Table 1.
Characteristics of targeted therapies new users for psoriatic arthritis from 2015 to 2021
| Characteristics, n (%) | TNFi | ||||
| Adalimumab | Etanercept | Golimumab | Certolizumab | Infliximab | |
| (n=4616) | (n=2623) | (n=954) | (n=683) | (n=70) | |
| Follow-up, median (IQR), mo.* | 12.6 (6.2–29.5) | 13.4 (5.6–36.5) | 14.0 (6.5–36.2) | 11.2 (5.5–27.9) | 10.7 (6.1–32.7) |
| Deaths | 8 (0.2) | 9 (0.3) | 3 (0.3) | 2 (0.3) | 0 |
| Sociodemographic characteristics | |||||
| Age, mean (SD), year | 48.0 (12.5) | 50.5 (13.2) | 47.7 (12.3) | 44.3 (12.7) | 50.1 (14.8) |
| Female sex | 2538 (55.0) | 1554 (59.3) | 557 (58.4) | 513 (75.1) | 41 (58.6) |
| Deprivation index† | |||||
| First quantile | 295 (6.5) | 251 (9.7) | 79 (8.4) | 44 (6.5) | 4 (5.9) |
| Second quantile | 979 (21.6) | 628 (24.2) | 189 (20.1) | 147 (21.8) | 24 (35.3) |
| Third quantile | 1504 (33.1) | 725 (28.0) | 274 (29.2) | 247 (36.5) | 17 (25.0) |
| Fourth quantile | 1556 (34.3) | 866 (33.4) | 356 (37.9) | 198 (29.3) | 19 (27.9) |
| Fifth quantile | 206 (4.5) | 124 (4.8) | 41 (4.4) | 40 (5.9) | 4 (5.9) |
| CUH coverage | 653 (14.2) | 356 (13.6) | 124 (13.0) | 108 (15.8) | 10 (14.3) |
| Associated inflammatory diseases | |||||
| Active psoriasis | 1382 (29.9) | 645 (24.6) | 163 (17.1) | 139 (20.4) | 12 (17.1) |
| IBD | 378 (8.2) | 14 (0.5) | 46 (4.8) | 21 (3.1) | 21 (30.0) |
| Uveitis | 23 (0.5) | 2 (0.08) | 1 (0.1) | 2 (0.3) | 0 |
| Comorbidities | |||||
| Diabetes | 384 (8.3) | 243 (9.3) | 58 (6.1) | 40 (5.9) | 7 (10.0) |
| Chronic heart failure | 28 (0.6) | 23 (0.9) | 2 (0.2) | 2 (0.3) | 1 (1.4) |
| Coronary heart disease | 145 (3.1) | 91 (3.5) | 30 (3.1) | 30 (4.4) | 7 (10.0) |
| Chronic respiratory disease | 361 (7.8) | 242 (9.2) | 71 (7.4) | 47 (6.9) | 6 (8.6) |
| Chronic liver disease | 99 (2.1) | 74 (2.8) | 11 (1.2) | 8 (1.2) | 4 (5.7) |
| Chronic renal failure | 11 (0.2) | 7 (0.3) | 0 | 2 (0.3) | 0 |
| Sequelae of stroke | 41 (0.9) | 32 (1.2) | 11 (1.2) | 3 (0.4) | 1 (1.4) |
| Obesity (proxy) | 424 (9.2) | 244 (9.3) | 85 (8.9) | 82 (12.0) | 6 (8.6) |
| Tobacco use (proxy) | 299 (6.5) | 149 (5.7) | 66 (6.9) | 39 (5.7) | 3 (4.3) |
| Alcohol intake (proxy) | 57 (1.2) | 42 (1.6) | 9 (0.9) | 4 (0.6) | 1 (1.4) |
| Other treatments of interest within 2 years | |||||
| csDMARDs | 2837 (61.5) | 1718 (65.5) | 598 (62.7) | 420 (61.5) | 30 (42.9) |
| Methotrexate | 2553 (55.3) | 1510 (57.6) | 516 (54.1) | 365 (53.4) | 27 (38.6) |
| Leflunomide | 280 (6.1) | 249 (9.5) | 90 (9.4) | 45 (6.6) | 1 (1.4) |
| Sulfasalazine | 191 (4.1) | 126 (4.8) | 49 (5.1) | 44 (6.4) | 2 (2.9) |
| NSAIDs | 2950 (63.9) | 1820 (69.4) | 682 (71.5) | 494 (72.3) | 27 (38.6) |
| Prednisone | 883 (19.1) | 668 (25.5) | 231 (24.2) | 178 (26.1) | 10 (14.3) |
| Care consumption within 2 years | |||||
| Hospitalisation for PsA‡ | 401 (8.7) | 296 (11.3) | 108 (11.3) | 90 (13.2) | 3 (4.3) |
| Specialist consultation (≥2) | 3402 (73.7) | 2133 (81.3) | 566 (82.9) | 771 (80.8) | 36 (51.4) |
| Specialist consultation (≥4) | 1755 (38.0) | 1362 (51.9) | 469 (49.2) | 341 (49.9) | 14 (20.0) |
