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Rheumatology (Oxford). 2019 Oct 30. pii: kez427. doi: 10.1093/rheumatology/kez427. [Epub ahead of print]

Retention and response rates in 14 261 PsA patients starting TNF inhibitor treatment-results from 12 countries in EuroSpA.

Author information

EuroSpA Coordinating Center, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup.
DANBIO Registry, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.
Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland.
Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
Institute of Rheumatology and Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic.
7 registry and Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
Research Unit, Spanish Society of Rheumatology, Madrid, Spain.
ROB-FIN Registry, Helsinki University and Helsinki University Hospital, Helsinki, Finland.
10 and the Department of Rheumatology, University Medical Centre Ljubljana, Slovenia, Ljubljana.
Centre for Rheumatology Research, University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
TURKBIO Registry and Division of Rheumatology, School of Medicine Dokuz Eylul University, Izmir, Turkey.
Center of Rheumatic Diseases, University of Medicine and Pharmacy, Bucharest, Romania.
Leitender Arzt der Universitätsklinik für Rheumatologie, Immunologie und Allergologie Inselspital, Bern, Switzerland.
15 registry, Rheumatology Department-Centro Hospitalar do Baixo Vouga and Ibimed-Institute for Biomedicine, University of Aveiro, Aveiro, Portugal.
Inflammation Center, Department of Rheumatology, Helsinki University Hospital, Helsinki, Finland.
University of Iceland, Faculty of Medicine, and Landspitali University Hospital, Reykjavik, Iceland.
Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.
Amsterdam Rheumatology & immunology Center (ARC), Academic Medical Center, Amsterdam.
Department of Rheumatology, Amsterdam UMC, VU University Medical Centre Amsterdam, Amsterdam, The Netherlands.
Epidemiology Group, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK.
GISEA registry, Rheumatology Unit - DETO, University of Bari, Bari, Italy.
Zitelabs Aps, Copenhagen.
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.



To investigate TNF inhibitor (TNFi) retention and response rates in European biologic-naïve patients with PsA.


Prospectively collected data on PsA patients in routine care from 12 European registries were pooled. Heterogeneity in baseline characteristics between registries were explored (analysis of variance and pairwise comparison). Retention rates (Kaplan-Meier), clinical remission [28-joint count DAS (DAS28) <2.6; 28 joint Disease Activity index for Psoriatic Arthritis ⩽4] and ACR criteria for 20% improvement (ACR20)/ACR50/ACR70 were calculated, including LUNDEX adjustment.


Overall, 14 261 patients with PsA initiated a first TNFi. Considerable heterogeneity of baseline characteristics between registries was observed. The median 12-month retention rate (95% CI) was 77% (76, 78%), ranging from 68 to 90% across registries. Overall, DAS28/28 joint Disease Activity index for Psoriatic Arthritis remission rates at 6 months were 56%/27% (LUNDEX: 45%/22%). Six-month ACR20/50/70 responses were 53%/38%/22%, respectively. In patients initiating a first TNFi after 2009 with registered fulfilment of ClASsification for Psoriatic ARthritis (CASPAR) criteria (n = 1980) or registered one or more swollen joint at baseline (n = 5803), the retention rates and response rates were similar to those found overall.


Approximately half of >14 000 patients with PsA who initiated first TNFi treatment in routine care were in DAS28 remission after 6 months, and three-quarters were still on the drug after 1 year. Considerable heterogeneity in baseline characteristics and outcomes across registries was observed. The feasibility of creating a large European database of PsA patients treated in routine care was demonstrated, offering unique opportunities for research with real-world data.


DAPSA28; DAS28; TNFi; drug survival; effectiveness; epidemiology; psoriatic arthritis; register; response; spondyloarthritis

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