Inflammatory hallmarks of lesser prominence in psoriatic arthritis patients starting biologics: A Nordic population-based cohort study

Rebekka Lund Hansen*, Tanja Schoedt Jørgensen, Lene Dreyer, Merete L. Hetland, Bente Glintborg, Johan Askling, Daniela Di Giuseppe, Lennart T.H. Jacobsson, Johan K. Wallman, Dan Nordstrom, Kalle Aaltonen, Eirik K. Kristianslund, Tore K. Kvien, Sella A. Provan, Björn Guðbjörnsson, Þorvarður Jón Löve, L. E. Kristensen

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Objectives: To assess secular trends in baseline characteristics of PsA patients initiating their first or subsequent biologic DMARD (bDMARD) therapy and to explore prescription patterns and treatment rates of bDMARDs from 2006 to 2017 in the Nordic countries. Methods: PsA patients registered in the Nordic rheumatology registries initiating any treatment with bDMARDs were identified. The bDMARDs were grouped as original TNF inhibitor [TNFi; adalimumab (ADA), etanercept (ETN) and infliximab (IFX)]; certolizumab pegol (CZP) and golimumab (GOL); biosimilars and ustekinumab, based on the date of release. Baseline characteristics were compared for the five countries, supplemented by secular trends with R2 calculations and point prevalence of bDMARD treatment. Results: A total of 18 089 patients were identified (Denmark, 4361; Iceland, 449; Norway, 1948; Finland, 1069; Sweden, 10 262). A total of 54% of the patients were female, 34.3% of patients initiated an original TNFi, 8% CZP and GOL, 7.5% biosimilars and 0.3% ustekinumab as a first-line bDMARD. Subsequent bDMARDs were 25.2% original TNFi, 9% CZP and GOL, 12% biosimilars and 2.1% ustekinumab. From 2015 through 2017 there was a rapid uptake of biosimilars. The total of first-line bDMARD initiators with lower disease activity increased from 2006 to 2017, where an R2 close to 1 showed a strong association. Conclusion: Across the Nordic countries, the number of prescribed bDMARDs increased from 2006 to 2017, indicating a previously unmet need for bDMARDs in the PsA population. In recent years, PsA patients have initiated bDMARDs with lower disease activity compared with previous years, suggesting that bDMARDs are initiated in patients with a less active inflammatory phenotype.

Original languageEnglish
Pages (from-to)140-146
Number of pages7
JournalRheumatology (United Kingdom)
Issue number1
Early online date27 Jun 2020
Publication statusPublished - Jan 2021

Bibliographical note

Funding Information:
This study was partly funded by a grant from NordForsk, FOREUM and the OAK Foundation (OCAY-18-774-OFIL).

Publisher Copyright:
© 2020 The Author(s). Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.

Other keywords

  • Adalimumab/therapeutic use
  • Antibodies, Monoclonal/therapeutic use
  • Antirheumatic Agents/therapeutic use
  • Arthritis, Psoriatic/drug therapy
  • Biosimilar Pharmaceuticals/therapeutic use
  • Certolizumab Pegol/therapeutic use
  • Cohort Studies
  • Drug Prescriptions/statistics & numerical data
  • Etanercept/therapeutic use
  • Female
  • Finland/epidemiology
  • Humans
  • Iceland/epidemiology
  • Infliximab/therapeutic use
  • Male
  • Middle Aged
  • Norway/epidemiology
  • Sweden/epidemiology
  • Time Factors
  • Ustekinumab/therapeutic use


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