| Corticosteroids injections (≥4) | 508 (11.0) | 360 (13.7) | 117 (12.3) | 105 (15.4) | 6 (8.6) |
| Opioids use | 3186 (69.0) | 1869 (71.3) | 677 (71.0) | 528 (77.3) | 52 (74.3) |
| Work stoppage (≥1) | 1379 (29.9) | 681 (26.0) | 283 (29.7) | 220 (32.2) | 19 (27.1) |
| Add-on therapies§ at index date | |||||
| csDMARDs | 2021 (43.8) | 1282 (48.9) | 478 (50.1) | 306 (44.8) | 23 (32.9) |
| Methotrexate | 1806 (39.1) | 1129 (43.0) | 405 (42.5) | 264 (38.7) | 23 (32.9) |
| Leflunomide | 150 (3.3) | 123 (4.7) | 52 (5.5) | 23 (3.4) | 0 |
| Sulfasalazine | 85 (1.8) | 38 (1.5) | 25 (2.6) | 23 (3.4) | 0 |
| NSAIDs | 1644 (35.6) | 1035 (39.5) | 376 (39.4) | 289 (42.3) | 12 (17.1) |
| Prednisone | 712 (15.4) | 498 (19.0) | 180 (18.9) | 126 (18.5) | 8 (11.4) |
| Add-on therapies¶ during follow-up | |||||
| csDMARDs | 1895 (41.1) | 1169 (44.6) | 442 (46.3) | 279 (40.9) | 23 (32.9) |
| Methotrexate | 1708 (37.0) | 1063 (40.5) | 383 (40.2) | 245 (35.9) | 23 (32.9) |
| Leflunomide | 136 (3.0) | 94 (3.6) | 45 (4.7) | 22 (3.2) | 0 |
| Sulfasalazine | 64 (1.4) | 24 (0.9) | 17 (1.8) | 17 (2.5) | 0 |
| NSAIDs | 1673 (36.2) | 1090 (41.6) | 432 (45.3) | 297 (43.5) | 19 (27.1) |
| Prednisone | 605 (13.1) | 437 (16.7) | 145 (15.2) | 115 (16.8) | 8 (11.4) |
| Characteristics, n (%) | IL-17i | IL-12/23i | JAKi | ||
| Secukinumab | Ixekizumab | Ustekinumab | Tofacitinib | Total | |
| (n=1452) | (n=344) | (n=1177) | (n=152) | (n=12 071) | |
| Follow-up, median (IQR), mo.* | 15.0 (7.3–30.4) | 13.2 (7.1–21.7) | 16.8 (8.6–36.5) | 8.5 (4.7–14.3) | 13.2 (6.4–31.4) |
| Deaths | 0 | 0 | 3 (0.3) | 0 | 25 (0.2) |
| Sociodemographic characteristics | |||||
| Age, mean (SD), year | 49.3 (12.2) | 49.4 (11.7) | 49.7 (13.0) | 52.7 (13.0) | 48.7 (12.7) |
| Female sex | 818 (56.3) | 181 (52.6) | 649 (55.1) | 114 (75.0) | 6965 (57.7) |
| Deprivation index† | |||||
| First quantile | 95 (6.6) | 22 (6.4) | 83 (7.2) | 10 (6.7) | 883 (7.4) |
| Second quantile | 283 (19.8) | 90 (26.2) | 249 (21.7) | 40 (26.7) | 2629 (22.1) |
| Third quantile | 520 (36.4) | 92 (26.8) | 404 (35.2) | 61 (40.7) | 3844 (32.3) |
| Fourth quantile | 461 (32.2) | 122 (35.6) | 369 (32.2) | 35 (23.3) | 3982 (33.5) |
| Fifth quantile | 71 (5.0) | 17 (5.0) | 42 (3.7) | 4 (2.7) | 549 (4.6) |
| CUH coverage | 248 (17.1) | 59 (17.2) | 174 (14.8) | 19 (12.5) | 1751 (14.5) |
| Associated inflammatory diseases | |||||
| Active psoriasis | 556 (38.3) | 174 (50.6) | 601 (51.1) | 28 (18.4) | 3700 (30.7) |
| IBD | 11 (0.8) | 2 (0.6) | 69 (5.9) | 7 (4.6) | 569 (4.7) |
| Uveitis | 3 (0.2) | 0 | 0 | 0 | 31 (0.3) |
| Comorbidities | |||||
| Diabetes | 154 (10.6) | 34 (9.9) | 127 (10.8) | 12 (7.9) | 1059 (8.8) |
| Chronic heart failure | 11 (0.8) | 5 (1.5) | 17 (1.4) | 5 (3.3) | 94 (0.8) |
| Coronary heart disease | 57 (3.9) | 16 (4.7) | 41 (3.5) | 5 (3.3) | 422 (3.5) |
| Chronic respiratory disease | 135 (9.3) | 36 (10.5) | 106 (9.0) | 20 (13.2) | 1024 (8.5) |
| Chronic liver disease | 31 (2.1) | 7 (2.0) | 52 (4.4) | 3 (2.0) | 289 (2.4) |
| Chronic renal failure | 2 (0.1) | 0 | 6 (0.5) | 1 (0.7) | 29 (0.2) |
