Depression and treatment timing affect the effectiveness of biologic therapy in psoriatic arthritis patients

According to data, a high tender joint count and depression, anxiety, or older age can also lead to discontinuation of biologic therapy in psoriatic arthritis (PsA). According to Dr. Rida and colleagues, new biological disease-modifying antirheumatic drugs (bDMARDs) for PsA have improved disease management and slowed radiographic disease progression. This study was published in the recent issue of Arthritic Care & Research.

This retrospective analysis of data from 571 PsA patients observed a 3-year persistence probability with certolizumab when used as the first biologic treatment and interleukin-17 inhibitors to be the lowest probability. Experts reported that certolizumab had the lowest drug survival, even after selection bias was considered when it was taken as a second treatment. Higher rates of drug cessation due to all causes were linked to depression and/or anxiety (relative risk [RR] 1.68, P = 0.01), while lower rates were linked to higher education (RR 0.65, P = 0.03). A higher tender joint count was linked to a higher risk of discontinuation due to all causes in the analysis that considered several courses of biologics (RR 1.02, P = 0.01). Obesity played a protective function (RR 0.56, P = 0.05), but older age at the beginning of the first treatment was related to a higher likelihood of cessation due to side effects (RR 1.03, P = 0.01).

A 2020 study compared the non-persistence time for either ustekinumab or secukinumab with the reference adalimumab group in PsA patients. Experts found that the persistency profile of ustekinumab treatment was relative to adalimumab. Moreover, the performance of secukinumab is dependent on biologic experience. Ustekinumab was linked to a lower risk of non-persistence compared to adalimumab in both biologic-experienced and biologic-naive patients (hazard ratio (HR) 0.48 and 0.65, respectively), whereas secukinumab was linked to a lower risk in biologic-experienced patients (HR 0.65) but a higher risk of non-persistence in biologic-naive patients (HR 1.20). Female sex, axial involvement, recent disease onset, biologic therapy experience, and no psoriasis were also linked to biologic non-persistence.

Thus, how long patients take a biologic depends on whether it was the first or second line of treatment. Drug discontinuance is caused by depression, anxiety, a higher number of sore joints, and advanced age.


  1. Rida MA, Lee KA, Chandran V, Cook RJ, Gladman DD. Persistence of Biologics in the Treatment of Psoriatic Arthritis (Psa): Data From a Large Hospital Based Longitudinal Cohort. Arthritis Care & Research. 2023 Mar 13.
  2. Geale K, Lindberg I, Paulsson EC, Wennerström EC, Tjärnlund A, Noel W, Enkusson D, Theander E. Persistence of biologic treatments in psoriatic arthritis: a population-based study in Sweden. Rheumatology advances in practice. 2020;4(2):rkaa070.