On-Label Treatment Persistence Through 24 Months Among Patients with Active Psoriatic Arthritis Initiating Guselkumab or Subcutaneous Tumor Necrosis Factor Inhibitors

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INTRODUCTION: There is limited prior literature comparing long-term treatment persistence between guselkumab and subcutaneous (SC) tumor necrosis factor inhibitors (TNFi) in biologic-naïve and biologic-experienced patients with active psoriatic arthritis (PsA). This study compared on-label persistence through 24 months between patients with active PsA newly initiating guselkumab or SC TNFi. METHODS: Plus database was used to identify adults with active PsA initiating guselkumab or an SC TNFi (adalimumab or biosimilar, certolizumab pegol, etanercept or biosimilar, SC golimumab) between 07/14/2020 and 12/31/2022 (index date: first treatment claim for one of these medications). Patients were further stratified as biologic-naïve (no pre-index biologic disease-modifying antirheumatic drug [bDMARD] claim) or biologic-experienced (≥ 1 pre-index bDMARD claim). The guselkumab and SC TNFi cohorts were balanced using overlap propensity score weighting. Treatment persistence with on-label therapy (absence of dose modification or therapy exposure gap of twice the duration between consecutive administrations, i.e., 112 days for guselkumab or 56 days for SC TNFi) was estimated using weighted Kaplan-Meier analysis through 24 months. On-label persistence rates were compared between cohorts using weighted Cox proportional hazards models. RESULTS: In the guselkumab cohort (N = 804), 361 (44.9%) were biologic-naïve and 443 (55.1%) were biologic-experienced; in the SC TNFi cohort (N = 2490), 2171 (87.2%) were biologic-naïve and 319 (12.8%) were biologic-experienced. At 24 months post index, on-label persistence rates were 45.5% (guselkumab) versus 28.5% (SC TNFi; P < 0.001). Patients initiating guselkumab were 2.24 times more likely to be persistent with on-label therapy through 24 months than patients initiating an SC TNFi (hazard ratio [95% confidence interval] 2.24 [1.90, 2.64]; P < 0.001). Results were consistent among biologic-naïve (2.36 [1.88, 2.98]; P < 0.001) and biologic-experienced patients (1.86 [1.46, 2.37]; P < 0.001). CONCLUSION: Patients with active PsA initiating guselkumab were significantly (approximately two times) more likely to remain persistent with on-label therapy through 24 months versus SC TNFi, overall and among biologic-naïve and biologic-experienced subgroups.

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