Predictors of b/tsDMARDs discontinuation and treatment response in psoriatic arthritis: results from the British Society for Rheumatology Psoriatic Arthritis Register (BSR-PsA)
Rheumatology · 27 Oct 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
Musculoskeletal trainees who see psoriatic arthritis patients should know that response to advanced therapy is often incomplete, and that baseline pain burden, obesity and disease severity predict poorer persistence.
The evidence
This UK registry study followed 815 adults with psoriatic arthritis who started a new biologic or targeted synthetic DMARD and looked for baseline factors linked to stopping the drug or responding at 12 months. About 65% were still on their starting drug at censoring. Patients starting a PDE4 inhibitor (apremilast) stopped more often than those starting a TNF inhibitor (unadjusted HR 2.62, 95% CI 1.71 to 4.00). Only about a quarter reached minimal disease activity or ACR50 at 12 months; women, older patients, the unemployed, and those with worse baseline disease or widespread pain responded less often.
b/tsDMARD discontinuation: Hazard ratio 2.62 (95% CI 1.71 to 4; ratio). Interpret in the study's stated comparison; this alone does not establish a treatment's causal effect.
Why this rigour score?
Inception cohortDesign starting point: 37.4
Raised the score
- Compared against current standard of care+3.4
- Aligned time zero+2.5
Lowered the score
No negative adjustments recorded.
Methods at a glance
Recorded assessment- Confounding adjustmentMultivariable regression
- Covariate balance confirmedNot applicable
- Outcome assessors blindedNot reported
- Comparable start of follow-upMet
- Adequate statistical powerNot reported
- Prospective registrationNot met
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
See the full score breakdown
- Study design starting point
- 37.4
- Aligned time zero
- +2.5
- Compared against current standard of care
- +3.4
- Final rigour score rounded
- 43 / 100
Study design sets the starting point and a ceiling of 76. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.Given that apremilast was stopped more often than TNF inhibitors, which psoriatic arthritis patients, if any, would you still start on a PDE4 inhibitor first?
2.If high polysymptomatic distress and obesity predict non-response, how should you counsel these patients and add non-drug treatments when starting a biologic?
Original publication title
Predictors of b/tsDMARDs discontinuation and treatment response in psoriatic arthritis: results from the British Society for Rheumatology Psoriatic Arthritis Register (BSR-PsA)