Psoriatic arthritis: the role of self-reported non-adherence, non-trough drug levels, immunogenicity and conventional synthetic DMARD co-therapy in adalimumab and etanercept response

Curry, P.D.K. orcid.org/0000-0003-0013-460X, Morris, A.P. orcid.org/0000-0002-6805-6014, Jani, M. orcid.org/0000-0002-1487-277X et al. (133 more authors) (2024) Psoriatic arthritis: the role of self-reported non-adherence, non-trough drug levels, immunogenicity and conventional synthetic DMARD co-therapy in adalimumab and etanercept response. Rheumatology Advances in Practice, 8 (1). rkae014. ISSN 2514-1775

Abstract

Objective

The aim of this study was to assess the relationship between self-reported non-adherence, non-trough drug levels, immunogenicity and conventional synthetic DMARD (csDMARD) co-therapy in TNF inhibitor (TNF-i) drug response in PsA.

Methods

Serum samples and adherence questionnaires were collected at baseline, 3, 6 and 12 months for PsA patients prescribed TNF-i. Non-trough adalimumab (ADL) and etanercept (ETN) drug levels were measured at 3 and 6 months using commercially available ELISAs. Clinical response was assessed using PsA response criteria (PsARC) and change in 28-joint DAS (ΔDAS28) between baseline and 3, 6 and 12 months.

Results

In 244 PsA patients (52.5% ADL and 47.5% ETN), self-reported non-adherence was associated with PsARC non-response over 12 months using generalized estimating equation (GEE) modelling (P = 0.037). However, there was no significant difference between non-trough ADL or ETN drug levels based on self-reported non-adherence. Higher ETN levels at 3 months were associated with PsARC response at 3 (P = 0.015), 6 (P = 0.037) and 12 months (P = 0.015) and over 12 months using GEE modelling (P = 0.026). Increased ADL drug levels at 3 months were associated with greater ΔDAS28 at 3 months (P = 0.019). ADL anti-drug antibody-positive status was significantly associated with lower 3- and 6-month ADL levels (P < 0.001) and ΔDAS28 and PsARC response at 3, 6 and 12 months. Meanwhile, MTX co-therapy was associated with a reduction in immunogenicity at 3 and 6 months (P = 0.008 and P = 0.024).

Conclusion

Although both were associated with reduced response, the objectively measured non-trough drug levels showed more significant associations with drug response than self-reported non-adherence measures.

Metadata

Item Type:	Article
Authors/Creators:	Curry, P.D.K. https://orcid.org/0000-0003-0013-460X Morris, A.P. https://orcid.org/0000-0002-6805-6014 Jani, M. https://orcid.org/0000-0002-1487-277X Chinoy, H. https://orcid.org/0000-0001-6492-1288 Barton, A. https://orcid.org/0000-0003-3316-2527 Bluett, J. https://orcid.org/0000-0001-5062-5779 Bluett, J. Chelliah, E.G. Chattopadhyay, C. Ho, P. Barton, A. Castelino, M. Bruce, I. Gorodkin, R. Hyrich, K. Parker, B. Chinoy, H. O’Neil, T. Herrick, A. Jones, A. Cooper, R. Dixon, W. Harrison, B. Jani, M. Low, A. Korendowych, E. McHugh, N. Tillett, W. Goodson, N. Lane, S. Shand, L. Pande, I. Gaywood, I. Rees, F. Rutter, M. Hayat, S. McHale, J.F. Jones, A.C. Lanyon, P. Gupta, A. Courtney, P.A. Srikanth, A. Abhishek, A. Kyle, S. Manhas, R. Nandagudi, A. Selvan, S. Bharadwaj, A. Gendi, N. Alshakh, R. Naz, S. Ahmad, M. Das, L. Pattrick, M. Bowden, A.P. Smith, E.E. Klimiuk, P. Speden, D.J. Bukhari, M. Kavaklieva, S. Ottewell, L. Massarotti, M. Packham, J. Watson, P. Sanders, P. Haque, S. Pal, B. Bruce, E. Karim, Z. Mackay, K. Shiels, H. Taylor, J. Jeffery, R. Nandi, P. Filer, C. Ismail, A. Mercer, L. Hassan, A. Russell, A. Durrani, M. Hassan, W. Samanta, A. Sheldon, P. Francis, J. Kinder, A. Neame, R. Moorthy, A. Bombardieri, M. Kelly, S. Maxwell, J. Akil, M. Till, S. Dunkley, L. Tattersall, R. Kilding, R. Tait, T. Kuet, K.-P. Grant, B. Kazmi, M. Graham, D. Abernethy, V.E. Clewes, A.R. Dawson, J.K. Fragoulis, G. Mewar, D. Tunn, E.J. Nelson, K. Kennedy, T.D. Dubois, C. Douglas, K. Ladoyanni, E. Koutsianas, C. Erb, N. Klocke, R. Whallett, A.J. Pace, A. Sandhu, R. John, H. Young Min, S.A. Cooper, A. Ledingham, J.M. Hull, R.G. McCrae, F. Wong Shaban Putchakayala, K. Kumari, R. Smith, G. Marguerie, C. Reynolds, P. Thornton, C. Gorman, C. Murphy, C. Roy, D. Horton, S. Castelino, M.
Copyright, Publisher and Additional Information:	© 2024 The Author(s). Published by Oxford University Press on behalf of the British Society for Rheumatology. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non Commercial License (https://creativecommons.org/ licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
Keywords:	TNF inhibitors; drug levels; drug response; immunogenicity; non-adherence; psoriatic arthritis
Dates:	Published: 30 January 2024 Published (online): 30 January 2024 Accepted: 19 January 2024 Submitted: 1 November 2023
Institution:	The University of Sheffield
Academic Units:	The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield)
Depositing User:	Symplectic Sheffield
Date Deposited:	14 Jun 2024 10:07
Last Modified:	14 Jun 2024 10:07
Status:	Published
Publisher:	Oxford University Press (OUP)
Refereed:	Yes
Identification Number:	10.1093/rap/rkae014
Related URLs:	PubMed URL
Open Archives Initiative ID (OAI ID):	oai:eprints.whiterose.ac.uk:213266

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Psoriatic arthritis: the role of self-reported non-adherence, non-trough drug levels, immunogenicity and conventional synthetic DMARD co-therapy in adalimumab and etanercept response

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