psychiatric comorbidities, while 28% and 11% had scores of 1 and at least 2, respectively, corresponding to the presence of a single or multiple conditions.
Over a median follow-up of 1.42 years, higher CCI scores were associated with reduced adherence to treatment, such that the median adherence for patients with a score of at least 2 was 1.3 years, compared with 2.2 years and 2.6 years for those with scores of 1 and 0, respectively, a significant difference.
And a multivariate analysis accounting for demographic and lifestyle factors and disease activity measures showed that the presence of multiple versus no comorbidities (CCI score of ≥2 vs 0) was significantly associated with reduced adherence, with a hazard ratio of 1.72.
Similarly, patients with a CCI score of at least 2 were significantly less likely to achieve a EULAR good or good-to-moderate response at 6 months than their counterparts without comorbidities. However, there was no significant difference between groups for this measure at the 3-month timepoint or with respect to ACR response rates.
Lead author Lars Erik Kristensen, from Copenhagen University Hospital, and co-workers noted several significant between-group differences prior to treatment initiation. For instance, patients with versus without comorbidities were more likely to also have higher tender and swollen joint counts at baseline, as well as higher scores on the Health Assessment Questionnaire Disability Index and other measures of disease activity.
Individuals with higher CCI scores were also more likely to have depression and/or anxiety at baseline compared with those who had a score of 0. And of note, patients with these psychiatric comorbidities had significantly reduced adherence to treatment, at a median of 1.7 years versus 2.4 years for those without depression and/or anxiety.
“The impact of psychological distress on [TNF inhibitor] treatment persistence needs further attention and is of particular importance, because depression and anxiety frequently are seen in PsA and may be treatable conditions,” Kristensen et al write in Arthritis Care & Research.
And they conclude: “Improved control and treatment of depression and/or anxiety before initiating [TNF inhibitors] may lead to better treatment persistence.”
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