Data from the Romanian Registry of Rheumatic Diseases for patients with psoriatic arthritis treated with biologic and targeted-synthetic disease-modifying anti-rheumatic drugs – 2023 update

Andra Rodica Bălănescu^(1,4), Magda Pîrvu⁽³⁾, Corina Mogoșan^(2,4,*), Daniela Nicoleta Popescu⁽³⁾, Claudiu Avram⁽⁵⁾, Răzvan Ionițescu⁽⁶⁾, Laura Otilia Damian⁽⁷⁾, Andrei Martin^(4,8), Cătălin Codreanu^(2,4)

1)Department of Internal Medicine and Rheumatology, "Sf. Maria" Hospital, Bucharest, Romania
2)"Dr. Ion Stoia" Clinical Center for Rheumatic Diseases, Bucharest, Romania
3)Department of Rheumatology "Colentina" Hospital, Bucharest, Romania
4)University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
5)Department of Balneology, Medical Rehabilitation and Rheumatology, "Victor Babeș" University of Medicine and Pharmacy Timișoara, Romania
6)Department of Rheumatology, Vâlcea Emergency County Hospital, Ramnicu-Vâlcea, Romania
7)Rheumatology Deptartment, Centre for Rare Autoimmune and Autoinflammatory Musculoskeletal Diseases-ERN-ReConnet, Emergency Clinical County Hospital Cluj, Cluj-Napoca, Romania
8)Department of Internal Medicine and Rheumatology, "Dr. I. Cantacuzino" Hospital, Bucharest, Romania

Background. The Romanian Registry of Rheumatic Diseases (RRBR) is an electronic database that includes information on all patients with immune-mediated rheumatic diseases undergoing innovative therapies. These real-world data include demographics, clinical manifestations, comorbidities, biologic disease-modifying anti-rheumatic drug (bDMARD) treatment regimens, as well as efficacy and safety data, which are analysed annually.
Methods. The aim of this report was to analyse the data recorded from patients diagnosed with psoriatic arthritis (PsA) enrolled in RRBR in 2022, especially considering the updated therapeutic protocol approved by the National Health Insurance Company of Romania, which now includes newly approved therapeutic agents.
Results. The findings revealed a relatively constant number of patients included in RRBR compared to previous years. Patients with PsA exhibited numerous comorbidities, with cardiovascular conditions being the most frequently observed. Most patients continued to receive combination therapy with a conventional synthetic disease-modifying anti-rheumatic drug (csDMARD), methotrexate being the most commonly used, although at a slightly lower percentage than in previous years. The concurrent use of systemic glucocorticoids was recorded at a very low percentage. There was a trend towards initiating biologic treatment earlier, with 40% of patients having initiated biologic therapy within the first two years after diagnosis. The most commonly prescribed bDMARDs remained TNF blockers, with etanercept (original + biosimilar) being the most prevalent, followed by adalimumab (original + biosimilar), data consistent with previous years, though the prescription percentage of biosimilars increased. Recently, other therapeutic agents with different mechanisms of action, (such as ixekizumab, guselkumab and tofacitinib), have been reimbursed in Romania. These medications were used in 41% of initiated cases and represented the first choice in case of treatment changes. Over 90% of patients included in RRBR exhibited low disease activity or were in remission state. Although the percentage of patients undergoing a tapering regimen remained low, this strategy proved to be a valid option for the majority to whom it was applied.
Conclusion. RRBR represents an invaluable tool for assessing real-world data concerning PsA patients and the therapeutic approaches used in Romania. It allows for the integration and interpretation of these findings in the context of similar registries, identifying aspects that could contribute to enhancing the quality of PsA management in our country.

Keywords: psoriatic arthritis, Romanian Registry of Rheumatic Diseases, biologics

Corresponding author(s): Corina Mogoșan, Dr. Ion Stoia Clinical Center for Rheumatic Diseases, 5th Thomas Masaryk Street, Bucharest, Romania; e-mail: cmogosan@yahoo.com