AB0535 PRESCRIPTION PATTERNS OF THE SECOND BIOLOGIC DMARD IN PSORIATIC ARTHRITIS THROUGH THE LAST DECADE: HURBIO-PsA REAL LIFE EXPERIENCE
Authors: U. Kalyoncu, O. Karadag, L. Kiliç, A. Akdoğan, I. Dogan, Ş. A. Bilgen, E. Bilgin, E. C. Bolek, A. Erden, B. Armagan, A. Sari, E. Duran, B. Farisoğullari, G. K. Yardimci, Z. Özsoy, G. Ayan, A. İ. Ertenli, M. Çalgüneri, S. Kiraz
Journal: Annals of the Rheumatic Diseases (2021)

Background: Psoriatic arthritis (PsA) is a multi-dimensional chronic disease, which can affect joints, skin and enthesis. Extrapolation of the positive treatment results of anti-tumor necrosis factor (TNF) alpha agents on spondyloarthritis and rheumatoid arthritis to the treatment practice of PsA lead to a new era for the management of PsA. However, unmet needs in the management of PsA lead to development of several drugs targeting different molecules and cytokines. The impact of these developments on PsA patients who are intolerant/unresponsive to the first biological disease-modifying anti-rheumatic drugs (bDMARD) still needs to be defined. Objectives: To explore the second biologic agent trends on PsA patients of our 10-years of single-center experience. Methods: HURBIO-PsA (Hacettepe University Rheumatology Biologic Registry) is a single center biological disease modifying anti-rheumatic drug (DMARD) registry since 2005 on PsA patients. Until the end of the 2020, 19 different rheumatologists contributed to the development of HURBIO-PsA. Anti-TNF drugs were approved as first line bDMARD for PsA patients. Distribution of the second-line biological agents (switch from first-line biological agent because of either adverse events or unresponsiveness) was calculated according to 5-year periods starting from the 2011. Also, demographic and serologic data of RA patients were reported. Results: A total of 225 PsA (225/443, 50.8%) patients, who was prescribed a second biological agent, was registered in HURBIO-PsA by the end of 2020. Of these patients, 74.7% was female. Mean age at the starting of bDMARD was 47.1 ± 11.6 years. 90 (40.0%) and 135 (60.0%) patients were prescribed with their second bDMARD in 2011-2015 and 2016-2020, respectively. There was a trend towards the increasing prescription of non-Anti-TNF bDMARDs as second-line over time, especially for secukinumab. Table 1. Distribution of second biologic DMARDs in PsA patients according to 5-years periods 2011-2015 2016-2020 Total Adalimumab 30 (33.3) 33 (24.4) 66 (29.3) Etanercept 33 (36.7) 8 (5.9) 41 (18.2) Infliximab 9 (10) 15 (11.1) 24 (10.6) Golimumab 9 (10) 5 (3.7) 14 (6.2) Certolizumab 5 (5.6) 34 (25.2) 39 (17.3) Anti-TNF 86 (95.6) 95 (70.4) 181 (80.5) Secukinumab 0 26 (19.3) 26 (11.5) Ustekinumab 0 10 (7.4) 10 (4.4) Abatacept 4 (4.4) 2 (1.5) 6 (2.6) Tofacitinib 0 2 (1.5) 2 (0.9) Non-Anti-TNF 4 (4.4) 40 (29.6) 44 (19.5) Total 90 (100) 135 (100) 225 (100) Approval years of drugs in Turkey ; Infliximab: 2003, etanercept:2004, adalimumab: 2005, golimumab: 2013, certolizumab: 2014, secukinumab: 2018, ustekinumab: 2018; abatacept and tofacitinib were given with the permission from the Ministry of Health of Turkey for off-label use authorization Conclusion: Almost half of the PsA patients switched their anti-TNF drugs to others. Non-Anti-TNF bDMARDs, especially secukinumab, becoming more frequently used as a second-line biologic agent in PsA in recent years. These bDMARD prescription trend is appropriate to EULAR PsA recommendations. Disclosure of Interests: None declared.