Vol.:(0123456789) 1 3 Rheumatology International https://doi.org/10.1007/s00296-018-4144-8 CLINICAL TRIALS Long-term etanercept survival in patients with psoriatic arthritis: a multicenter retrospective analysis in daily clinical practice in Spain Gustavo Deza 1  · Jaime Notario 2  · Marta Ferran 1  · Emma Beltrán 3  · Miriam Almirall 3  · Rebeca Alcalá 1  · José Carlos Ruiz‑Carrascosa 4  · Ricardo Sánchez 4  · Silvia Pérez 5  · María Luz García‑Vivar 5  · Eva Galíndez 5  · Maribel Mora 6  · Jesús Rodríguez 6  · Fernando Gallardo 1 Received: 11 July 2018 / Accepted: 21 August 2018 © Springer-Verlag GmbH Germany, part of Springer Nature 2018 Abstract Although several randomized clinical trials and observational studies have evaluated the efectiveness, safety and drug sur- vival of etanercept (ETN) in the treatment of psoriatic arthritis (PsA), long-term data regarding these aspects are currently scarce. For this reason, we sought to investigate the long-term survival and safety of ETN in PsA patients in 4 tertiary care Spanish hospitals over a 13-year observation period (from 2004 to 2017). The records of 85 PsA patients were reviewed. ETN showed an excellent survival profle, with rates of treatment discontinuation at 1, 3, 5 and 10 years of 15, 37, 46 and 59%, respectively. In our cohort, a trend toward longer drug survival in patients with shorter disease duration and those who were treated with ETN as their frst biologic agent was observed. On the other hand, combination therapy with conventional disease-modifying antirheumatic drugs did not provide greater improvement on the long-term drug survival. Only 12% of the patients reported adverse events (AEs) during therapy, being most of them of mild to moderate intensity, and in only 7% AEs led to drug discontinuation. To the best of our knowledge, the present study shows the largest follow-up period of ETN-treated population analyzed in a real-life setting, and these results demonstrate the positive safety profle and long-term efectiveness of this biologic agent in the management of PsA patients. Keywords Arthritis · Etanercept · Psoriasis · Psoriatic · Survival · TNF-α blockers Introduction Psoriatic arthritis (PsA) is a chronic and heterogeneous dis- ease characterized by infammation of the joints, tendons and entheses [1, 2]. Its prevalence among Caucasian population is approximately 0.05–0.25%, with an estimated incidence ranging from 3.6 to 7.2 per 100,000 person-years [1]. Due to pain, swelling and occasional joint deformity, PsA may lead to a signifcant functional impairment and profound impact on the patients’ quality of life. Conventional drug therapy of PsA has mainly consisted of non-steroidal anti-infammatory drugs, regular physi- otherapy, local injections of corticosteroids, and the con- ventional synthetic disease-modifying antirheumatic drugs (csDMARDs), such as methotrexate (MTX), sulfasalazine and leflunomide [2–4]. However, many patients remain uncontrolled despite these therapies [3]. The emergence of biological tumor necrosis factor-α (TNF-α) inhibitors was a breakthrough in the management of PsA, since these agents have demonstrated their ability to induce a rapid and per- sistent clinical remission and improve many aspects of the disease [5–7]. As of yet, fve TNF-α blockers are licensed for PsA management: etanercept (ETN), adalimumab (ADA), infiximab (IFX), golimumab and certolizumab, with the greater experience and data available on larger cohorts of patients for the frst three drugs [8]. ETN is a recombinant, dimeric fusion protein consisting of two molecules of the soluble, extracellular ligand-binding portion of the p75 human TNF receptor linked to the Fc por- tion of human immunoglobulin G 1 [9]. ETN blocks the inter- action of TNF with receptors on the cell surface, prevents TNF-mediated infammatory cellular responses and modu- lates the efects of other TNF-induced molecules [9]. Several randomized controlled trials (RCTs) have demonstrated the Rheumatology INTERNATIONAL Gustavo Deza and Jaime Notario contributed equally to this work. * Fernando Gallardo 93702@parcdesalutmar.cat Extended author information available on the last page of the article