OBJECTIVE: To investigate real-world retention and remission rates in PsA patients initiating a 2nd or 3rd TNFi and the association with reason for discontinuation from the previous TNFi-treatment. METHODS: Prospectively collected routine care data from 12 European registries were pooled. Retention rates (Kaplan-Meier estimation) and crude/LUNDEX-adjusted rates of Disease Activity Score 28 and Disease Activity index for PSoriatic Arthritis (DAS28 and DAPSA28) remission were calculated and compared with adjusted Cox regression analyses and Chi-squared test, respectively). RESULTS: We included 5233 (2nd TNFi) and 1906 (3rd TNFi) patients. Twelve-month retention rates for the 2nd and 3rd TNFi were 68% (95%CI: 67-70%) and 66% (64-68%), respectively. Patients who stopped the previous TNFi due to AE/LOE had 12-month retention rates of 66%/65% (2nd TNFi), and 65%/63% (3rd TNFi), respectively. Patients who stopped the previous TNFi due to LOE after less vs more than 24 weeks had 12-month retention rates of 54%/69% (2nd TNFi), and 58%/65% (3rd TNFi). Six-month crude/LUNDEX-adjusted DAS28 remission rates were 48%/35% and 38%/27%, and DAPSA28 remission rates were 19%/14% and 14%/10%, for the 2nd and 3rd TNFi. CONCLUSION: Two-thirds of patients remained on TNFi at 12months for both the 2nd and 3rd TNFi, while one-third and one-quarter of patients were in DAS28 remission after 6months on the 2nd and 3rd TNFi. While drug effectiveness was similar in patients who stopped the previous TNFi due to AE compared to overall LOE, drug effectiveness was better in patients who had stopped the previous TNF due to secondary LOE compared to primary LOE.

Aberdeen Centre for Arthritis and Musculoskeletal Health University of Aberdeen Aberdeen United Kingdom

Amsterdam UMC University of Amsterdam Department of Clinical Immunology and Rheumatology Amsterdam The Netherlands; Amsterdam Rheumatology and immunology Center Academic Medical Center Amsterdam The Netherlands

biorx si and the Department of Rheumatology University Medical Centre Ljubljana Slovenia and Faculty of Medicine University of Ljubljana Ljubljana Slovenia

Center for treatment of Rheumatic and Musculoskeletal Diseases Diakonhjemmet Hospital Oslo Norway and Faculty of Medicine University of Oslo Oslo Norway

Center of Rheumatic Diseases University of Medicine and Pharmacy Bucharest Romania

Centre for Rheumatology Research University Hospital and Faculty of Medicine University of Iceland Reykjavik Iceland

Copenhagen Center for Arthritis Research Center for Rheumatology and Spine Diseases Centre for Head and Orthopaedics Rigshospitalet Glostrup Denmark

Copenhagen Center for Arthritis Research Center for Rheumatology and Spine Diseases Centre for Head and Orthopaedics Rigshospitalet Glostrup Denmark; Department of Clinical Medicine University of Copenhagen Copenhagen Denmark

Copenhagen Center for Arthritis Research Center for Rheumatology and Spine Diseases Centre for Head and Orthopaedics Rigshospitalet Glostrup Denmark; Department of Rheumatology Geneva University Hospital Geneva Switzerland; Research Unit Sørlandet Hospital Kristianssand Norway

DANBIO Registry Center for Rheumatology and Spine Diseases Centre for Head and Orthopaedics Rigshospitalet Glostrup Denmark; Department of Rheumatology Aarhus University Hospital Aarhus Denmark

Department of Rheumatology and Inflammation Research Sahlgrenska Academy at University of Gothenburg Gothenburg Sweden

Department of Rheumatology Geneva University Hospital Geneva Switzerland

GISEA registry Rheumatology Unit DETO University of Bari Bari Italy

Health Technology Assessment Agency Instituto de Salud Carlos 3 Madrid Spain

Inflammation Center Department of Rheumatology Helsinki University Hospital Helsinki Finland

Institute of Rheumatology and Department of Rheumatology 1st Faculty of Medicine Charles University Prague Czech Republic

Leitender Arzt der Universitätsklinik für Rheumatologie Immunologie und Allergologie Inselspital Bern Switzerland

Radboudumc Department of Rheumatology PO box 9101 6500 Nijmegen HB The Netherlands

Reuma pt registry Rheumatology Department Centro Hospitalar do Baixo Vouga Aveiro and Comprehensive Health Research Center NOVA University of Lisbon Lisboa Portugal

Reuma pt registry; Department of Rheumatology Hospital Garcia de Orta Almada and Instituto de Medicina Molecular Faculdade de Medicina Universidade de Lisboa Lisboa Portugal

Rheumatology Department Complejo Hospitalario Universitario de Santiago de Compostela Santiago de Compostela Santiago Spain

ROB FIN Registry Helsinki University and Helsinki University Hospital Helsinki Finland

TURKBIO Registry and Division of Rheumatology School of Medicine Dokuz Eylul University Izmir Turkey

University of Iceland Faculty of Medicine and Landspitali University Hospital Reykjavik Iceland

Zitelabs Aps Copenhagen Denmark

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