Unmet needs in psoriatic arthritis patients receiving immunomodulatory therapy: results from a large multinational real-world study

  • Rieke AltenEmail author
  • P. G. Conaghan
  • V. Strand
  • E. Sullivan
  • S. Blackburn
  • H. Tian
  • K. Gandhi
  • S. M. Jugl
  • A. Deodhar
Original Article



There are limited data on therapy selection and switching in psoriatic arthritis (PsA). This 18 country, real-world study assessed use and switching of immunomodulatory therapy (biologic/apremilast), the extent of treatment failure and its association with reduced physical functioning, health-related quality of life (HRQoL), and work productivity and activity impairment (WPAI).


PsA patients under routine care and their treating physicians provided demographics, current therapy, reasons for switching, duration of first therapy, HRQoL, HAQ-DI, and WPAI. Current immunomodulatory therapy was determined as “failing” if, after ≥ 3 months, physician-rated disease severity had worsened, remained severe, was “unstable/deteriorating,” or they were dissatisfied with disease control and/or did not consider treatment a “success.”


Included were 3714 PsA patients; 1455 (40.6%) had never received immunomodulatory therapy; 1796 (50.1%) had ever received 1 immunomodulatory therapy and 331 (9.2%) ≥ 1. Lack of efficacy with first immunomodulatory therapy was the most common reason for switching; patients whose physicians indicated “primary lack of efficacy” as the reason, switched after a mean of 9.4 months. Patients currently failing immunomodulator therapies (n = 246) had poorer HRQoL compared with treatment success (n = 1472) measured by EQ-5D-3L (0.60 vs 0.77%; P < 0.0001); SF-36 PCS (40.8% vs 46.1%; P < 0.0001) MCS (41.1% vs 45.3%; P < 0.0001). Physical functioning, activity, and work productivity were also more impaired (HAQ-DI: 0.88 vs 0.56; activity impairment: 46.7% vs 29.7%; overall work impairment: 35.4% vs 26.1%; all P < 0.0001).


Poor treatment response in PsA is associated with substantial negative patient impact. In cases of primary treatment failure, timely switching is needed.


Health-related quality of life Psoriatic arthritis TNFi Treatment Work 



PGC is supported in part by the UK NIHR Leeds Biomedical Research Centre. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health. The authors and Novartis would like to thank all patients and physicians who participated in this study.

Funding information

This study was supported by Novartis Pharma AG, Switzerland. Medical writing support was provided by Kate Revill of Adelphi Real World Ltd., funded by Novartis Pharma AG.

Compliance with ethical standards

Conflict of interest

RA has received grants or research support from Bristol-Myers Squibb, consulting fees from Bristol-Myers Squibb, Novartis, Pfizer Roche, and Eli Lilly. PGC has received speakers’ bureau or consulting fees from Bristol- Myers Squibb, Pfizer, and Novartis. VS has received grants and/or consulting fees from AbbVie, Amgen, AstraZeneca, BMS, Boehringer Ingelheim, Celltrion, Corrona LLC, Crescendo Bioscience, EMD Serono, F. Hoffmann-La Roche Ltd./Genentech, Inc., GSK, Janssen, Eli Lilly, Merck, Novartis, Pfizer, Regeneron, Samsung, Sandoz, Sanofi, and UCB and has served on advisory boards for AbbVie, Amgen, AstraZeneca, BMS, Celltrion, Crescendo/Myriad Genetics, EMDSerono, Genentech/Roche, GSK, Janssen, Lilly, Novartis, Pfizer, Regeneron, Sandoz, Sanofi, and UCB. AD has received grants or research support from AbbVie, Eli Lilly, GlaxoSmithKline, Janssen, Novartis, Pfizer, and UCB Pharma, and consulting fees from Eli Lilly, Janssen, Novartis, Pfizer, and UCB Pharma. ES and SB are employees of Adelphi Real World; HT and KG are shareholders and employees of Novartis; SJ is a shareholder and employee of Novartis Pharma AG.

Supplementary material

10067_2019_4446_Fig4_ESM.png (45 kb)
Supplementary Fig. 1

Reasons for switching from first to second TNFi (n = 304). Physician-reported reasons given for patient switching from first- to second-line immunomodulator therapy. *Secondary lack of efficacy (loss of response over time); ‡ I wanted to use a bDMARD that can be used in combination; † I wanted to use bDMARD that can be used as a monotherapy. bDMARD: biologic disease modifying anti-rheumatic drugs; MOA, mode of action (PNG 44 kb)

10067_2019_4446_MOESM1_ESM.tif (128 kb)
High-resolution image (TIF 128 kb)


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Copyright information

© International League of Associations for Rheumatology (ILAR) 2019

Authors and Affiliations

  • Rieke Alten
    • 1
    Email author
  • P. G. Conaghan
    • 2
  • V. Strand
    • 3
  • E. Sullivan
    • 4
  • S. Blackburn
    • 4
  • H. Tian
    • 5
  • K. Gandhi
    • 5
  • S. M. Jugl
    • 6
  • A. Deodhar
    • 7
  1. 1.Internal Medicine II, Rheumatology bei Schlosspark-KlinikUniversity MedicineBerlinGermany
  2. 2.Leeds Institute of Rheumatic and Musculoskeletal MedicineUniversity of Leeds & NIHR Leeds Biomedical Research CentreLeedsUK
  3. 3.Stanford UniversityPalo AltoUSA
  4. 4.Adelphi Real WorldManchesterUK
  5. 5.Novartis Pharmaceuticals CorporationEast HanoverUSA
  6. 6.Novartis Pharma AGBaselSwitzerland
  7. 7.Oregon Health & Science UniversityPortlandUSA

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