• Lorena Exposito, Carlos Sánchez-Piedra, Paloma Vela-Casasempere, Manuel José Moreno-Ramos, Cristina Campos, Cristina Bohorquez, Javier Manero, Jerusalem Calvo-Gutiérrez, Carlos Rodríguez-Lozano, Dolores Ruiz-Montesino, Noemí Busquets, Javier García-González, Isabel Castrejón, Fernando Alonso, Sagrario Bustabad, and Federico Díaz-González.
• Rheumatology Unit, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
• Eur. J. Clin. Invest. 2024 Feb 1; 54 (2): e14095e14095.

ObjectiveThe persistence of biologic (b) and targeted synthetic (ts) disease-modifying antirheumatic drugs(DMARDs) in monotherapy versus in combination with conventional synthetic (cs) DMARDs is still a controversial topic in rheumatic diseases. To clarify this issue, the retention of the initial treatment strategy of b/tsDMARD in combination with csDMARD versus monotherapy in rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) patients under real-life conditions was evaluated. Factors associated with maintenance of the initial strategy were analysed.MethodsNested cohort study within the Spanish BIOBADASER III registry. Bivariate comparisons and multivariate Cox proportional hazards models were used for the analyses.ResultsA total of 2521 patients were included in the study. In the multivariate model, the initial strategy of combination therapy was associated with shorter persistence in patients with RA (hazard ratio [HR] 1.58;95% confidence interval [CI] 1.00-2.50; p = .049), PsA (HR 2.48; 95% CI 1.65-3.72) and AS (HR 16.77; 95% CI 7.37-38.16; p < .001), regardless of sex, time of disease progression, baseline disease activity, glucocorticoid use or type of b/tsDMARD. Overall, the combination strategy was associated with an increased incidence of adverse events (incidence rate ratio [IRR] 1.13; 95% CI 1.05-1.21).ConclusionsIn this real-life study, the strategy of combining a b/tsDMARD with a csDMARD is associated with lower persistence and worse safety profile compared to monotherapy in RA and especially in PsA and AS, suggesting that combination therapy should be rethought as first choice in RA patients, but especially in PsA and AS patients.© 2023 The Authors. European Journal of Clinical Investigation published by John Wiley & Sons Ltd on behalf of Stichting European Society for Clinical Investigation Journal Foundation.

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