Valorization of Vegetal Fibers (Hemp, Flax, Miscanthus and Bamboo) in a Fiber Reinforced Screed (FRS) Formulation

A persistent rise in the costs of construction materials has led to the need to address this problem in line with the Sustainable Development Goals. This research employed vegetal soft and rigid fibers in a screed mortar to produce a sustainable fabric-cement matrix. Four different vegetal-dried fibers (hemp, flax, miscanthus, and bamboo) with dosages of 0.4, 0.6, 0.8, 1.2, 2, and 4 kg/m³ were used. Laboratory investigations were slump test, bulk density, air occluded, shrinkage, and mechanical strength. Scanning Electron Microscope (SEM) assessments were performed and analyzed on the natural fibers and the screed formulation. The results highlight that fiber dosages significantly influence the above-mentioned properties.

POS0288 A CANADIAN RETROSPECTIVE CHART REVIEW EVALUATING CONCOMITANT METHOTREXATE DE-ESCALATION PATTERNS IN RA PATIENTS TREATED WITH BIOLOGIC OR TARGETED SYNTHETIC DMARDS

Background

Rheumatoid arthritis (RA) guidelines recommend methotrexate (MTX) as anchor therapy in combination with biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs). However, its tolerability is challenging with a significant proportion of patients not adhering to their prescribed MTX regimen following b/tsDMARD initiation. Rates of MTX tapering and withdrawal have been reported elsewhere but Canadian data are lacking.

Objectives

This multi-centre, retrospective chart-based cohort study assessed the frequency of MTX withdrawal or tapering following initiation of a b/tsDMARD in Canadian adults with RA.

Methods

Patients were eligible if they received MTX for ≥3 months before initiation of a b/tsDMARD that was then prescribed continuously for ≥18 months and was initiated in combination with MTX. Patients taking oral prednisone or equivalent at a dose >10 mg per day, and those whose b/tsDMARD was prescribed prior to 2014, were excluded.

Results

Data from 889 patients were included in the analysis. Mean age was 50.6 years and 72.6% were female. Mean time since diagnosis was approximately 8 years. Of the 46.1% of patients with a documented assessment of disease status at baseline, 62.7% of patients had high disease activity. Baseline mean (SD) MTX dose was 18.9 (6.63) mg/week, administered orally (57.4%), subcutaneously (41.3%), or intramuscularly (1.2%). Overall, 270 (30.4%) patients either tapered (123, 13.8%) or discontinued (147, 16.5%) their MTX within 2 years of initiating the b/tsDMARD. Methotrexate dose was unchanged for 582 (65.5%) subjects and increased for 37 (4.2%) subjects. The prescribed b/tsDMARD was most often a tumor necrosis factor inhibitor (TNFi,52.1%), followed by a Janus kinase inhibitor (JAKi, 18.3%), other modes of action (OMA) which included abatacept and rituximab (17.7%) and interleukin-6 inhibitor (IL-6i, 11.9%). The b/tsDMARD type with the highest frequency of MTX Taper or Discontinued was IL-6i (37 patients, 34.9%) followed by TNFi (144 patients, 31.1%), JAKi (47 patients, 28.8%) and OMA (44 patients, 28.0%). In the MTX Discontinued group, the most common reasons for MTX discontinuation were patient decision (27.2%) and adverse events (24.5%). In the MTX Tapered group, the most common reasons for MTX dose change were planned tapering (36.6%) and adverse events (29.3%). In the MTX Increased group, insufficient clinical response (73.0%) was the most common reason provided for MTX dose change. Baseline factors associated with MTX dose discontinuation and tapering by multiple logistic regression were a shorter time since diagnosis (Odds ratio [OR]: 0.981; 95% confidence interval [CI]: 0.964 – 0.999. P=0.0401), use of non-DMARD medications excluding steroids (OR: 0.683; 95%CI: 0.503 – 0.929. P=0.0150) and a greater number of comorbidities (OR: 1.054; 95%CI: 1.001 – 1.110. P=0.0444). The mean (SD) weekly MTX dose at the end of the data extraction period was 14.13 (4.81) mg for the MTX Tapered group, with 109 (88.6%) subjects taking a weekly MTX dose ≥10 mg. In the MTX Increased group the mean (SD) weekly MTX dose was 22.3 (3.74) mg. Interpretation of the effect of MTX dose on disease activity, fatigue, pain and functional status is challenging due to missing data, but most patients in all 4 groups transitioned to low disease activity or remission during the study period.

Conclusion

Methotrexate withdrawal or tapering occurred in 30.4% of Canadians with RA within two years following b/tsDMARD initiation. There was no evidence of worsening disease activity in these patients. These proportion of Canadian RA patients who reduce or discontinue MTX after the initiation of a ts/bDMARD are generally consistent with those reported in other regions of the world.

Acknowledgements

AbbVie Corp. funded the research for this study and provided writing support for this abstract. AbbVie participated in the study design; study research; collection, analysis, and interpretation of data; and writing, reviewing, and approving this abstract for submission. All authors had access to the data; participated in the development, review, and approval of the abstract; and agreed to submit this abstract to EULAR 2022.

AbbVie and the authors thank all study investigators for their contributions and the patients who participated in this study. Medical writing support was provided by John Howell PhD of McDougall Scientific and funded by AbbVie, Inc.

Disclosure of Interests

Louis Bessette Speakers bureau: Amgen, BMS, Janssen, UCB, AbbVie, Pfizer, Merck, Lilly, Novartis, Sanofi, Sandoz, Gilead, Fresenius Kabi, Consultant of: Amgen, BMS, Janssen, UCB, AbbVie, Pfizer, Merck, Lilly, Novartis, Sanofi, Sandoz, Gilead, Fresenius Kabi, Grant/research support from: Amgen, BMS, Janssen, UCB, AbbVie, Pfizer, Merck, Lilly, Novartis, Sanofi, Sandoz, Gilead, Fresenius Kabi, Brandusa Florica Speakers bureau: AbbVie, Amgen, Lilly, Pfizer, Janssen, Novartis, Merck, Consultant of: AbbVie, Amgen, Lilly, Pfizer, Janssen, Novartis, Merck, Grant/research support from: AbbVie, Amgen, Lilly, Pfizer, Janssen, Novartis, Merck, Pierre-André Fournier Shareholder of: AbbVie, Employee of: AbbVie, Tanya Girard Shareholder of: AbbVie, Employee of: AbbVie, Latha Naik Speakers bureau: AbbVie, Consultant of: AbbVie, Grant/research support from: AbbVie, Dalton Sholter Speakers bureau: AbbVie, Amgen, BMS, Celgene, Gilead, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sandoz, UCB, Consultant of: AbbVie, Amgen, BMS, Celgene, Gilead, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sandoz, UCB, Grant/research support from: AbbVie, Amgen, BMS, Celgene, Gilead, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Sandoz, UCB, Philip Baer Speakers bureau: Abbvie, Amgen, Lilly, Pfizer, Janssen, Teva, Fresenius Kabi, Viatris, Opticann, Novartis, Organon, Gilead, Celltrion, Astra Zeneca, GSK, Consultant of: Abbvie, Amgen, Lilly, Pfizer, Janssen, Teva, Fresenius Kabi, Viatris, Opticann, Novartis, Organon, Gilead, Celltrion, Astra Zeneca, GSK, Grant/research support from: Abbvie, Amgen, Lilly, Pfizer, Janssen, Teva, Fresenius Kabi, Viatris, Opticann, Novartis, Organon, Gilead, Celltrion, Astra Zeneca, GSK

AB1180 COVID-19 HAD DISPROPORTIONATE IMPACTS ON RA SYMPTOMS AND FUNCTION BY SEX AND AGE: RESULTS FROM THE CANADIAN EARLY ARTHRITIS COHORT (CATCH)

Background

During the COVID-19 pandemic, Canadians with RA faced considerable uncertainty due to greater risk of infection, hospitalization, changing access to RA medications, and very limited access to in-person RA care. Further, to reduce transmission of the virus and COVID-related hospitalizations, stringent mitigation measures were implemented across the country to greatly reduce social contacts including curfews, limits on private gatherings and business closures. Little is known about the impact of the COVID-19 pandemic and associated mitigation efforts in RA. We hypothesized that women and younger adults with RA would report greater impairments in HRQL.

Objectives

To compare changes in HRQL prior-to and during the COVID-19 pandemic by sex and age groups in real-world RA patients seen in routine practice settings.

Methods

Data were from patients in the Canadian Early Arthritis Cohort (CATCH) who completed a study visit in the year prior to the COVID-19 pandemic (Mar 2019 through Feb 2020) and a repeat assessment during the pandemic period (Mar 2020 – Jan 2022). RA disease activity was assessed using the RA Flare Questionnaire, a validated patient-reported measure of current RA disease symptoms (pain, stiffness, fatigue) and function (physical, participation). An RA-FQ score ≥ 20 was used to classify RA symptoms consistent with an RA inflammatory flare. HRQL was assessed using PROMIS-29 Adult Profiles. We compared changes in mean Physical (PHS) and Mental Health (MHS) scores, and the proportion of patients with impairments in each domain (i.e., scores ≥ 55 for pain interference, fatigue, anxiety, depression, and sleep and ≤45 for physical function and participation) before and during the COVID-19 pandemic across sex and age groups (<40, 40-64, ≥65 years).

Results

The 938 CATCH participants in the analytic sample with data available at both time periods had a mean (SD) age of 60 (13) and RA symptom duration of 5.8 (3.7) years; 72% were women, 88% were white, and 64% reported >high school education. Most (80%) were in CDAI REM/LDA at the most recent visit prior to start of pandemic. The proportion of patients with RA-FQ ≥20 were similar at both time periods. While physical and emotional RA symptom impacts remained stable in men prior to and during the COVID-19 pandemic, women reported significant increases in anxiety and depression during the pandemic period. Younger RA patients <40 reported increases in depression, and older RA patients (65+) reported increases in anxiety and greater impacts on participation.

Conclusion

Our results illustrate that while the proportions of patients with high inflammatory disease activity were similar prior to and during the COVID-19 pandemic, we observed disproportionate impacts on HRQL by sex and age with a higher proportion of women, adults <40, and those ≥65 years of age experiencing greater impairments in several HRQL domains.

Table 1.DomainWomen (N = 673)Men (N=265)Age <40 (N=84)Age 45-64 (N=492)Age 65+ (N= 362)BeforeDuringBeforeDuringBeforeDuringBeforeDuringBeforeDuringRA Flare >20%17%21%19%18%13%7%18%21%18%21%Anxiety34%*42%*23%23%42%55%32%35%28%*35%*Depression28%*34%*22%20%25%*42%*28%28%24%30%Fatigue36%38%24%23%43%43%36%33%26%32%Pain47%52%48%45%39%48%46%49%49%54%Physical function54%57%46%46%40%40%49%50%59%62%Participation42%47%34%36%37%38%40%41%40%*49%*Sleep30%34%18%22%26%29%29%33%23%28%

*p <0.05

Acknowledgements

CATCH is supported through unrestricted research grants from: Amgen and Pfizer Canada since 2007; AbbVie since 2011; Medexus since 2013; Sandoz Canada since 2019; Fresenius Kabi Canada since 2021 and; Organon Canada since 2021. Previous funding from Janssen Canada (2011-16); UCB Canada and Bristol-Myers Squibb Canada (2011-18); Hoffman La Roche (2011-21); Sanofi Genzyme (2016-17); Eli Lilly Canada (2016-20); Merck Canada (2017-21) and Gilead Sciences Canada (2020-21)

Disclosure of Interests

None declared

POS0683 EFFICACY AND SAFETY OF UPADACITINIB IN TNFi-IR PATIENTS WITH RHEUMATOID ARTHRITIS FROM THREE PHASE 3 CLINICAL TRIALS

Background

For patients with RA who are refractory to biologic DMARDs (bDMARDs), such as tumor necrosis factor inhibitors (TNFis), optimal disease control is less likely to be achieved with subsequent therapy.1 In line with recommendations from EULAR and ACR, switching to a treatment with a different mechanism of action is appropriate for these patients.

