As quality of life (QoL) in patients with psoriatic arthritis (PsA) is significantly lower when compared with patients with psoriasis, one of the main goals of treating PsA is improving QoL.
Patients with psoriatic arthritis (PsA) receiving biologic disease-modifying antirheumatic drugs (bDMARDs) had significant improvements in quality of life (QoL) when compared with those receiving placebo, according to a study published in BMJ Open.1
“This is the first meta-analysis focusing on the effects of bDMARDs on the quality of life among patients with PsA,” investigators stated. “Rosen et al reported that the QoL of patients with PsA is significantly lower than that of patients with psoriasis. Therefore, one of the main objectives of treating PsA is to improve the QoL of patients.”
In this meta-analysis, investigators used a variety of databases, such as PubMed, Cochrane Library, China National Knowledge Infrastructure, Web of Science, VIP, and WanFang to find randomized controlled trails (RCTs) analyzing bDMARDs in patients with PsA that included information on QoL-related outcomes between November 2020 and February 2022. Keywords, such as “psoriatic arthritis,” “biologic,” “health-related quality of life,” “disease activity index for psoriatic arthritis,” and “psoriasis ability index” were used to filter for relevant studies.
The Health Assessment Questionnaire Disability Index (HAQ-DI), mental component summary of the Short Form 36 (SF-36 MCS), physical component summary of the Short Form 36 (SF-36 PCS), EuroQol Visual Analogue Scale, Dermatology Life Quality Index, and Psoriasis Area Severity Index (PASI) 50/75/90/100 were used to assess the correlation between QoL and treatment with bDMARDs.
After removing duplicates and irrelevant studies, 37 RCTs (47 articles) were included, with a total of 14,115 patients. When compared with placebo, patients receiving bDMARDs had significantly greater improvements across all assessments, including better scores regarding SF-36 PCS (MD=3.76; 95% CI, 3.42 to 4.10; p<0.00001) and SF-36 MCS (MD=1.76; 95% CI, 1.27 to 2.25; p<0.00001), and a decrease in HAQ-DI (MD=−0.19; 95% CI, −0.22 to –0.17; p<0.00001).
When compared with methotrexate (MTX) and tofacitinib, bDMARDs had no significant advantages or disadvantages. Results did not change for those receiving bDMARDs + MTX compared with monotherapy MTX.
Results of subgroup HAQ-DI analyses were as follows: bDMARDs versus placebo −0.21 (MD, 95% CI, −0.23 to –0.18); bDMARDs + MTX versus MTX −0.22 (MD, 95% CI, −0.58 to 0.14); bDMARDs versus tofacitinib –0.01 (MD, 95% CI, −0.05 to 0.04); and bDMARDs versus MTX –0.03 (MD, 95% CI, −0.04 to –0.02).
Several limitations were addressed, including publication bias, as all of the publications were written in either English or Chinese. Further, it was difficult to perform subgroup analysis based on different countries or regions because the majority of RCTs were multicenter by design. Lastly, long-term effects could not be studied as the follow-up period for the RCTs were no longer than 24 weeks.
“This meta-analysis demonstrated that the use of bDMARDs by patients with PsA appeared to significantly improve the QoL compared with a placebo,” investigators concluded. “To compare bDMARDs with other therapeutic agents, more extensive studies are still required to confirm the effect of single and combined bDMARDs.”
Lu Y, Dai Z, Lu Y, Chang F. Effects of bDMARDs on quality of life in patients with psoriatic arthritis: meta-analysis. BMJ Open. 2022;12(4):e058497. Published 2022 Apr 12. doi:10.1136/bmjopen-2021-058497