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Войти в исследования Drug retention of TNF versus IL-23 inhibitors in psoriatic arthritis: a multicenter real-life cohort study.
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Parisi Simone, Becciolini Andrea, D'Onofrio Bernardo, Lo Gullo Alberto, Addimanda Olga, Magnani Mirco, Reta Massimo, Andracco Romina, Mansueto Natalia, Del Medico Patrizia, Caccavale Rosalba, Paroli Marino, Larosa Maddalena, Bianchi Gerolamo, Camellino Dario, Raffeiner Bernd, Nucera Valeria, Ianniello Aurora, Giampietro Cecilia, Ometto Francesca, Priora Marta, Molica Colella Aldo Biagio, Bravi Elena, Platè Ilaria, Arrigoni Eugenio, Ravagnani Viviana, Bezzi Alessandra, Mascella Fabio, Focherini Maria Cristina, Fiorenza Alessia, Rovera Guido, Vitetta Rosetta, Scolieri Palma, Bruzzese Vincenzo, Volpe Alessandro, Bixio Riccardo, Marchetta Antonio, Lumetti Federica, Farina Antonella, Bernardi Simone, Girelli Francesco, Visalli Elisa, Amato Giorgio, De Lucia Francesco, Dal Bosco Ylenia, Foti Roberta, Foti Rosario, Serale Francesca, Cipollone Francesco, Di Penta Myriam, Sabatini Emanuela, Celletti Eleonora, Franchina Veronica, Colella Francesco Molica, Ferrero Giulio, Sandri Gilda, Giuggioli Dilia, Ditto Maria Chiara, Fusaro Enrico, Adorni Giuditta, Di Donato Eleonora, Santilli Daniele, Lucchini Gianluca, Ariani Alarico
Аннотация
OBJECTIVES: To compare the effectiveness of TNFi versus IL23i in real-life PsA patients.
DESIGN: This multicenter retrospective observational study is part of the BIRRA (BIologics Retention Rate Assessment) project. Consecutive patients with PsA-classified according to the CASPAR criteria-were screened across 29 Italian rheumatology referral centers.
METHODS: We analyzed 1418 therapeutic lines for PsA initiated between 2019 and 2024 across 29 Italian rheumatology centers. Treatment lines were categorized as TNFi or IL23i based on the drug's MoA. Demographic, clinical, and treatment-related data were collected. The primary outcome was treatment retention, evaluated by Kaplan-Meier survival analysis. A Cox proportional hazards model adjusted for a propensity score (PS) was used to account for confounding factors.
RESULTS: Among 1418 prescriptions (1270 TNFi; 148 IL23i), IL23i lines were associated with older age, longer disease duration, higher baseline disease activity, and more prior biologic disease-modifying antirheumatic drugs exposure. Despite this, no significant difference in crude retention was observed. After PS adjustment, IL23i prescriptions showed significantly longer treatment retention than TNFi (hazard ratio 0.53; 95% confidence interval: 0.31-0.90; p = 0.02). Axial or mixed PsA phenotype and higher baseline Disease Activity in Psoriatic Arthritis score were associated with lower retention.
CONCLUSION: In this real-world cohort, IL23i prescriptions demonstrated comparable treatment persistence compared to TNFi, even in more challenging clinical scenarios. These findings support the inclusion of IL23i as a valid therapeutic option in PsA. Prospective studies are needed to confirm their positioning in treatment algorithms.