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Residual disease associated with suboptimal treatment response in patients with psoriatic arthritis: a systematic review of real world evidence

Abstract:

Objective: This systematic literature review aimed to identify and summarise real-world observational studies reporting the type, prevalence and/or severity of residual symptoms and disease in adults with psoriatic arthritis (PsA) who have received treatment and been assessed against remission or low disease activity targets.

Methods: Patients had received treatment and been assessed with treat-to-target metrics including minimal disease activity (MDA), Disease Activity Index in PsA (DAPSA) and others. MEDLINE, Embase® and the Cochrane Database of Systematic Reviews (CDSR) were searched using search terms for PsA, treatment targets and observational studies. Screening of search results was completed by two independent reviewers; studies were included if they reported relevant residual disease outcomes in adults with PsA who had received one or more pharmacological treatments for PsA in a real-world setting. Non-observational studies were excluded. Information from included studies was extracted into a prespecified grid by a single reviewer and checked by a second reviewer.

Results: Database searching yielded 2,328 articles; 42 publications (27 unique studies) were included. 23 studies reported outcomes for MDA assessed patients, 14 studies reported outcomes for DAPSA assessed patients. Physician- and patient reported residual disease was less frequent and/or severe in patients reaching targets, but often not absent, including when patients achieved very low disease activity (VLDA) or remission. For example, studies reported 0–8% patients in DAPSA (or clinical DAPSA) remission had >1 tender joint, 25–39% had PASI >1, and 0–10% had patient reported pain >15. Residual disease was usually less frequent and/or severe among patients achieving MDA-assessed targets versus DAPSA­assessed targets, especially for skin outcomes.

Conclusion: The findings demonstrate a need for further optimisation of care for patients with PsA.

Publication status:
Published
Peer review status:
Peer reviewed

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Publisher copy:
10.1007/s40744-022-00443-y

Authors


More by this author
Institution:
University of Oxford
Division:
MSD
Department:
NDORMS
Sub department:
Botnar Research Centre
Role:
Author
ORCID:
0000-0002-4756-663X


Publisher:
Springer
Journal:
Rheumatology and Therapy More from this journal
Volume:
9
Pages:
803–821
Publication date:
2022-04-12
Acceptance date:
2022-03-14
DOI:
EISSN:
2198-6576


Language:
English
Keywords:
Pubs id:
1246332
Local pid:
pubs:1246332
Deposit date:
2022-03-18

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