Objectives

To describe the efficacy and safety of upadacitinib (UPA) 15 mg once daily in patients with RA and an inadequate response or intolerance to TNFis (TNFi-IR).

Methods

A post hoc subgroup analysis was conducted in TNFi-IR patients who were treated with UPA 15 mg once daily in three Phase 3 clinical trials: SELECT-BEYOND,2 -CHOICE,3 and -COMPARE.4 For COMPARE, only patients treated with adalimumab and switched to UPA as rescue therapy were included. ≥20/50/70% improvement in ACR criteria, DAS28(CRP), CDAI, and SDAI, as well as change from baseline in HAQ-DI and other patient-reported outcomes (PROs) were reported through 24 weeks. Non-responder imputation was used for all missing categorical outcomes; as observed (COMPARE) or multiple imputation (CHOICE, BEYOND) were used for missing continuous outcomes. Pooled safety results were presented as exposure-adjusted event rates (EAERs) with a cut-off of June 30, 2021.

Results

568 TNFi-IR patients were included: 146 from BEYOND, 263 from CHOICE, and 159 from COMPARE. Mean duration since RA diagnosis was longer for BEYOND and CHOICE versus COMPARE; cardiovascular (CV) risk factors were common among this refractory population (Table 1). ACR20/50/70 and disease activity outcomes observed in the TNFi-IR population were generally consistent with the overall BEYOND2 and CHOICE3 bDMARD-IR populations, and consistent across the three studies in the TNFi-IR subgroups (Figure 1). Improvements in PROs including HAQ-DI, fatigue, pain, and morning stiffness over 24 weeks were observed (data not shown). Pooled safety results reporting 1574.8 patient-years (PY) of exposure in the TNFi-IR subgroup showed similar results to the overall BEYOND2 and CHOICE3 bDMARD-IR study populations, with EAERs of 3.1 events/100 PY for herpes zoster and 0.8 events/100 PY for adjudicated major adverse CV events, adjudicated venous thromboembolism (VTE), and malignancy excluding non-melanoma skin cancer. The EAER of any AE leading to death was 1.4 events/100 PY.

Table 1.

Baseline characteristics of TNFi-IR patients treated with UPA 15 mg

n (%), unless specifiedSELECT-BEYOND (n=146)SELECT-CHOICE (n=263)SELECT-COMPARE (ADA → UPA) (n=159)Female122 (83.6)219 (83.3)133 (83.6)Mean (SD) age, years56.6 (11.0)55.5 (11.1)53.9 (10.6)Mean (SD) duration of RA diagnosis, years13.2 (9.5)12.5 (9.4)8.2 (8.5)Concomitant csDMARDs MTX alone100 (70.4)195 (74.1)159 (100.0) MTX and other csDMARDs20 (14.1)25 (9.5)0 csDMARDs other than MTX22 (15.5)38 (14.4)0Concomitant oral steroids73 (50.0)140 (53.2)98 (61.6)1 prior bDMARD68 (46.6)172 (65.4)142 (89.3)2 prior bDMARDs40 (27.4)62 (23.6)17 (10.7)a≥3 prior bDMARDs38 (26.0)29 (11.0)0Failed ≥1 prior TNFi due to lack of efficacyb131 (89.7)223 (84.8)159 (100.0)History of VTE / CV event3 (2.1) / 28 (19.2)6 (2.3) / 20 (7.6)4 (2.5) / 14 (8.8)CV risk factors Hypertension72 (49.3)109 (41.4)68 (42.8) Diabetes mellitus22 (15.1)34 (12.9)17 (10.7) Smoking (current former past)68 (46.6)109 (41.5)55 (34.6) Elevated LDL-C (≥3.36 mmol/L)38 (26.0)52 (20.0)48 (30.2) Low HDL-C (≤1.55 mmol/L)80 (54.8)171 (65.0)88 (55.3)

aThese patients received one bDMARD before entry into SELECT-COMPARE.

bRemaining patients were intolerant to ≥1 prior TNFi.

Conclusion

In this post hoc subgroup analysis, TNFi-IR patients treated with UPA 15 mg achieved clinically meaningful efficacy responses over 24 weeks, with safety consistent with the overall bDMARD-IR patient population in the Phase 3 program.

References

[1]Rendas-Baum R, et al. Arthritis Res Ther 2011;13:R25;

[2]Genovese C, et al. Lancet 2018;391:2513–24;

[3]Rubbert-Roth A, et al. NEJM 2020;383:1511–21;

[4]Fleischmann R, et al. Ann Rheum Dis 2019;78:1454–62.

Acknowledgements

AbbVie funded this study; contributed to its design; participated in data collection, analysis, and interpretation of the data; and participated in the writing, review, and approval of the abstract. AbbVie and the authors thank all study investigators for their contributions and the patients who participated in this study. No honoraria or payments were made for authorship. Medical writing support was provided by Amy Wilson, MSc, of 2 the Nth (Cheshire, UK), and was funded by AbbVie.

Disclosure of Interests

Roy M. Fleischmann Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Eli Lilly, Galvani, Gilead, GSK, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Amgen, Biosplice, Bristol-Myers Squibb, Flexion, Gilead, Horizon, Eli Lilly, Galvani, Janssen, Novartis, Pfizer, Sanofi-Aventis, Selecta, Teva, UCB, Viela, and Vorso, Louis Bessette Speakers bureau: AbbVie, Amgen, Bristol-Meyers Squibb, Celgene, Eli Lilly, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi-Aventis, Teva, and UCB, Consultant of: AbbVie, Amgen, Bristol-Meyers Squibb, Celgene, Eli Lilly, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi-Aventis, Teva, and UCB, Grant/research support from: AbbVie, Amgen, Bristol-Meyers Squibb, Celgene, Eli Lilly, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi-Aventis, Teva, and UCB, Jeffrey Sparks Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead, Inova Diagnostics, Janssen, Optum, and Pfizer, Stephen Hall Consultant of: AbbVie, Amgen, Bristol-Meyers Sqibb, Eli Lilly, Gilead, Janssen, Merck, Novartis, and UCB, Grant/research support from: AbbVie, Amgen, Bristol-Meyers Sqibb, Eli Lilly, Gilead, Janssen, Merck, Novartis, and UCB, Manish Jain Consultant of: AbbVie, Amgen, Eli Lilly, Novartis, and Pfizer, Grant/research support from: AbbVie, Amgen, Eli Lilly, Novartis, and Pfizer, Adriana Kakehasi Speakers bureau: AbbVie, Amgen, Eli Lilly, Fresenius Kabi, Janssen, Novartis, Pfizer, Sandoz, and UCB, Consultant of: AbbVie, Amgen, Eli Lilly, Fresenius Kabi, Janssen, Novartis, Pfizer, Sandoz, and UCB, Grant/research support from: AbbVie, Amgen, Eli Lilly, Fresenius Kabi, Janssen, Novartis, Pfizer, Sandoz, and UCB, Yanna Song Shareholder of: AbbVie (may own stock or options), Employee of: AbbVie, Sebastian Meerwein Shareholder of: AbbVie (may own stock or options), Employee of: AbbVie, Ryan DeMasi Shareholder of: AbbVie (may own stock or options), Employee of: AbbVie, Jessica Suboticki Shareholder of: AbbVie (may own stock or options), Employee of: AbbVie, Andrea Rubbert-Roth Consultant of: AbbVie, AbbVie Deutschland, Amgen, Bristol-Myers Squibb, Chugai Pharmaceuticals, Eli Lilly, F. Hoffman-La Roche, Gilead Sciences, Janssen Global Services, Novartis, and Sanofi Pasteur

OP0308-HPR MORE THAN HALF OF RA PATIENTS WITH A LIFETIME HISTORY OF MOOD DISORDERS WERE ANXIOUS AND DEPRESSED DURING THE COVID-19 PANDEMIC: RESULTS FROM THE CANADIAN EARLY COHORT (CATCH) STUDY

Background

A growing number of studies indicate the considerable mental health impacts of the prolonged COVID-19 pandemic in the general population as chronic stress is a risk factor for the development of depression and anxiety. Mood disorders are more prevalent in RA and a history of anxiety or depressive disorders increases the risk of recurrence in the future.

Objectives

To compare trends in prevalence of anxiety and depressive symptoms, prior to and during the COVID-19 pandemic in RA patients with and without a lifetime history of mood disorders.

Methods

Data were from RA patients diagnosed and treated for RA in rheumatology clinics across Canada enrolled in the Canadian Early Arthritis Cohort (CATCH) Study. We estimated monthly trends in prevalence of clinically significant levels of anxiety and depression (PROMIS Depression and Anxiety 4a score 55+) from all visits between Mar 2019 and Jan 2022 and compared monthly trends in anxiety and depression in the year prior to (Mar 2019- Feb 2020) and during the pandemic (Mar 2020 to Jan 2022) stratified by lifetime history of mood disorders.

Results

4,148 visits were completed from Mar 2019 to Jan 2022 in 1,644 RA patients with a mean (SD) age of 60 (14) and disease duration of 6 (4) years. 73% were women, 84% white, 60% had completed some post-secondary education, and 77% were in CDAI REM/LDA at the visit closest to the start of pandemic. 253 (15%) reported a lifetime history of depression and 217 (13%) a lifetime history of anxiety; 8% reported prior treatment for either.

Patients with a history of mood disorders had higher levels of depression and anxiety prior-to and during the pandemic compared with patients without a history of mood disorders (Table 1). Proportions were highest during COVID waves in all and were substantially higher and more variable in people with a previous history of mood disorders as compared to those without a history (Figure 1). While depressive symptoms peaked early in the pandemic, anxiety increased with each wave, peaking in Wave 3 (May-Jun 2021).

Table 1.

Prevalence of depression and anxiety symptoms prior to and during the COVID-19 pandemic in RA patients with and without a history of mood disorders.

Period Prevalence (monthly range)DepressionAnxietyNo historyPrior HistoryNo HistoryPrior HistoryN observations35276213610538Prepandemic (3/19 - 2/20)21%(14%-30%)51%(29%-64%)27%(20%-35%)58%(31%-89%)Pandemic (3/20 - 1/22)22%(15%-29%)53%(33%-78%)28%(20%-43%)59%(33%-80%)Figure 1.

During the first 22 months of the COVID-19 pandemic, the proportion of patients with depression and anxiety increased in all groups. More than half of those with a history of emotional distress had clinically significant levels of depression and anxiety; proportions were highest during COVID waves in all and were substantially higher in people with previous history as compared to those without a history (see Figure 1). Whereas depressive symptoms peaked early in the pandemic, anxiety increased with each wave, peaking in Wave 3 (May-Jun 2021).

Conclusion

Symptoms of anxiety and depression were common in Canadian adults with RA prior to and after the onset of the COVID-19 pandemic. Whereas others have found that high levels of depression and anxiety occurred early in the pandemic but declined fairly rapidly in the general population1, emotional distress was not attenuated over time in this large cohort of RA patients. Individuals reporting lifetime history of mood disorders were more than twice as likely to report anxiety and depression, with depression peaking early in the pandemic and anxiety growing with each successive wave in the first year. The results demonstrate the importance of applying a lifetime perspective as previous episodes of anxiety and depression may be an important marker of increased vulnerability and recurrence in RA patients, particularly during the pandemic.

