Predictors of response to TNF blockers in patients with polyarticular psoriatic arthritis
2016
Psoriatic arthritis (PsA) is a chronic inflammatory
rheumatic disease with a broad clinical spectrum. PsA
can affect the axialskeleton, peripheral joints, entheses,
synovial sheaths of tendons, skin, nails and extra-articular
organs. Tumour necrosis factor alpha blockers
(TNF blockers) were a breakthrough development in
the treatment of PsA. Identifying predictors of response
to biological therapiesin patients with PsA is of utmost
importance, especially in view of the costs and potential
side effects of these agents. The aims of the present
study were to determine baseline predictive factors of
response to biological therapies, at 3 and 6 months, in
PsA patients with polyarticular involvement (with or
without axial involvement). Data were collected from
the RheumaticDiseases Portuguese Register(Reuma.pt).
Eligible patients had to be anti-TNF-naive at baseline
and to have at least 3 months of follow-up after the beginning
of TNF blocker therapy. Only patients with information
on at least one of the response measures (at
3 or 6 months of follow-up) were included in the analysis.
Univariable logistic regression analysis of potential
baseline predictors of European League Against Rheu-matism (EULAR) good clinical response, EULAR good/
/moderate response, 28-joint Disease Activity Score
with three variables including the erythrocyte sedimentation
rate (DAS28-3V-ESR) remission and Health
Assessment Questionnaire (HAQ) response were performed.
Multivariable logistic regression using a forward
selection procedure was used until the best-fit
model was obtained, taking confounding effects into
account. A total of 180 patients were eligible for the
study (mean age 52 years, 54% women). In multivariable
analysis at 3 months, females were less likely to attain
a good EULAR response [OR=0.082 (95%
CI=0.024, 0.278)], a DAS28-3V-ESR remission
[OR=0.083 (95% CI=0.017, 0.416)], a moderate or
good EULAR response [OR=0.091 (95% CI=0.011,
0.091)] and a HAQ response [OR=0.074 (95%
CI=0.009, 0.608)]. At 6 months, female gender was
also less likely to achieve a good EULAR response
[OR=0.060 (95% CI=0.011, 0.325)], DAS28-3V-ESR
remission [OR=0.060 (95% CI=0.012, 0.297)], and a
HAQ response [OR=0.138 (95% CI= 0.029, 0.654)]. In
this study we found that gender was the most consistent
predictor of response to TNF blocker therapy in
patients with polyarticular PsA, with females having a
lower probability ofresponse compared to males. These
findings suggest that gender-related biochemical, hormonal
and psychological factors could play an importantrole
in the response to TNF blockertherapy in PsA.
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