OBJECTIVES

: As a PDE4 inhibitor, apremilast is a unique agent in the treatment armamentarium for psoriatic arthritis (PsA). It is the one targeted immune modulating (TIM) treatment that may be combined with csDMARDs, biologic therapies, or used as a monotherapy. Here we examined care for PsA in a large network of community rheumatologists focusing on use of apremilast relative to TNF inhibitors.

METHODS

: This study analyzed patients diagnosed with PsA receiving apremilast monotherapy or TNF inhibitor monotherapy as initial targeted treatment between Jan 2014 to Nov 2019 with ≥6 months follow-up. Disease Assessment Scores (DAS) were calculated using CDAI or Rapid 3. As a surrogate for clinical effectiveness, we examined time from monotherapy initiation to modification or discontinuation, defined as either drug discontinuation or addition of a csDMARD or TIM, via KM analyses.

RESULTS

: Of 817 apremilast-treated patients, 378 (46%) had no prior observed PsA treatment, 205 (25%) had previous csDMARDs treatment alone, and 234 (29%) previously received other TIM therapies. 329 apremilast-treated patients and 2438 TNFi-treated patients were identified as receiving monotherapy with no prior TIM therapy. From the TNFi-group, a subset of 658 patients were selected based on propensity score matching. Characteristics for the apremilast monotherapy and TNFi monotherapy groups differed significantly for gender and age group but not for baseline disease severity. Median time from monotherapy initiation to initial modification or discontinuation was significantly different between apremilast (17.0 months) and TNFi (34.4 months, p=0.002). In subset analyses, these differences persisted among females (p = 0.03), males (p <0.001) and patients with severe baseline DAS (p=0.009), but not different among non-severe baseline DAS.

CONCLUSIONS

: Time to apremilast modification or discontinuation was significantly less than the matched TNFi group. However, when stratified by baseline DAS, those with low DAS had no difference in time to modification between apremilast and TNFi.