References

[1]Fancourt D et al. Trajectories of anxiety and depressive symptoms during enforced isolation due to COVID-19 in England. Lancet Psychiatry. 2021;8:141-9.

Acknowledgements

CATCH is supported through unrestricted research grants from: Amgen and Pfizer Canada since 2007; AbbVie Corporation since 2011; Medexus since 2013; Sandoz Canada since 2019; Fresenius Kabi Canada since 2021 and; Organon Canada since 2021. Previous funding from Janssen Canada (2011-16); UCB Canada and Bristol-Myers Squibb Canada (2011-18); Hoffman La Roche Limited (2011-21); Sanofi Genzyme (2016-17); Eli Lilly Canada (2016-20); Merck Canada (2017-21) and; Gilead Sciences Canada (2020-21)

Disclosure of Interests

None declared

POS0643 SUSTAINABILITY OF RESPONSE BETWEEN UPADACITINIB AND ADALIMUMAB IN PATIENTS WITH RHEUMATOID ARTHRITIS: RESULTS THROUGH 3 YEARS FROM THE SELECT-COMPARE TRIAL

Background

The primary treatment target for patients with active rheumatoid arthritis (RA) is sustained clinical remission (REM) or low disease activity (LDA).1,2 A greater proportion of patients with RA and inadequate response to methotrexate (MTX) receiving the JAK inhibitor, upadacitinib (UPA), achieved REM/LDA compared with adalimumab (ADA), both with background MTX, through 26 weeks in the phase 3, SELECT-COMPARE trial.3

Objectives

We assessed sustainability of response over 3 years in UPA-treated patients with RA.

Methods

SELECT-COMPARE included a 26-week, double-blind, placebo (PBO)-controlled period, a 48-week, double-blind active comparator-controlled period, and an ongoing long-term extension for up to 10 years. Patients on background MTX received UPA 15 mg once daily, PBO, or ADA 40 mg every other week. Patients who did not achieve at least 20% improvements in tender and swollen joint counts (Weeks 14-22) or LDA (CDAI ≤10 at Week 26) were rescued from UPA to ADA or PBO/ADA to UPA. This post hoc analysis evaluated clinical REM (CDAI ≤2.8; SDAI ≤3.3), LDA (CDAI ≤10; SDAI ≤11), and DAS28(CRP) <2.6/≤3.2 at first occurrence (prior to treatment switch [rescue]), as well as over 3 years following initial response in patients randomized to UPA or ADA. For those patients who achieved REM/LDA, Kaplan-Meier was used to define the time from when the response was first achieved to the earliest date at which the response was lost at two consecutive visits, discontinuation of study drug, or losing response at the time of rescue. The predictive ability of time to CDAI REM/LDA was assessed using Harrell’s concordance (c)-index (range: 0 [all predictions wrong] to 1.0 [perfect predictive ability]. Non-responder imputation was used for missing data.

Results

Through 3 years, a significantly higher proportion of patients receiving UPA + MTX vs ADA + MTX achieved CDAI REM (47% vs 35%, P = 0.001) as well as CDAI LDA (70% vs 60%, P = 0.001). At 30 months after first occurrence of response, CDAI REM/LDA was sustained in 19%/42% of patients randomized to UPA and 10%/30% of patients randomized to ADA (Figure 1). Time to initial clinical response did not appear to be predictive of sustained disease control. The c-index for CDAI REM/LDA was 0.50/0.60 on UPA vs 0.49/0.56 on ADA. Through the last follow-up visit, 37%/58% of patients receiving UPA and 27%/48% on ADA remained in CDAI REM/LDA, respectively (Figure 2). Of patients who lost CDAI REM, 68% on UPA and 55% on ADA remained in LDA. Additionally, roughly similar proportions on UPA and ADA recaptured CDAI REM/LDA (UPA, 40%/17%; ADA, 48%/19%). Similar results were observed for REM/LDA based on SDAI and for DAS28(CRP) <2.6/≤3.2.

Conclusion

Among patients with inadequate response to MTX, a higher proportion receiving UPA + MTX achieved remission or LDA across disease activity measures vs ADA + MTX. UPA-treated patients demonstrated a consistently higher sustained response rate over 3 years compared to those receiving ADA. Furthermore, significant proportions of patients who lost response on either UPA or ADA were able to recapture remission or LDA.

References

[1]Smolen et al. Ann Rheum Dis 2020;79:685–99.

[2]Singh et al. Arthritis Rheumatol 2016;68:1–26.

[3]Fleischmann et al. Arthritis Rheumatol 2019;71:1788–1800.

Acknowledgements

AbbVie funded these studies and participated in the study design, research, analysis, data collection, interpretation of data, reviewing, and approval of the publication. No honoraria or payments were made for authorship. Medical writing support was provided by Matthew Eckwahl, PhD, of AbbVie.

Disclosure of Interests

Peter Nash Speakers bureau: AbbVie, BMS, Pfizer, Gilead/Galapagos, Sanofi, Celgene, Novartis, Lilly, Janssen, UCB, Samsung, MSD, Roche, Consultant of: AbbVie, BMS, Pfizer, Gilead/Galapagos, Sanofi, Celgene, Novartis, Lilly, Janssen, UCB, Samsung, MSD, Roche, Grant/research support from: AbbVie, BMS, Pfizer, Gilead/Galapagos, Sanofi, Celgene, Novartis, Lilly, Janssen, UCB, Samsung, MSD, Roche, Arthur Kavanaugh Consultant of: AbbVie Inc., Amgen, Astra-Zeneca, BMS, Celgene, Centocor-Janssen, Pfizer, Roche, and UCB, Grant/research support from: AbbVie Inc., Amgen, Astra-Zeneca, BMS, Celgene, Centocor-Janssen, Pfizer, Roche, and UCB, Maya H Buch Speakers bureau: AbbVie, Boehringer Ingleheim, Eli Lilly, Merck-Serono, and Sanofi, Consultant of: AbbVie, Boehringer Ingleheim, Eli Lilly, Merck-Serono, and Sanofi, Grant/research support from: Pfizer, Gilead, and UCB, Bernard Combe Consultant of: AbbVie, BMS, Celltrion, Gilead, Galapagos, Janssen, Eli Lilly, MSD, Pfizer, Roche Chugai, Louis Bessette Speakers bureau: Amgen, BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Eli Lilly, Novartis, Sandoz, Gilead, Fresenius Kabi, and Teva, Consultant of: Amgen, BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Eli Lilly, Novartis, Sandoz, Gilead, Fresenius Kabi, and Teva, Grant/research support from: Amgen, BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Eli Lilly, Novartis, Sandoz, Gilead, Fresenius Kabi, and Teva, In-Ho Song Shareholder of: AbbVie Inc., Employee of: Amgen, BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Eli Lilly, Novartis, Sandoz, Gilead, Fresenius Kabi, and Teva, Tim Shaw Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Yanna Song Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Jessica Suboticki Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Roy M. Fleischmann Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Eli Lilly, GSK, Janssen, Novartis, Pfizer Inc, Sanofi-Aventis, and UCB, Grant/research support from: AbbVie, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Genentech, Janssen, Novartis, Pfizer Inc, Regeneron, Roche, Sanofi-Aventis and UCB

POS0607 IMPROVING TREAT-TO-TARGET IMPLEMENTATION IN RHEUMATOID ARTHRITIS: A SYSTEMATIC LITERATURE REVIEW OF BARRIERS, FACILITATORS, AND INTERVENTIONS

Background

Treat-to-target (T2T) is integral to international recommendations for managing patients with rheumatoid arthritis (RA),1,2 but its implementation in clinical practice is suboptimal.3 Understanding T2T barriers and facilitators may inform strategies for improving T2T implementation in RA.

Objectives

To review published evidence on barriers to and facilitators of T2T implementation in RA, and interventions designed to improve T2T implementation.

Methods

Two systematic literature searches were conducted to identify barriers to or facilitators of, and interventions designed to improve, T2T implementation in RA (Jan 1, 2015–Mar 1, 2021 and Jan 1, 2010–Jul 1, 2021, respectively). The quality of each study was assessed using the appropriate Critical Appraisal Skills Programme (CASP) checklist.4 Barriers/facilitators and interventions were grouped into categories and summarized descriptively.

Results

The barriers/facilitators literature search retrieved 235 articles. Seventy-seven of these, which described primary studies mentioning a total of 331 T2T barriers/facilitators in RA, were included in the analysis. The interventions literature search identified 451 articles, including 70 primary studies reporting a total of 56 unique interventions to improve T2T implementation in RA. The quality of the studies varied; however, most addressed at least half of the information evaluated in the CASP checklists. Barriers/facilitators were categorized into 18 key target areas for patients (n=7), healthcare professionals (HCPs; n=6), or patients and HCPs (n=5). These related to: HCPs’ or patients’ knowledge or perceptions; patients’ clinical or social conditions; patient–HCP communication or alignment; and time or resources (Figure 1). The 56 interventions were grouped into 18 types (Table 1). More than half of the interventions (n=30; 53.6%) were designed to improve or streamline disease activity or patient-reported outcome assessments or increase patient–HCP alignment on disease activity. Interventions designed to improve shared decision-making were also common (n=23; 41.1%); these included patient and HCP education (n=15), decision aids (n=7), and shared decision-making prompts (n=3). Of the 56 interventions, 20 (35.7%) reported improvements in T2T implementation and/or patient outcomes in RA. However, as most interventions were evaluated in single centers, their effectiveness, feasibility, and generalizability across other regions or healthcare settings were unclear.

Table 1.

Interventions for improving T2T implementation in RA, by type

Type of interventionNumber of unique interventions (n=56)aElectronic disease assessment recording11Disease assessment process/quality improvement initiative8Allied HCP-supported T2T strategy8Patient educational tools7Patient decision aid7HCP performance feedback7Integrated PRO assessment6Ultrasound assessment5HCP learning collaborative (structured learning sessions + performance feedback)4Patient PRO dashboard/visual feedback tool4Telehealth monitoring3HCP T2T/shared decision-making prompt3Nurse-led patient education3Multidisciplinary team program3HCP training2Patient telehealth education2HCP decision-making tool1Patient group sessions1

aInterventions may be assigned to more than one category

PRO, patient-reported outcome

Conclusion

While practical methods designed to improve T2T implementation in RA are available, their effectiveness and feasibility will likely vary by region and healthcare setting. More primary research is required to identify the most relevant barriers/facilitators and prioritize the most appropriate interventions to optimize T2T implementation both globally and locally.

References

[1]Smolen JS, et al. Ann Rheum Dis 2020;79:685–99

[2]Smolen JS, et al. Ann Rheum Dis 2016;75:3–15

[3]Yu Z, et al. Arthritis Care Res 2018;70:801–6

[4]Critical Appraisal Skills Programme 2019. https://casp-uk.net/casp-tools-checklists/ (Last accessed November 2021)

Acknowledgements

AbbVie funded the evidence synthesis and had the opportunity to review and comment on the publication prior to submission. However, decisions regarding the final publication content were made solely by the authors. Medical writing support was provided by Hilary Wong, PhD, of 2 the Nth (Cheshire, UK), and was funded by AbbVie.

