Abstract
Objectives
Evidence evaluating effectiveness of biologic and targeted synthetic (b/ts) DMARDs in adults with PsA after exposure to ≥ 3 b/tsDMARDs is lacking. We aimed to evaluate response to sequential lines of b/tsDMARDs.
Methods
In this multicentre retrospective observational study, 22 hospitals submitted data from routine clinic appointments of patients with PsA treated with b/tsDMARDs. Purposive sampling obtained a study population exposed to advanced lines of therapy. Effectiveness outcome measures (PsARC/TJC/SJC) at baseline and first follow up (12–16 weeks) for each line were recorded. Odds of achieving PsARC in 2nd/3rd line were compared with 4th+ line.
Results
437 participants (163 male, 274 female) and 1459 treatment courses were included: 430 1st line, 633 2nd/3rd line and 396 4th+ line. The adjusted odds ratio (95% confidence intervals) for achieving PsARC in 1st line vs 2nd/3rd line was 1.91 (1.40, 2.60) and 4th+ line vs 2nd/3rd line was 1.13 (0.84, 1.55). There was no significant difference in change from baseline TJC/SJC between 2nd/3rd and 4th+ lines.
Conclusion
In this cohort the highest chance of a positive PsARC response was to 1st line b/tsDMARD: twice the chance of response vs 2nd/3rd line. The chance of a positive PsARC response to 4th+ lines of b/tsDMARD was not significantly different to 2nd/3rd lines after adjustment. This indicates that patients in a UK cohort can continue to have a meaningful response to later lines of treatment. This is the first available evidence of response to later lines of b/tsDMARD treatment in PsA.
Evidence evaluating effectiveness of biologic and targeted synthetic (b/ts) DMARDs in adults with PsA after exposure to ≥ 3 b/tsDMARDs is lacking. We aimed to evaluate response to sequential lines of b/tsDMARDs.
Methods
In this multicentre retrospective observational study, 22 hospitals submitted data from routine clinic appointments of patients with PsA treated with b/tsDMARDs. Purposive sampling obtained a study population exposed to advanced lines of therapy. Effectiveness outcome measures (PsARC/TJC/SJC) at baseline and first follow up (12–16 weeks) for each line were recorded. Odds of achieving PsARC in 2nd/3rd line were compared with 4th+ line.
Results
437 participants (163 male, 274 female) and 1459 treatment courses were included: 430 1st line, 633 2nd/3rd line and 396 4th+ line. The adjusted odds ratio (95% confidence intervals) for achieving PsARC in 1st line vs 2nd/3rd line was 1.91 (1.40, 2.60) and 4th+ line vs 2nd/3rd line was 1.13 (0.84, 1.55). There was no significant difference in change from baseline TJC/SJC between 2nd/3rd and 4th+ lines.
Conclusion
In this cohort the highest chance of a positive PsARC response was to 1st line b/tsDMARD: twice the chance of response vs 2nd/3rd line. The chance of a positive PsARC response to 4th+ lines of b/tsDMARD was not significantly different to 2nd/3rd lines after adjustment. This indicates that patients in a UK cohort can continue to have a meaningful response to later lines of treatment. This is the first available evidence of response to later lines of b/tsDMARD treatment in PsA.
| Original language | English |
|---|---|
| Article number | keaf570 |
| Number of pages | 26 |
| Journal | Rheumatology |
| Early online date | 5 Nov 2025 |
| DOIs | |
| Publication status | E-pub ahead of print - 5 Nov 2025 |
Acknowledgements
We acknowledge the hard work and contribution of all those who submitted participant data, including all the members of the SEQUENCE Study Group. We would like to thank all the participants of the study. C.G. would like to thank the Bristol and Avon Dermatology Research Trust for support and funding (not related to this study). This study was presented as an abstract at EULAR 2024 (SEQUENCE: Effectiveness of Sequential Biologic and Targeted Small Molecule DMARDs in Psoriatic Arthritis in the United Kingdom, European Congress of Rheumatology, 12–15 June 24, Vienna).Funding
We would like to thank the British Psoriatic Arthritis Consortium for funding this project. L.C. is funded by the National Institute for Health and Care Research (NIHR) Oxford Biomedical Research Centre (BRC). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
| Funders | Funder number |
|---|---|
| Not added |
Keywords
- Psoriatic arthritis
- Bdmard
- Tsdmard
- Biologic
- Inflammatory arthritis
- 4th line