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Minimal disease activity and drug discontinuation rate in elderly psoriatic arthritis patients on TNF-alpha blockers

Psoriatic arthritis ( PsA ) is an inflammatory arthropathy, associated with skin and/or nail psoriasis.
Real world data on efficacy and safety of TNF-alpha blockers in the elderly with psoriatic arthritis are lacking.

The aim of the study was to evaluate the effectiveness, through the achievement of minimal disease activity ( MDA ), drug discontinuation rate, and safety in elderly patients with psoriatic arthritis on TNF-alpha blockers.

A multicenter, observational study was carried out in four Italian centers. The assessment of disease activity and safety were performed at the start of anti-TNF-alpha ( T0 ), at 6 months ( T6 ) and at 12 months ( T12 ).

A total of 145 patients with psoriatic arthritis were included in the study. At baseline 68 ( 46.9% ) patients were on Etanercept, 60 ( 41.3% ) on Adalimumab, 11 ( 7.6% ) on Golimumab, and 6 ( 4.1% ) on Infliximab.

All the variables concerning activity of psoriatic arthritis showed a statistically significant improvement when comparing T6 and T12 with T0.

After 6 and 12 months of therapy, respectively, 31 ( 22.6% ) and 71 ( 51.8% ) patients achieved minimal disease activity ( p less than 0.001 ).

The drug discontinuation rate was 5.5% with a mean of 6.8 months ( range 2-10 months ), and it was due to lack of efficacy, adverse events, and lost to follow-up.

Nine patients ( 6.2% ) reported the onset of mild infections resolved with antimicrobial specific oral regimen without therapy interruption.

TNF-alpha blockers are effective in the achievement of a low disease status and safe in elderly patients with psoriatic arthritis. Therefore, age should not be considered a limitation to their use. ( Xagena )

Costa L et al, Clin Rheumatol 2017; 36:1797-1802