Disclosure of Interests

Laure Gossec Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Galapagos, Gilead, GSK, Janssen, Lilly, Novartis, Pfizer, Samsung Bioepis, Sanofi-Aventis, and UCB, Grant/research support from: Amgen, Galapagos, Lilly, Pfizer, and Sandoz, Louis Bessette Consultant of: AbbVie, Celgene, Fresenius Kabi, Gilead, Lilly, Novartis, Pfizer, Sandoz, and UCB, Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Gilead, Janssen, Lilly, Novartis, Pfizer, and UCB, Ricardo Xavier Speakers bureau: AbbVie, Janssen, Lilly, Novartis, Pfizer, and Roche, Consultant of: AbbVie, Janssen, Lilly, Novartis, Pfizer, and Roche, Grant/research support from: AbbVie, Janssen, Lilly, and Pfizer, Ennio Giulio Favalli Speakers bureau: AbbVie, Bristol-Myers Squibb, Celltrion, Galapagos, Janssen, Lilly, MSD, Novartis, Pfizer, Sanofi-Genzyme, and UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celltrion, Galapagos, Janssen, Lilly, MSD, Novartis, Pfizer, Sanofi-Genzyme, and UCB, Andrew Ostor Consultant of: AbbVie, Bristol-Myers Squibb, Gilead, Janssen, Lilly, Novartis, Paradigm, Pfizer, Roche, and UCB, Grant/research support from: AbbVie, Bristol-Myers Squibb, Gilead, Janssen, Lilly, Novartis, Paradigm, Pfizer, Roche, and UCB, Maya H Buch Consultant of: AbbVie, Boehringer Ingelheim, Galapagos, Gilead, Lilly, and Pfizer (consulting fees paid to the host institution and travel honoraria), Grant/research support from: Pfizer and UCB

AB0357 INCIDENCE AND DETERMINANTS OF INFECTION IN RHEUMATOID ARTHRITIS PATIENTS TREATED WITH GOLIMUMAB IN REAL-WORLD PRACTICE

Background

Although biologic use in rheumatoid arthritis (RA) has a well-characterized infections risk factor, most studies evaluating this association were conducted on first-generation anti-tumor necrosis factor (TNFi) agents or in early years post-drug development (early 2000).

Objectives

To (i) characterize the long-term incidence of infection in a real-world cohort of RA patients treated with subcutaneous golimumab (GLM) in Canadian routine care; (ii) assess the impact of infections on GLM retention, and (iii) explore factors associated with the risk of infection.

Methods

BioTRAC registry was a prospective, multicenter study that collected real-world clinical, laboratory, safety and patient-reported data from TNFi naïve patients or treated with biologics for a period of <6 months before enrolment. This post-hoc analysis included patients with RA who initiated GLM treatment. The incidence density rates (IDR) of total serious (SI) and non-serious (NSI) infections were calculated for the overall follow-up (90 months) period as well as by 6-month interval. Time to first infection and time to treatment discontinuation were assessed with the Kaplan-Meier estimator of the survival function. Determinants of infection over time or within the first 6 months were explored using generalized estimating equation models and logistic regression, respectively.

Results

530 patients were included with a mean (SD) age of 57.7 (13.0) years and disease duration of 8.0 (8.3) years. Of these, 404 (76.2%) were females, 74 (14.0%) were treated with ≤15mg/week MTX, 280 (52.8%) with >15mg/week MTX, while 173 (32.6%) were not on MTX. In terms of corticosteroids (CS), 72 (13.6%) were treated with ≤5mg/day, 63 (11.9%) with >5mg/day, and 391 (73.8%) were not on CS. Diabetes (4.5%), pulmonary disease (8.9%), and renal disease (18.5%) were present.

Over a mean follow-up duration of 27.0 months, the IDR for total infections, NSI, and SI was 35.10 events/100 PYs, 32.90 events/100 PYs, and 2.23 events/100 PYs. Median estimated time to first infection was 52.9 months (SI: 84.9 months; NSI: 55.1 months) (Table 1). The incidence of total infections was 44.0, 37.3, 35.1, 29.4, 31.1, 35.7, 19.3 and 7.4 events/100 PYs at 0-6 months, 6-12 months, 12-24 months, 24-36 months, 36-48 months, 48-60 months, 60-72 months, 72-84 months, respectively and no infections between 84-90 months. In terms of determinants, no significant associations were identified for the incidence of infections within the first 6 months. However, presence of pulmonary disease was identified as a significant determinant of total infections (OR [95%CI]: 2.19 [1.36-3.52]) and NSI (2.22 [1.35-3.66]) over time, while higher age (1.08 [1.00-1.26]) and high (≥5 mg/day) CS dose (7.25 [1.12-46.80]) were associated with significantly higher odds of SI. Incidence of SI (6.48 [1.16-36.13]), but not NSI, was associated with significantly higher odds of GLM discontinuation; additional predictors of discontinuation were increased baseline CDAI (1.06 [1.04-1.08]) and use of concomitant MTX at low dose (0.52 [0.30-0.91]) or high dose (0.71 [0.49-1.04]).

Table 1.

Incidence Density Rate (IDR) by Infection Type.

Infection TypeIDR (Events/100 PYs)Median Time to 1st Infection (months)Total Infections35.152.9Non-serious Infections32.984.9Serious Infections2.255.1

Conclusion

The infection rates reported with GLM in this cohort are low compared to the rates reported in earlier registry studies with TNFi. Changes in the characteristics of patients starting TNFi (lower disease activity, shorter disease duration, less exposure to CS) in recent years may explain the decreased risk of infection. Compared to the available literature, treatment with GLM was associated with relatively low infection rate. Most infections occurred during the first 6 months of treatment and decreased thereafter. Presence of pulmonary disease, higher age, and higher CS dose were identified as significant predictors of infections. SIs, but not NSIs, were associated with significantly higher odds of treatment discontinuation-TNFi.

Disclosure of Interests

Louis Bessette Speakers bureau: Amgen, BMS, Janssen, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis, Gilead, Sandoz, Fresenius Kabi, Teva, Consultant of: Amgen, BMS, Janssen, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis, Gilead, Sandoz, Fresenius Kabi, Teva, Grant/research support from: Amgen, BMS, Janssen, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis, Gilead, Sandoz, Fresenius Kabi, Teva, Proton Rahman Speakers bureau: AbbVie, Amgen, Bristol Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Amgen, Bristol Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, and UCB, Grant/research support from: Janssen and Novartis, John Kelsall: None declared, Jane Purvis: None declared, Emmanouil Rampakakis Consultant of: Janssen, Allen Lehman Shareholder of: Johnson & Johnson, Employee of: Janssen Pharmaceutical Companies of Johnson & Johnson, Meagan Rachich Shareholder of: Johnson & Johnson, Employee of: Janssen Pharmaceutical Companies of Johnson & Johnson, Francois Nantel Shareholder of: Johnson & Johnson, Employee of: Retiree from Janssen Pharmaceutical Companies of Johnson & Johnson, Marilise Marrache Shareholder of: Johnson & Johnson, Employee of: Janssen Pharmaceutical Companies of Johnson & Johnson, Odalis Asin Milan Shareholder of: Johnson & Johnson, Employee of: Employees of Janssen Pharmaceutical Companies of Johnson & Johnson

OP0229 OSTEOARTHRITIS OF THE KNEE, INFLAMMATION, AND THE EFFECT OF ADALIMUMAB (OKINADA): A RANDOMIZED PLACEBO-CONTROLLED TRIAL

Background

Cytokines such as tumor necrosis factor (TNFα) have been shown to elicit inflammatory and catabolic events in the joints of patients with osteoarthritis. Recent RCTs demonstrated that TNFα inhibition has no effect on pain and MRI-detected synovitis or bone marrow lesions in patients with erosive hand OA1-3. However, the progression of bone erosions was reduced in a subgroup of patients with more clinically swollen distal interphalangeal joints in one RCT1. Consequently, it remains possible that TNFα inhibition may have beneficial effects in specific subgroups of patients with a high inflammatory component.

Objectives

We aimed to evaluate the efficacy and safety of a TNFα inhibitor, adalimumab (ADA), in a proof-of-concept study in patients with inflammatory OA of the knee.

Methods

OKINADA was a 52-week, randomized, double-blind, placebo-controlled, parallel-group study done at 11 sites in Canada (NCT02471118). Eligible participants were adults (aged ≥18 years) with a diagnosis of OA of the index knee and classified according to American College of Rheumatology criteria, including radiological evidence of OA (Kellgren-Lawrence grades 2 or 3) with clinical signs of knee effusion. Subjects had persistent knee pain of ≥ one month duration with a pain score of ≥ 4 (0-10 NRS) in the index knee at screening and baseline despite conventional treatment with maximum tolerated acetaminophen and/or non-steroidal anti-inflammatory drug. Patients were randomly assigned (1:1) to receive subcutaneous 40 mg ADA every 2 weeks or placebo (PBO). Primary endpoint was the Outcome Measures in Rheumatology and Osteoarthritis Research Society International set of responder criteria (OMERACT-OARSI) at week 16 defined as: (1) improvement in pain or function ≥50% and an absolute change ≥20 mm; or (2) improvement of ≥20% with an absolute change ≥10 mm in at least two of the following three categories: pain, function, and patient’s global assessment. Secondary endpoints included: the Knee Injury and Osteoarthritis Outcome Score (KOOS) for the domains of pain, activities of daily living (ADL), OA symptoms, sport and recreation function (SRF), and knee-related quality of life (QoL), patient’s global assessment of disease status (PGAD), investigator global assessment of disease status (IGAD), and expanded Target Joint Assessment (TJA) score.

Results

A total of 59 patients were randomized (29 to PBO, 30 to ADA). The primary endpoint was not met: OMERACT-OARSI combined (ADA: 9 [30.0%] vs PBO: 7 [24.1%], p=0.62). For KOOS pain, ≥20% improvement was noted in 11 (36.7%) ADA vs 7 (24.1%) PBO patients (p=0.30), and ≥50% improvement in 5 (16.7%) ADA vs 6 (20.7%) PBO patients (p=0.69). There were no significant treatment-group differences in baseline to 16-week change in continuous secondary endpoints (ADA vs PBO: KOOS ADL 6.5 vs 8.4 (p=0.71), KOOS QoL 10.1 vs 7.4 (p=0.66), KOOS symptoms 7.8 vs 11.5 (p=0.42), KOOS SRF 5.8 vs 7.7 (p=0.76), PGAD -1.0 vs 0.1 (p=0.10), IGAD -1.5 vs -2.1 (p=0.30), TJA -2.4 vs -2.2 (p=0.87) or in lab markers (ESR, CRP). There were 11 withdrawals (4 ADA, 7 PBO) of which 2 were for adverse events (1 ADA, 1 PBO) and 2 for increasing knee pain (1 ADA, 1 PBO). No new safety signals were identified and there were no serious adverse events.

Conclusion

Although the treatment was safe, short-term treatment with anti-TNFα therapy does not appear to provide clinically meaningful improvements in OA symptoms in patients with established radiographic knee OA. Analyses of structural endpoints will be reported when results are available.

References

[1]Verbruggen G, et al. Ann Rheum Dis 2012; 71: 891-8.

[2]Chevalier X, et al. Ann Rheum Dis 2015; 74: 1697-705.

[3]Aitken D, et al. Osteoarthritis Cartilage 2018; 26: 880-7.

