Better Clinical Responses Observed With Early Initiation of DMARD Therapy in Treatment of PsA

Among patients with psoriatic arthritis (PsA), initiation of therapy with disease modifying antirheumatic drugs (DMARDs) within 1 year of diagnosis achieved better clinical response compared with those who postponed therapy initiation, according to a study recently presented at American College of Rheumatology Convergence 2022.

Researchers described patient characteristics and compared clinical and patient-reported outcomes (PROs) between patients with PsA in the CorEvitas PsA/Spondyloarthritis (SpA) Registry who initiated DMARD therapy earlier vs later in their disease course.

Patients were classified as early initiators (initiated the same or subsequent year of PsA diagnosis) or as late initiators (initiated > 1 subsequent year after PsA diagnosis). The correlations of early vs late DMARD initiation with disease activity and PROs at 6 months were measured utilizing unadjusted and adjusted linear and Poisson regression.

A total of 291 patients were included: 229 (79%) were early and 62 (21%) were late initiators. Among early initiators, 83% initiated therapy in the same or subsequent year of PsA diagnosis. Among late initiators, 50% initiated therapy 2 to 7 years after PsA diagnosis.

The average age at DMARD initiation was 53.2 and 54 years for early and late initiators, respectively. Early and late initiators varied according to smoking status (14% early vs 6.5% late current smokers), history of depression (15.7% vs 8.1%), and history of fibromyalgia (10.9% vs 4.8%).

Results revealed that early initiators described greater severity of disease activity and worse PROs at index visit than late initiators. From index to 6-month follow-up visit, improvements were observed across all disease activity measures and PROs in both groups, with greater improvements observed in the early initiators in the unadjusted models.

In adjusted analyses, early initiation was more likely to be correlated with better response, although only achievement of minimal disease activity and average change in clinical disease activity index (β = 95% CI, −3.4 [- 6.2, to 0.49] were statistically significantly different. Results were comparable in sensitivity analyses centered on time from symptom onset.

In this study, the authors noted that among patients who initiated their first DMARD therapy, improvements across all disease activity measures and PROs up to 6 months post-initiation were experienced in both early and late initiators.

They concluded, “However, findings indicate that a better response, including minimal disease activity, may be achieved in patients initiating DMARD therapy within 1 year of diagnosis vs delaying treatment initiation.”


—Yvette C. Terrie



Mease P, Nowak M, Choi J, Lehman T, Sreih A, Blachley T, Dube B, Ho K, Middaugh N, Ogdie A. Impact of delay of treatment with disease modifying antirheumatic drugs (DMARDs) in psoriatic arthritis: lessons from the CorEvitas PsA/SpA registry. Paper presented at: American College of Rheumatology Convergence 2022; November 10-24, 2022; Philadelphia, PA. Accessed November 14, 2022.