Effectiveness of Certolizumab-Pegol in Rheumatoid Arthritis, Spondyloarthritis, and Psoriatic Arthritis Based on the BIOPURE Registry: Can Early Response Predict Late Outcomes?

BackgroundIdentification of predictors of clinical response to certolizumab-pegol (certolizumab) may aid the decision-making process for treating patients with rheumatoid arthritis (RA), spondyloarthritis (SpA), and psoriatic arthritis (PsA).ObjectiveThe aim of our study was to evaluate the effectiveness of certolizumab and identify any predictors of favorable outcome in patients with RA, PsA, or SpA.MethodsWe studied 355 RA, SpA, and PsA patients starting treatment with certolizumab. Endpoints of the study were drug survival and identification of predictors of clinical outcome. Drug retention was analyzed via the Kaplan-Meier method, and hazard ratios (HRs) were estimated using Cox regression models.ResultsOf 355 certolizumab initiators, 178 had RA, 94 had PsA, and 83 had SpA. Biologic-naive RA patients had significantly higher survival rates (73.3%) than switchers taking certolizumab as a second-line (49.0%) or third- or next-line biologic agent (51.2%; p=0.0001). Instead, PsA and SpA patients showed similar drug retention rates regardless of the line of treatment. A significant clinical improvement from baseline was seen at 3months for RA (28 joint-Disease Activity Score [DAS28]; p=0.001), PsA (Disease Activity Index for PsA [DAPSA]; p=0.001), and SpA (Bath Ankylosing Disease Index; p=0.01). Biologic-naive patients had the lowest HR (0.31; p=0.001) of discontinuing certolizumab for RA, and the highest HR (7.94; p=0.01) of achieving minimal disease activity (MDA) for PsA. For PsA, a predictor of late MDA was the achievement of low/remission DAPSA at 3months, and 3-month low/remission DAS28 predicted late remission for RA.ConclusionsOur study revealed that the best predictor of certolizumab effectiveness in unselected patients with RA, PsA, or SpA was a biologic-naive status and achievement of an early response within 3months.