Acknowledgements

Abbvie supported this investigator-initiated study

Disclosure of Interests

Walter P Maksymowych Speakers bureau: Abbvie, Janssen, Novartis, Pfizer, UCB, Consultant of: Abbvie, Boehringer Ingelheim, Celgene, Eli-Lilly, Galapagos, Novartis, Pfizer, UCB, Grant/research support from: Abbvie, Novartis, Pfizer, UCB, Louis Bessette Speakers bureau: Amgen, BMS, Janssen, Roche, UCB, Abbvie, Pfizer, Merck, Lilly, Novartis, Sanofi, TEVA, Fresenius Kabi, Sandoz, Consultant of: Amgen, BMS, Janssen, Roche, UCB, Abbvie, Pfizer, Celgene, Lilly, Novartis, Sanofi, Gilead, TEVA, Fresenius Kabi, Sandoz, Grant/research support from: Amgen, BMS, Janssen, Roche, UCB, Abbvie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis, Gilead, Robert G Lambert Paid instructor for: Novartis, Amanda Carapellucci: None declared, C. Thomas Appleton Speakers bureau: Abbvie, Amgen, Bristol Myers Squibb, Celgene, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Organon, Pfizer, Hoffman LaRoche, Sandoz, Sanofi-Genzyme, UCB, Consultant of: Abbvie, Amgen, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Organon, Pfizer, Hoffman LaRoche, Sandoz, Sanofi-Genzyme, UCB, Grant/research support from: Abbvie, Fresenius Kabi, Novartis, Pfizer

Validity of the Health Assessment Questionnaire Predicting All-Cause Mortality in Early Rheumatoid Arthritis: Reply to three letters to the editor

We appreciate the interest in our manuscript concerning the Health Assessment Questionnaire disability index (HAQ) in an early rheumatoid arthritis incident cohort (the CATCH cohort) which predicted all-cause mortality (1). We will clarify queries raised in letters to the editor (2-4).

OP0143 IMPACT OF ADALIMUMAB VERSUS NON-BIOLOGIC THERAPY ON DISEASE ACTIVITY AND PATIENT-REPORTED OUTCOMES IN ANKYLOSING SPONDYLITIS OVER 24 MONTHS – RESULTS OF THE COMPLETE-AS CANADIAN OBSERVATIONAL STUDY

Background:

COMPLETE-AS was an observational study among Canadian biologic-naïve adults with active ankylosing spondylitis (AS) treated with either adalimumab or subsequent non-biologic disease-modifying anti-rheumatic drugs and/or non-steroidal anti-inflammatory drugs (nbDMARD/NSAID) after having switched from initial treatment with a preceding nbDMARD and/or NSAID due to lack of response or intolerance, as per treating physician judgement.

Objectives:

To assess the impact of adalimumab on disease activity and patient-reported outcomes among adalimumab- vs. nbDMARD/NSAID-treated patients over 24 months.

Methods:

Patients were enrolled between July 2011 and December 2017 and followed for up to 24 months. Treatment was per routine care and all analyses were perfomed using the intent-to-treat (ITT) approach. Between-group differences for change in patient-reported disease activity (BASDAI), morning stiffness (minutes/day), functional limitation (BASFI), quality of life (QoL: SF-12), depression (BDI-II), and work productivity (WLQ) were assessed with repeated measures models for overall treatment effect; baseline-adjusted estimates (least square means [LSM]) for each visit were produced. Achievement of, and time to the following endpoints were assessed: 50% improvement from baseline in BASDAI (BASDAI50); minimum clinically important improvements (MCIIs) in BASDAI (Δ≥1.1); BASFI (Δ≥0.6); SF-12 physical component score (PCS; Δ≥4.4) and mental component score (MCS; Δ≥3.1); and low disease activity for BASDAI (<4) and BASFI (<3.8).

Results:

A total of 452 adalimumab-treated patients and 187 nbDMARD/NSAID-treated patients were enrolled in the study and included in the analyses. At baseline, mean (SD) BASDAI [6.4 (1.8) vs. 5.0 (1.8); p<0.001] and BASFI [5.5 (2.4) vs. 3.7 (2.4)] were however significantly (p<0.001) higher among adalimumab-treated patients compared to nbDMARD/NSAID-treated patients, respectively.

Over 24 months, adalimumab-treated patients had significantly lower overall BASDAI scores compared to nbDMARD/NSAID-treated patients [estimate (95% CI): -0.7 (-1.2, -0.3); p=0.007]. BASFI scores were also significantly lower among adalimumab-treated patients over the course of the study [estimate (95% CI): -0.4 (-0.8, 0.0); p=0.013]. Both groups had statistically comparable outcomes for morning stiffness, BDI-II, WLQ, and SF-12.

Adalimumab-treated patients were also at significantly higher odds of achieving therapeutic response thresholds, including BASDAI50 [OR (95% CI): 1.7 (1.2-2.3)], BASDAI<4 [1.8 (1.2-2.7)], MCII for BASDAI [1.9 (13.-2.9)], and MCII for BASFI [1.6 (1.1-1.2)]. Time to achievement of each threshold was significantly shorter among adalimumab-treated patients for BASDAI50 [HR (95% CI): 1.8 (1.1-2.8)], BASDAI<4 [1.7 (1.6-3.6)], and MCII for BASDAI [1.5 (1.0-2.3)]. Time to achievement of MCII for BASFI was not statistically different between groups; for BASFI<3.8 and MCII for both SF-12 PCS and MCS, both odds of, and time to achievement, were also statistically comparable.

At month 24, baseline-adjusted BASDAI and BASFI was comparable (p>0.05): LSM (95%CI) 3.5 (3.3, 3.8) vs. 3.6 (3.2-4.0), and 2.9 (2.6-3.1) vs. 3.3 (2.9-3.7), respectively, for adalimumab-treated vs. nbDMARD/NSAID-treated patients.

Conclusion:

Among Canadian patients with active AS, adalimumab-treated patients reported a greater overall reduction in disease burden related to both self-reported disease activity and functional capacity compared to nbDMARD/NSAID-treated patients, along with higher odds and shorter time to achieving therapeutic response thresholds. Despite the overall beneficial effects observed with adalimumab, residual disease burden, however, is observed for Canadian AS patients even after 24 months of treatment.

Acknowledgements:

The authors wish to acknowledge JSS Medical Research for their contribution to the statistical analysis, medical writing, and editorial support during the preparation of this abstract. AbbVie provided funding to JSS Medical Research for this work.

Disclosure of Interests:

Louis Bessette Speakers bureau: Speaker for Amgen, BMS, Janssen, UCB, AbbVie, Pfizer, Merck, Celgene, Lilly, Novartis, Gilead, Sandoz, Fresenius Kabi, Consultant of: Consultant for Amgen, BMS, Janssen, UCB, AbbVie, Pfizer, Celgene, Lilly, Novartis, Gilead, Sandoz, Samsung Bioepis, Fresenius Kabi, Grant/research support from: Investigator for Amgen, BMS, Janssen, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis, Gilead, Andrew Chow Speakers bureau: Speaker for AbbVie, BMS, Janssen, Pfizer, Consultant of: Consultant for AbbVie, Amgen, BMS, Celgene, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Grant/research support from: Investigator for AbbVie, Amgen, BMS, Celgene, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, Viktoria Pavlova Speakers bureau: Speaker for Amgen, Abbvie, BMS, Jenssen, Lilly, Merk, Novartis, Roche, UCB, and Pfizer, Consultant of: Consultant for Amgen, Abbvie, BMS, Jenssen, Lilly, Merk, Novartis, Roche, UCB, and Pfizer, Grant/research support from: Investigator for Janssen, UCB, Abbvie, and Pfizer; and received research grants from UCB, Marie-Claude Laliberté Employee of: Employee of AbbVie, Majed Khraishi Speakers bureau: Speaker for AbbVie, Consultant of: Consultant for AbbVie, Grant/research support from: Principal Investigator for AbbVie

POS1047 IMPACT OF UPADACITINIB ON REDUCING PAIN IN PATIENTS WITH ACTIVE PSORIATIC ARTHRITIS: RESULTS FROM TWO PHASE 3 TRIALS IN PATIENTS WITH INADEQUATE RESPONSE TO NON-BIOLOGIC OR BIOLOGIC DMARDs

Background:

Pain is a dominant symptom of psoriatic arthritis (PsA), and pain reduction is a priority for patients (pts) that is often assessed in clinical trials. Upadacitinib (UPA), a Janus kinase (JAK) inhibitor engineered for increased selectivity for JAK1 over JAK2, JAK3, and tyrosine kinase2, has demonstrated safety and efficacy in pts with active PsA in the SELECT-PsA 1 and 2 studies.1,2

Objectives:

The objective of this analysis was to compare the efficacy of UPA vs placebo (PBO) and adalimumab (ADA) on pain using different assessments through 24 weeks (wks).

Methods:

The SELECT-PsA program enrolled adult pts with active PsA with prior inadequate response (IR) or intolerance to ≥1 non-biologic DMARD (SELECT-PsA 1; NCT03104400) or prior IR or intolerance to ≥1 biologic DMARD (SELECT-PsA 2; NCT03104374). Concomitant background therapy with ≤2 non-biologic DMARDs was allowed but not required. Pts were randomized to UPA 15 mg or UPA 30 mg once daily (QD) or PBO (both studies), or ADA 40 mg every other week (EOW; SELECT-PsA 1 only). Pain was assessed as proportion of pts achieving ≥30%, ≥50%, or ≥70% reduction from baseline (BL) in Pt’s global assessment (PGA) of pain numeric rating scale (NRS) score (0–10), proportion of pts achieving minimal clinically important difference (MCID) in pain (defined as ≥1 point reduction or 15% reduction from BL on a 0–10 NRS)3,4 and change from baseline in pain NRS (0–10) at all time points. In addition, change from BL in BASDAI questions 2 (spinal pain) and 3 (joint pain/swelling) and 36-Item Short Form Survey (SF-36) questions 7 (bodily pain) and 8 (pain interference) at weeks 12 and 24 were assessed. Non-responder imputation was used for binary endpoints and mixed-effects model for repeated measurements for continuous endpoints. The statistical significance defined as P<0.05 was exploratory in nature.

Results:

In both studies, a significantly higher proportion of pts receiving UPA 15 mg QD and UPA 30 mg QD vs PBO achieved improvements in most pain endpoints as early as wk 2, and improvements were generally either sustained or increased through wk 24 (nominal P<0.05). A significant improvement with UPA vs PBO was also observed for change from BL in PGA of pain NRS scores over time, as well as in BASDAI spinal pain and joint pain/swelling and SF-36 bodily pain and pain interference at weeks 12 and 24. In SELECT-PsA 1 significantly higher proportions of pts receiving UPA 30 mg QD vs ADA 40 mg EOW achieved improvements in most pain assessments as early as wk 2 which were sustained through wk 24; improvements in several assessments were also significantly greater with UPA 15 mg QD vs ADA 40 mg EOW at wk 24 (nominal P <0.05; Data will be presented).

Conclusion:

In pts with active PsA who had inadequate response to non-biologic or biologic DMARDs, a greater proportion of pts treated with UPA vs PBO achieved rapid, significant, and clinically meaningful reductions in pain across multiple pain assessments. The reductions in pain were sustained over 24 wks.

References:

[1]McInnes I. et al. Ann Rheum Dis. 2020;79(Suppl 1):12-13.

[2]Genovese M.C. et al. Ann Rheum Dis. 2020;79(Suppl 1):139.

[3]Dworkin, R.H. et al. J Pain. 2008;9(2):105-121.

[4]Salaffi F. et al. Eur J Pain. 2004;8:283–291.

Acknowledgements:

AbbVie funded this study and participated in the study design, research, analysis, data collection, interpretation of data, reviewing, and approval of the publication. All authors had access to relevant data and participated in the drafting, review, and approval of this publication. No honoraria or payments were made for authorship. Medical writing support was provided by M Hovenden and J Matsuura of ICON plc (North Wales, PA) and was funded by AbbVie.