| Sequelae of stroke | 28 (1.9) | 6 (1.7) | 11 (0.9) | 1 (0.7) | 134 (1.1) |
| Obesity (proxy) | 174 (12.0) | 28 (8.1) | 163 (13.9) | 10 (6.6) | 1216 (10.1) |
| Tobacco use (proxy) | 126 (8.7) | 37 (10.8) | 99 (8.4) | 12 (7.9) | 830 (6.9) |
| Alcohol intake (proxy) | 24 (1.7) | 11 (3.2) | 24 (2.0) | 1 (0.7) | 173 (1.4) |
| Other treatments of interest within 2 years | |||||
| csDMARDs | 842 (58.0) | 197 (57.3) | 662 (56.2) | 104 (68.4) | 7408 (61.4) |
| Methotrexate | 748 (51.5) | 179 (52.0) | 600 (51.0) | 87 (57.2) | 6585 (54.6) |
| Leflunomide | 92 (6.3) | 20 (5.8) | 62 (5.3) | 19 (12.5) | 858 (7.1) |
| Sulfasalazine | 46 (3.2) | 10 (2.9) | 33 (2.8) | 7 (4.6) | 508 (4.2) |
| NSAIDs | 849 (58.5) | 167 (48.6) | 555 (47.2) | 80 (52.6) | 7624 (63.2) |
| Prednisone | 238 (16.4) | 40 (11.6) | 162 (13.8) | 56 (36.8) | 2466 (20.4) |
| Care consumption within 2 years | |||||
| Hospitalisation for PsA‡ | 106 (7.3) | 25 (7.3) | 93 (7.9) | 11 (7.2) | 1133 (9.4) |
| Specialist consultation (≥2) | 962 (66.3) | 190 (55.2) | 650 (55.2) | 115 (75.7) | 8825 (73.1) |
| Specialist consultation (≥4) | 456 (31.4) | 53 (15.4) | 361 (30.7) | 61 (40.1) | 4872 (40.4) |
| Corticosteroids injections (≥4) | 144 (9.9) | 24 (7.0) | 116 (9.9) | 15 (9.9) | 1395 (11.6) |
| Opioids use | 1010 (69.6) | 209 (60.8) | 738 (62.7) | 102 (67.1) | 8371 (69.4) |
| Work stoppage (≥1) | 362 (24.9) | 93 (27.0) | 263 (22.3) | 35 (23.0) | 3335 (27.6) |
| Add-on therapies§ at index date | |||||
| csDMARDs | 520 (35.8) | 124 (36.1) | 373 (31.7) | 80 (52.6) | 5207 (43.1) |
| Methotrexate | 448 (30.9) | 111 (32.3) | 325 (27.6) | 69 (45.4) | 4580 (37.9) |
| Leflunomide | 56 (3.9) | 11 (3.2) | 39 (3.3) | 9 (5.9) | 463 (3.8) |
| Sulfasalazine | 22 (1.5) | 3 (0.9) | 11 (0.9) | 2 (1.3) | 209 (1.7) |
| NSAIDs | 504 (34.7) | 82 (23.8) | 322 (27.4) | 33 (21.7) | 4297 (35.6) |
| Prednisone | 204 (14.1) | 41 (11.9) | 136 (11.6) | 44 (29.0) | 1949 (16.2) |
| Add-on therapies¶ during follow-up | |||||
| csDMARDs | 455 (31.3) | 97 (28.2) | 335 (28.5) | 65 (42.8) | 4760 (39.4) |
| Methotrexate | 408 (28.1) | 85 (24.7) | 285 (24.2) | 56 (36.8) | 4256 (35.3) |
| Leflunomide | 40 (2.8) | 11 (3.2) | 42 (3.6) | 8 (5.3) | 398 (3.3) |
| Sulfasalazine | 13 (0.9) | 1 (0.3) | 10 (0.9) | 2 (1.3) | 148 (1.2) |
| NSAIDs | 555 (38.2) | 95 (27.6) | 441 (37.5) | 36 (23.7) | 4638 (38.4) |
| Prednisone | 193 (13.3) | 27 (7.9) | 147 (12.5) | 38 (25.0) | 1715 (14.2) |
*Two patients were lost to follow-up in the adalimumab group.
†Data were missing for 184 patients; individuals in first quantile are least disadvantaged.
‡PsA code as main diagnosis for a hospitalisation>1 day.
§Defined as a period of <30 days between reimbursements of a csDMARD, NSAIDs, or prednisone and the targeted therapy.
csDMARDs, conventional synthetic disease-modifying antirheumatic drugs; CUH, complementary universal health; IBD, inflammatory bowel disease; IL-17i, interleukin 17 inhibitors; IL-12/23i, interleukin 12 and 23 inhibitor; JAKi, Janus kinase inhibitors; NSAIDs, non-steroidal anti-inflammatory drugs; PsA, psoriatic arthritis; TNFi, tumour necrosis factor inhibitors.