Effects of previous csDMARDs exposure and csDMARDs co-medication on psoriatic arthritis refractory to bDMARDs

While new targeted therapies are approved and available for patients with psoriatic arthritis (PsA), complete remission remains an area of unmet need. Importantly, a proportion of patients are refractory to one or more biologic disease-modifying antirheumatic drugs (bDMARDs), resulting a significant clinical challenge. Although conventional synthetic disease-modifying antirheumatic drug (csDMARD) has been one of the most widely used medications for PsA, very few studies have investigated the impact of the previous csDMARDs exposure on the risk of development of PsA refractory to bDMARDs. Moreover, there is no conclusive recommendation on the comedication with csDMARDs during bDMARDs therapy. To elucidate the impact of previous csDMARDs exposure and csDMARDs co-medication on the treatment outcome of PsA refractory to bDMARDs, a retrospective study was performed at the Department of Dermatology of Xiangya Hospital.尽管目前已有针对银屑病关节炎（psoriatic arthritis, PsA）的新型靶向治疗药物获批并可用于临床患者，但实现疾病完全缓解仍是一项尚未满足的临床需求。值得关注的是，部分患者对一种或多种生物改善病情抗风湿药（biologic disease-modifying antirheumatic drugs, bDMARDs）产生耐药，这已然成为一项严峻的临床挑战。虽然传统合成改善病情抗风湿药（conventional synthetic disease-modifying antirheumatic drug, csDMARD）是银屑病关节炎应用最为广泛的治疗药物之一，但目前极少有研究探讨既往csDMARD暴露对bDMARD耐药型银屑病关节炎发病风险的影响。此外，针对bDMARD治疗期间联合使用csDMARD的方案，目前尚无明确的临床推荐。为阐明既往csDMARD暴露及联合用药对bDMARD耐药型银屑病关节炎治疗结局的影响，湘雅医院皮肤科开展了一项回顾性研究。