Disclosure of Interests:

Iain McInnes Consultant of: AbbVie, AstraZeneca, Boehringer Ingelheim, Bristol Myers, Celgene, Janssen, Leo, Lilly, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, AstraZeneca, Boehringer Ingelheim, Bristol Myers, Celgene, Janssen, Leo, Lilly, Novartis, Pfizer, and UCB, William Tillett Speakers bureau: AbbVie, Amgen, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Amgen, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, and UCB, Philip J Mease Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers, Celgene, Galapagos, Genentech, Gilead, GlaxoSmithKline, Janssen, Leo, Lilly, Merck, Novartis, Pfizer, Sun Pharma, and UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers, Celgene, Galapagos, Genentech, Gilead, GlaxoSmithKline, Janssen, Leo, Lilly, Merck, Novartis, Pfizer, Sun Pharma, and UCB, Grant/research support from: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers, Celgene, Galapagos, Genentech, Gilead, GlaxoSmithKline, Janssen, Leo, Lilly, Merck, Novartis, Pfizer, Sun Pharma, and UCB, Kurt de Vlam Speakers bureau: Celgene Eli Lilly, Galapagos, Novartis, and UCB, Consultant of: Celgene, Eli Lilly, Galapagos, Novartis, and UCB, Grant/research support from: Celgene and Galapagos, Louis Bessette Speakers bureau: Amgen, BMS, Janssen, UCB, AbbVie, Pfizer, Merck, Celgene, Lilly, Novartis, and Sanofi, Consultant of: Amgen, BMS, Janssen, UCB, AbbVie, Pfizer, Merck, Celgene, Lilly, Novartis, Sanofi, Gilead, Grant/research support from: Amgen, BMS, Janssen, UCB, AbbVie, Pfizer, Merck, Celgene, Lilly, Novartis, Sanofi, and Gilead, Ralph Lippe Shareholder of: AbbVie, Employee of: AbbVie, anna maniccia Shareholder of: AbbVie, Employee of: AbbVie, Patrick Zueger Shareholder of: AbbVie, Employee of: AbbVie, Dai Feng Shareholder of: AbbVie, Employee of: AbbVie, Koji Kato Shareholder of: AbbVie, Employee of: AbbVie, Andrew Ostor Consultant of: AbbVie, BMS, Roche, Janssen, Lilly, Novartis, Pfizer, UCB, Gilead, and Paradigm.

OP0262-HPR THE NEURO-QOL UPPER EXTREMITY FUNCTION SCALE: NEW OPPORTUNITIES TO MORE RELIABLY AND PRECISELY MEASURE SELF-REPORTED HAND FUNCTION AND SELF-CARE ACTIVITIES IN PEOPLE WITH RA

Background:

RA is an inflammatory disease that results in pain and loss of function, especially in the hands and wrists. Brief self-assessment tools that can reliably and precisely quantify hand/wrist function are needed to assess inflammatory activity when a physical exam is not feasible and to capture day-to-day experience of living with RA. Neuro-QoL is part of the PROMIS family of self-report measures created using a patient-centred approach and IRT methodology. The Neuro-Qol Upper Extremity Function (UEF) scale measures ability across fine motor and ADLs involving digital, manual and reach-related function and self-care. Little is known about its performance in RA.

Objectives:

To evaluate the validity and responsiveness of the 8-item Neuro-QoL UEF in RA. We hypothesized scores would be strongly (r>.70) associated with MHAQ, MD-HAQ, and PROMIS PF, moderately (r=.4 to .7) to symptoms, disease activity, and QoL indicators, and be responsive to change in disease activity and PF.

Methods:

Data were from the 0 and 6-month visits of adults with early RA (sx <1 yr) enrolled in the Canadian Early Arthritis Cohort, a prospective real-world study at 16 sites across Canada. Participants completed the Neuro-QoL UEF, MHAQ, MDHAQ, PROMIS-29, and PT Global at each visit. Rheumatologists recorded joint counts and MD Global. To evaluate content validity, we examined descriptive statistics across CDAI disease activity levels, and Pearson correlations between the Neuro-QOL UEF, legacy measures, CRP & ESR. Responsiveness was assessed by correlating change scores from visits 0-6 between Neuro-QoL UEF, disease activity and legacy PF scores.

Results:

The 262 participants were mostly white (83%) women (71%) with a mean (SD) age of 55 (13). Summary statistics at 6-months are shown in Table 1. Neuro-QOL UEF was moderately-strongly correlated with MHAQ, MDHAQ, PROMIS-PF (|r|=.63-.75) and moderately correlated with pain and stiffness, (|r|=.59, -.64), and CDAI, SDAI, PT&MD Global, TJ & SJ (|r|=.39-.58). Neuro-QOL UEF was moderately correlated with PROMIS QoL domains Pain, Fatigue, Anxiety, Depression, Sleep & Participation (|r|=.39-.60).

Table 1.

Summary statistics of physical function and RA disease activity indices at 6 months.

MeanSDMdn25%75%(Min, Max)Physical FunctionNeuro-Qol UEF46.59.753.837.553.8(21.8, 53.8)MHAQ (0-3)0.290.430.130.000.38(0.00, 2.25)MD-HAQ (0-10)1.391.640.700.002.00(0.00, 8.00)PROMIS-PF46.48.546.239.556.0(23.3, 56.0)RA Disease ActivityCDAI9.39.96.03.013.0(0.0, 56.0)SDAI10.710.96.83.115.2(0.0, 57.0)Patient Global3.02.5315(0, 10)MD Global1.82.2103(0, 9)Swollen Joints (28)2.13.7002(0, 20)Tender Joints (28)2.43.9103(0, 24)

Neuro-QOL scores decreased in a dose-response manner across worsening CDAI DA states reflecting increasing impairment (Table 2). Persons with HDA reported the highest disability, scoring nearly 0.5 SD lower on the Neuro-QoL UEF than PROMIS PF. Change from baseline to 6 months in Neuro-QoL UEF was moderately correlated with changes in PROMIS PF, MHAQ, PT Global, and CDAI (|r|=.44-.65). The mean change and range from 0-6 months in Neuro-QoL was significantly larger than in PROMIS (8.9 [95% CI 7.5, 10.4] vs. 5.4 [95% CI 4.4, 6.4])(see Figure).

Table 2.

Mean scores (95% CI) at 6 months by CDAI level.

REMLDAMDAHADNeuroQol UEF52.8 (51.8, 53.7)48.1 (46.6, 49.7)42.0 (39.4, 44.6)33.8 (30.5, 37.1)MHAQ (0-3)0.05 (0.02, 0.09)0.19 (0.14, 0.24)0.45 (0.34, 0.57)0.90 (0.63, 1.17)MD-HAQ (0-10)0.31 (0.17, 0.46)1.11 (0.90, 1.32)2.15 (1.71, 2.59)3.56 (2.56, 4.56)PROMIS-PF52.8 (51.4, 54.2)46.8 (45.3, 48.2)42.3 (40.4, 44.2)38.0 (34.4, 41.6)

Conclusion:

Clinicians, researchers, and patients benefit from practical self-report tools that reliably and precisely monitor hand function in RA. Results offer initial evidence of validity and responsiveness and support use of Neuro-QoL UEF to self-assess inflammatory activity in the hands and day-to-day experiences of living with RA.

Acknowledgements:

The CATCH study was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada - Founding sponsors since January 2007; AbbVie Corporation and Hoffmann-LaRoche since 2011; Medexus Inc. since 2013;, Merck Canada since 2017, Sandoz Canada, Biopharmaceuticals since 2019,Gilead Sciences Canada since 2020 and Fresenius Kabi Canada Ltd. since 2021. Previously funded by Janssen Biotech from 2011-2016, UCB Canada and Bristol-Myers Squibb Canada from 2011-2018, Sanofi Genzyme from 2016-2017, and Eli Lilly Canada from 2016-2020.

Disclosure of Interests:

None declared

AB0558 CLINICAL EFFECTIVENESS AND SAFETY OF ADALIMUMAB VERSUS NON-BIOLOGIC THERAPY IN PSORIATIC ARTHRITIS PATIENTS OVER 24 MONTHS – RESULTS OF THE COMPLETE-PsA CANADIAN OBSERVATIONAL STUDY

Background:

COMPLETE-PsA was an observational study of biologic-naïve Canadian adults with active psoriatic arthritis (PsA) treated with adalimumab or non-biologic disease-modifying anti-rheumatic drugs (nbDMARD) after switch from initial therapy.

Objectives:

The aim of this analysis was to assess the 24-month clinical effectiveness and safety of adalimumab vs. nbDMARD in the treatment of PsA in a real-life setting.

Methods:

Eligible patients were biologic naïve adults, with active PsA who required change in their treatment regimen due to inadequate response or intolerance, per the judgment of the treating physician. Patients were enrolled between July/2011 and December/2017 and followed for up to 24 months. Patients were treated as per routine care. The primary endpoint, change in DAS-28 to month 24, was assessed with baseline-adjusted multivariable models and the least square mean (LSM) estimates were generated; Physician’s Global Assessment of disease activity (PGA, 100mm VAS) was assessed using similar methodology. Probability of achieving the following therapeutic response thresholds was ascertained and odds ratios (ORs) were generated: 50%/70% improvement in the American College of Rheumatology criteria (ACR50/ACR70), DAS-28<3.2 (low disease activity or remission; LDA/remission), DAS-28<2.6 (remission), modified minimal disease activity (mMDA: achievement of 5/7 of: TJC and SJC ≤1 each, BSA ≤3%, pain ≤15 (VAS, mm), Patient Global Assessment [PtGA] ≤20, HAQ-DI ≤0.5, and no enthesitis), and psoriasis (PsO) BSA <3%.

Results:

A total of 277 adalimumab and 148 nbDMARD- treated patients were included as part of the intent-to-treat population. Baseline methotrexate was reported by 61.7% and 81.1% of adalimumab and nbDMARD-treated patients, respectively. PsO BSA at baseline was predominantly <3% for both adalimumab (60.2%) and nbDMARD (64.6%) patients. Adalimumab-treated patients reported significantly (p<0.05) higher mean (SD) disease activity for both DAS-28 [4.8 (1.2) vs. 4.3 (1.1)] and PGA [59.4 (19.5) vs. 51.0 (21.8) mm] at baseline.

For the primary endpoint, baseline-adjusted month 24 DAS-28 levels were significantly lower for adalimumab vs. nbDMARD patients [LSM (95%CI): 2.4 (2.2-2.6) vs. 3.0 (2.7-3.3); p=0.037]. In addition, rapid and sustained reductions in DAS-28 were observed for adalimumab-treatment patients, with overall treatment effect significant (p<0.001) in favor of adalimumab [estimate (95%CI): -1.1 (-1.4, -0.7)]; similar results were observed for PGA [-12.9 (-1.7, -8.0)]. Adalimumab-treated patients were at significantly higher (p<0.001) odds of attaining therapeutic response thresholds compared to DMARD-treated patients, specifically: DAS-28 LDA/remission [OR (95%CI): 4.5 (2.8, 7.3)] or remission [OR (95% CI): 4.1 (2.7-6.3)], ACR50 [OR (95% CI): 3.0 (2.0-4.6)], ACR70 [OR (95% CI): 3.1 (2.0-4.9)], mMDA [OR (95% CI): 2.4 (1.6-3.6)], and PsO BSA <3% [OR (95% CI): 2.2 (1.2-3.7)].

Overall, 32 (10.7%) of adalimumab-treated patients reported 86 AEs, the most common related to infections [16 events in 10 (3.3%) patients].

Conclusion:

Real-world treatment with adalimumab was more effective in improving disease activity and psoriasis severity, over 24 months when compared to nbDMARDs and was associated with significantly greater likelihood of achieving minimal disease activity. Observed AEs were consistent with the established safety profile of adalimumab.

Disclosure of Interests:

Majed Khraishi Speakers bureau: Speaker for AbbVie, Consultant of: Consultant for AbbVie, Grant/research support from: Principal Investigator for AbbVie, Jacqueline Stewart Speakers bureau: Speaker for Abbvie, Janssen, and Johnson & Johnson, Consultant of: Advisory Board Consultant for AbbVie, Amgen, Celgene, Merck, Novartis, Pfizer, and Sanofi-Genzyme;, Grant/research support from: Participated in research with AbbVie, Bristol Myers Squibb, Janssen, and Roche, Yatish Setty Consultant of: Advisory Board meetings with AbbVie and Janssen, Marie-Claude Laliberté Employee of: Employee of AbbVie, Louis Bessette Speakers bureau: Speaker for Amgen, BMS, Janssen, UCB, AbbVie, Pfizer, Merck, Celgene, Lilly, Novartis, Gilead, Sandoz, and Fresenius Kabi, Consultant of: Consultant for Amgen, BMS, Janssen, UCB, AbbVie, Pfizer, Celgene, Lilly, Novartis, Gilead, Sandoz, Samsung Bioepis, and Fresenius Kabi, Grant/research support from: Investigator for Amgen, BMS, Janssen, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis, and Gilead.

POS1459-HPR IDENTIFYING MEANINGFUL CHANGE IN THE RA FLARE QUESTIONNAIRE SCORES IN RHEUMATOID ARTHRITIS

Background:

The RA-FQ is a patient-reported measure of current disease activity in RA that can be used to identify disease flares. The RA-FQ queries pain, physical function, fatigue, stiffness, and participation and yields a score from 0-50. We previously reported on reliability, validity, and responsiveness.

Objectives:

To identify changes in RA-FQ that represent minimal and meaningful improvement or worsening from the perspective of people with RA, treating rheumatologists, and in relation to disease activity indices. We hypothesized that

Methods:

Data were from adults with early RA (sx <1 year) enrolled in the Canadian Early Arthritis Cohort, a prospective study of real-world patients treated across Canada. Participants completed the RA-FQ, Patient Global, and RA transition item since last visit (a little vs. a lot better or worse or same) between consecutive 3- and 6-month visits. Rheumatologists recorded joint counts, MD Global, and change in RA. We compared mean change across improvement and worsening using patient anchors and disease activity indicators.

Results:

The 808 adults were mostly white (84%) women (71%) with a mean (SD) age of 55 (15) and moderate-high CDAI level (85%) at enrollment. Most (79%) reported their RA had changed; 59% were better and 20% worse. Patients who were a lot worse had a mean increase of 8.9 points whereas those who rated themselves as a lot better had a -6.0 decrease on the RA-FQ (Figure 1). Minimal worsening and improvement were associated with 4.7 and -1.8 change in RA-FQ scores, respectively, while patients who rated their RA unchanged had stable RA-FQ scores (Table 1).

Similar changes were evident in CDAI, SDAI, and DAS indices (Table 1). Larger differences were observed with patient vs. physician global scores and tender vs. swollen joints. Across measures, the change associated with worsening was greater than for improvement. Results supported all prespecified hypotheses ab.

Table 1.

Spearman’s correlation coefficients of PsAQoL with the other parameters for construct validity

DomainA Lot Better(N=346; 43%)A Little Better(N=132; 16%)The Same(N=174; 21%)A Little Worse(N=94; 12%)A Lot Worse(N=62; 8%)Δ95% CISDΔ95% CISDΔ95% CISDΔ95% CISDΔ95% CISDRA-FQ Total (0-50)-6.0(-7.1, -4.9)10.3-1.8(-3.2, -0.3)8.4-0.1(-1.3, 1.1)8.14.7(2.9, 6.6)9.18.9(5.1, 12.7)15.0 Pain-1.2(-1.4, -0.9)2.4-0.4(-0.8, 0.0)2.30.0(-0.2, 0.3)1.81.3(0.8, 1.7)2.22.0(1.2, 2.9)3.3 Physical Function-1.3(-1.6, -1.1)2.4-0.3(-0.6, 0.1)2.10.0(-0.3, 0.3)2.10.9(0.4, 1.4)2.41.8(0.8, 2.7)3.7 Fatigue-1.1(-1.4, -0.8)2.6-0.4(-0.7, 0.0)1.90.0(-0.3, 0.3)2.10.7(0.3, 1.1)2.11.3(0.5, 2.1)3.2 Stiffness-1.1(-1.4, -0.9)2.4-0.4(-0.7, 0.0)2.0-0.1(-0.4, 0.2)2.01.1(0.6, 1.5)2.21.8(1.0, 2.7)3.3 Participation-1.2(-1.5, -1.0)2.5-0.1(-0.5, 0.3)2.1-0.1(-0.4, 0.2)2.20.8(0.4, 1.3)2.22.0(1.1, 2.8)3.4Disease ActivityCDAI*-5.3(-6.3, -4.3)9.1-3.3(-5.4, -1.3)11.5-0.8(-2.0, 0.5)8.11.7(-0.1, 3.5)8.86.8(3.7, 9.8)12.0SDAI-5.6(-6.8, -4.4)9.2-3.5(-6.1, -0.9)12.2-1.9(-3.6, -0.2)8.91.5(-0.7, 3.7)9.24.7(1.0, 8.4)12.2DAS28-CRP-0.7(-0.8, -0.6)1.01-0.5(-0.7, -0.2)1.2-0.2(-0.4, 0.0)1.00.3(0.1, 0.5)1.00.5(0.2, 0.9)1.2Patient Global (0-10)-1.3(-1.5, -1.0)2.7-0.5(-0.9, -0.1)2.1-0.1(-0.4, 0.2)2.11.3(0.8, 1.8)2.42.9(2.1, 3.6)3.1MD Global (0-10)-1.2(-1.4, -1.0)1.9-0.7(-1.1, -0.3)-0.1-0.1(-0.4, 0.2)1.90.1(-0.3, 0.5)2.80.7(0.0, 1.5)2.8Swollen Joints (28)-1.4(-1.7, 1.0)3.2-1.0(-1.8, -0.2)4.6-0.4(-0.9, 0.0)3.00.0(-0.7, 0.7)3.41.3(0.2, 2.5)4.6Tender Joints (28)-1.5(-1.9, -1.1)3.9-1.3(-2.2, -0.3)5.50.0(-0.7, 0.6)4.30.3(-0.7, 1.2)4.52.2(0.8, 3.5)5.4

Conclusion:

In this large cohort of adults with ERA, the RA-FQ was responsive to change and generally distinguish between minimal and meaningful improvement and worsening. These data add to a growing evidence demonstrating robust psychometric properties of the RA-FQ and offer initial guidance about the amount of change associated with improvement or worsening, supporting its use in RA care, research and decision-making.

Acknowledgements:

The CATCH study was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada - Founding sponsors since January 2007; AbbVie Corporation and Hoffmann-LaRoche since 2011; Medexus Inc. since 2013;, Merck Canada since 2017, Sandoz Canada, Biopharmaceuticals since 2019,Gilead Sciences Canada since 2020 and Fresenius Kabi Canada Ltd. since 2021. Previously funded by Janssen Biotech from 2011-2016, UCB Canada and Bristol-Myers Squibb Canada from 2011-2018, Sanofi Genzyme from 2016-2017, and Eli Lilly Canada from 2016-2020.

Disclosure of Interests:

None declared

POS0232 CLINICAL EFFECTIVENESS OF ADALIMUMAB VERSUS NON-BIOLOGIC THERAPY IN THE MANAGEMENT OF EXTRA-ARTICULAR MANIFESTATIONS IN ANKYLOSING SPONDYLITIS PATIENTS OVER 24 MONTHS – RESULTS OF THE COMPLETE-AS CANADIAN OBSERVATIONAL STUDY

Background:

COMPLETE-AS was a Canadian observational study among biologic-naïve adults with active ankylosing spondylitis (AS) initiated on either adalimumab (ADA) or subsequent non-biologic disease-modifying anti-rheumatic drugs and/or non-steroidal anti-inflammatory drugs (nbDMARD/NSAID) after a switch from initial treatment due to inadequate response or intolerance, as per the judgement of the treating physician.

Objectives:

The aim of this analysis was to assess the 24-month effectiveness of ADA compared to nbDMARD/NSAID in the management of heel enthesitis and extra-articular manifestations (EAMs).

Methods:

Patients were enrolled between July 2011 and December 2017, and followed for up to 24 months. Patients were treated as per routine care and all analyses were performed using the intent-to-treat (ITT) approach. The disease outcomes assessed in this study included enthesitis (of the heel) and EAMs [inflammatory bowel disease (IBD), uveitis, and psoriasis (PsO)]. The rate ratio (RR) for first occurrence or flare-up/exacerbation of disease outcomes was ascertained with multivariate models. The time to first occurrence of EAMs and enthesitis was ascertained with Cox proportional hazard models, generating a hazard ratio (HR).

Results:

A total of 452 patients treated with ADA and 187 patients receiving a subsequent nbDMARD/NSAID were enrolled in the study. Baseline characteristics were overall comparable between treatment groups: patients had a mean (SD) age of 42.7 (13.4) years, 55.6% were male, and 85.8% were Caucasian. The mean (SD) duration of AS since diagnosis was 5.6 (9.3) years. A total of 17.7%, 12.4%, 18.5%, and 16.3% of patients had experienced enthesitis, IBD, uveitis, and PsO, respectively at baseline. Disease severity (mean [SD] BASDAI) was however higher among ADA- vs. nbDMARD/NSAID-treated patients (6.4 [1.8] vs. 5.0 [1.8]; p<0.001).

In terms of the rates of first occurrence or flare-up/exacerbation of enthesitis and EAMs, statistically significant between-group differences were found, whereby ADA-treated patients had a 60% reduced rate of both uveitis [RR (95% CI): 0.4 (0.2-0.6)] and enthesitis [0.4 (0.3-0.7)] compared to nbDMARD/NSAID-treated patients. The rates of first occurrence or flare-up/exacerbation for IBD [1.1 (0.7-1.7)] and PsO [3.3 (0.9-12.7)]were statistically comparable between treatment groups.

The time to first occurrence of both enthesitis and uveitis was also statistically significant (p<0.05) between groups. ADA-treated patients had a 50% lower risk of enthesitis as a first occurrence compared to nbDMARD/NSAID-treated patients [HR (95% CI): 0.5 (0.3-0.9)], and an 80% lower risk of uveitis [0.2 (0.0-0.8)]. The time to first occurrence of IBD [0.7 (0.2-2.1)] and PsO [1.9 (0.8-4.6)], were statistically comparable between treatment groups.

Conclusion:

Despite a comparable proportion of patients reporting baseline EAMs and enthesitis, patients treated with ADA were less likely to experience a first occurrence or flare-up/exacerbation, of both enthesitis and uveitis compared to patients treated with nbDMARD/NSAID. The results of this real-world Canadian study suggest that treatment with ADA among AS patients is more effective at preventing the first occurrence / exacerbation of select EAMs and heel enthesitis.

Acknowledgements:

The authors wish to acknowledge JSS Medical Research for their contribution to the statistical analysis, medical writing, and editorial support during the preparation of this abstract. AbbVie provided funding to JSS Medical Research for this work.

Disclosure of Interests:

Louis Bessette Speakers bureau: Speaker for Amgen, BMS, Janssen, UCB, AbbVie, Pfizer, Merck, Celgene, Lilly, Novartis, Gilead, Sandoz, Fresenius Kabi, Consultant of: Consultant for Amgen, BMS, Janssen, UCB, AbbVie, Pfizer, Celgene, Lilly, Novartis, Gilead, Sandoz, Samsung Bioepis, Fresenius Kabi, Grant/research support from: Investigator for Amgen, BMS, Janssen, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis, Gilead, Boulos Haraoui Speakers bureau: Speakers for AbbVie, Amgen, BMS, Gilead, Lilly, Merck, Pfizer, Sandoz, and UCB, Consultant of: Advisor for AbbVie, Amgen, BMS, Gilead, Lilly, Merck, Pfizer, Sandoz, and UCB, Grant/research support from: Research grants from AbbVie, Amgen, BMS, Gilead, Lilly, Merck, Pfizer, Sandoz, and UCB, Brandusa Florica Speakers bureau: Speaker for Merck, AbbVie, Roche, BMS, and Novartis, Consultant of: Consultant for Roche, AbbVie, Pfizer, Janssen, Celgene, and UCB, Grant/research support from: Investigator for AbbVie, Pfizer, and BMS, Marie-Claude Laliberté Employee of: Employee of AbbVie, Majed Khraishi Speakers bureau: Speaker for AbbVie, Consultant of: Consultant for AbbVie, Grant/research support from: Principal Investigator for AbbVie.

POS0087 LONG-TERM SAFETY AND EFFICACY OF UPADACITINIB OR ADALIMUMAB IN PATIENTS WITH RHEUMATOID ARTHRITIS: RESULTS AT 3 YEARS FROM THE SELECT-COMPARE STUDY

Background:

In the SELECT-COMPARE study, the Janus kinase inhibitor, upadacitinib (UPA), demonstrated significant improvements in the signs and symptoms of rheumatoid arthritis (RA) when administered at 15 mg once daily (QD) on background methotrexate (MTX) compared with adalimumab (ADA) plus MTX at Week 12 that were maintained through 72 weeks in patients with prior inadequate response to MTX.1

Objectives:

To assess the long-term safety and efficacy of UPA vs ADA over 3 years in the ongoing long-term extension (LTE).

Methods:

Patients receiving background MTX were randomized 2:2:1 to UPA 15 mg QD, placebo (PBO), or ADA 40 mg every other week. Between Weeks 14-26, rescue was mandated for either lack of response (<20% improvement in tender or swollen joint counts: Weeks 14, 18, 22) or failure to achieve a targeted disease outcome (CDAI low disease activity: Week 26). Patients who completed the 48-week double-blind period could enter an LTE for up to 10 years total. This analysis describes patients through 3 years of treatment. Treatment-emergent adverse events (TEAEs) per 100 patient years (PY), including events of special interest (AESI), were summarized up to 3 years based on exposure to UPA and to ADA. Efficacy was analyzed by original randomized groups. Patients who were rescued or prematurely discontinued study drug were categorized as non-responders for visits after rescue or discontinuation. Descriptive analyses were performed without formal statistical comparisons.

Results:

In total, 651, 651, and 327 patients were randomized at baseline to receive UPA, PBO, and ADA, respectively. Between Weeks 14-26, 252 (39%) patients were rescued from UPA to ADA, 159 (49%) were rescued from ADA to UPA, and all PBO patients were switched to UPA by Week 26.1 A higher proportion of patients randomized to UPA completed 3 years without rescue compared to those randomized to ADA (47% vs 36%, respectively). UPA was generally well-tolerated as assessed by the rates of TEAEs, including serious AEs, AEs leading to discontinuation of study drug, and AESIs, including serious and opportunistic infections, malignancies, adjudicated major adverse cardiac events or venous thromboembolism; Figure 1). Consistent with previous analyses, the event rates of AESIs were generally comparable between the UPA and ADA groups, while herpes zoster, lymphopenia, hepatic disorder, and CPK elevation were reported at higher rates with UPA. Consistent with earlier time points, greater proportions of patients randomized to UPA achieved low disease activity and remission at 3 years based on CDAI, as well as DAS28(CRP) ≤3.2 or <2.6, compared with patients randomized to ADA (Table 1).

Conclusion:

The safety profile of UPA was consistent with the results reported previously and with the integrated Phase 3 safety analysis.1,2 Higher levels of clinical response continued to be observed with UPA vs ADA through 3 years of treatment.

References:

[1]Fleischmann R, et al. Ann Rheum Dis 2020;79:323.

[2]Cohen SB, et al. Ann Rheum Dis 2020; doi: 10.1136/annrheumdis-2020-218510.

Table 1.

Efficacy Endpoints at 3 Years (NRI)

Endpoints, % (95% CI)UPA 15 mg QDN=651*ADA 40 mg EOWN=327*CDAI ≤1039 (36, 43)29 (24, 34)CDAI ≤2.824 (21, 28)17 (12, 21)DAS28(CRP) ≤3.237 (33, 41)26 (21, 31)DAS28(CRP) <2.632 (29, 36)22 (17, 26)

ADA, adalimumab; CI, confidence interval; DAS28(CRP), Disease Activity Score for 28-joints C-Reactive Protein; CDAI, clinical disease activity index; EOW, every other week; NRI, non-responder imputation; QD, once daily; UPA, upadacitinib.

*Patients who were rescued prior to/at Week 26 were considered non-responders. 252/651 and 159/327 patients were rescued of those randomized to UPA and ADA, respectively.

Acknowledgements:

AbbVie and the authors thank the patients, trial sites, and investigators who participated in this clinical trial. AbbVie, Inc was the trial sponsor, contributed to trial design, data collection, analysis & interpretation, and to writing, reviewing, and approval of final version. No honoraria or payments were made for authorship. The authors thank Dr. Tim Shaw of AbbVie Inc. for his support with the interpretation of the data. Medical writing support was provided by Ramona Vladea, PhD, of AbbVie, Inc.

Disclosure of Interests:

Roy Fleischmann Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Eli Lilly, GSK, Janssen, Novartis, Pfizer Inc, Sanofi-Aventis, and UCB, Grant/research support from: AbbVie, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Genentech, Janssen, Novartis, Pfizer Inc, Regeneron, Roche, Sanofi-Aventis and UCB, Eduardo Mysler Consultant of: AbbVie, AstraZeneca, Lilly, Pfizer, Roche, BMS, Sandoz, GSK, Janssen, Grant/research support from: AbbVie, AstraZeneca, Lilly, Pfizer, Roche, BMS, Sandoz, GSK, Janssen, Louis Bessette Consultant of: Amgen, BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Eli Lilly, Novartis, Gilead, Grant/research support from: Amgen, BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Eli Lilly, Novartis, Gilead, Charles Peterfy Shareholder of: Spire Sciences, Inc, Speakers bureau: Amgen, Bristol-Myers Squibb, Consultant of: Aclaris, Centrexion, Daiichi Sankyo, EMD, Serono, Five Prime, Flexion Therapeutics, Genentech, Gilead, GlaxoSmithKline, Istresso, Eli Lilly, Myriad Genetics, Novartis, Roche, SetPoint, Sorrento, UCB, Employee of: Spire Sciences, Inc, Patrick Durez Speakers bureau: BMS, Sanofi, Eli Lilly, Celltrion, Yoshiya Tanaka Speakers bureau: Daiichi-Sankyo, Astellas, Chugai, Eli Lilly, Pfizer, AbbVie, YL Biologics, Bristol-Myers, Takeda, Mitsubishi-Tanabe, Novartis, Eisai, Janssen, Teijin, Consultant of: Daiichi-Sankyo, Astellas, Chugai, Eli Lilly, Pfizer, AbbVie, YL Biologics, Bristol-Myers, Takeda, Mitsubishi-Tanabe, Novartis, Eisai, Janssen, Teijin, Grant/research support from: Asahi-kasei, Mitsubishi-Tanabe, Chugai, Takeda, Sanofi, Bristol-Myers, UCB, Daiichi-Sankyo, Eisai, Ono, Jerzy Swierkot Speakers bureau: AbbVie, Sandoz, Pfizer, Roche, BMS, UCB, MSD, Accord, Janssen, Consultant of: AbbVie, Sandoz, Pfizer, Roche, BMS, UCB, MSD, Accord, Janssen, Grant/research support from: AbbVie, Sandoz, Pfizer, Roche, BMS, UCB, MSD, Accord, Janssen, Nasser Khan Shareholder of: AbbVie, Employee of: AbbVie, Xianwei Bu Shareholder of: AbbVie, Employee of: AbbVie, Yihan Li Shareholder of: AbbVie, Employee of: AbbVie, In-Ho Song Shareholder of: AbbVie, Employee of: AbbVie.

AB0555 IMPACT OF ADALIMUMAB VERSUS NON-BIOLOGIC THERAPY ON CLINICAL AND PATIENT-REPORTED OUTCOMES IN PSORIATIC ARTHRITIS OVER 24 MONTHS – RESULTS OF THE COMPLETE-PsA CANADIAN OBSERVATIONAL STUDY

Background:

COMPLETE-PsA was a Canadian observational study of biologic-naïve adults with active psoriatic arthritis (PsA) treated with adalimumab (ADA) or conventional systemic disease-modifying anti-rheumatic drugs (csDMARDs) after switch from a previous conventional therapy.

Objectives:

To compare the impact of ADA vs csDMARDs on clinical and patient-reported outcomes due to PsA over 24 months.

Methods:

Eligible patients were biologic naïve adults with active PsA who required change in their treatment due to inadequate response or non-tolerance, as per treating physician judgement. Patients were enrolled between July/2011 and December/2017 and followed for a maximum 24 months. Treatment was as per routine care. Outcome measures included tender/swollen joint count (TJC/SJC), morning stiffness (min/day), patient’s global assessment of disease activity (PtGA) and pain (both 100 mm VAS), quality of life (DLQI), and functional disability (HAQ-DI). Outcome changes over time were evaluated using multivariable models adjusting for baseline measures. Achievement of modified minimal disease activity [mMDA, 5/7 of: TJC and SJC ≤1 each, psoriasis BSA ≤3%, pain ≤15 (VAS, mm), PtGA ≤20, HAQ-DI ≤0.5, and no enthesitis], and presence of enthesitis and dactylitis, were assessed descriptively. Analyses were conducted in the intent-to-treat population.

Results:

A total of 277 ADA and 148 csDMARD-treated patients were included in the analysis. At baseline, 61.7% of ADA and 81.1% of csDMARD patients reported concomitant methotrexate. Compared to the csDMARD group, ADA-treated patients demonstrated significantly (p<0.05) greater baseline disease severity with respect to mean (SD) joint count [TJC: 8.9 (6.2) vs. 7.4 (6.6); SJC: 7.4 (5.0) vs. 5.9 (4.6)], morning stiffness [83.5 (98.2) vs. 61.8 (77.4) min/day], PtGA [56.1 (24.1) vs. 45.1 (24.7) mm], pain [58.5 (24.3) vs. 50.1 (24.0) mm], DLQI scores [6.1 (6.9) vs. 4.3 (5.3)] and HAQ-DI [1.1 (0.6) vs. 0.8 (0.6)]. The rate of baseline mMDA was slightly lower for ADA patients (4.3% vs. 7.4%; p=0.178). Baseline prevalence of enthesitis was comparable (ADA: 28.4% vs. csDMARD: 23.4%; p=0.276), while dactylitis was significantly more prevalent for csDMARD patients (26.2% vs. 36.3%; p=0.031).

Overall effect of treatment group, over 24 months, significantly (p<0.05) favored the ADA vs. csDMARD-treated patients for TJC [estimate (95%CI): -2.4 (-3.4, -1.4)] SJC [-1.8 (-2.5, -1.2)], PtGA [-3.7 (-9.3, 1.9)], DLQI [-1.5 (-2.5, -0.5)], and HAQ-DI [-0.1 (-0.2, 0.0)] (Figure 1). There was no significant difference for morning stiffness and pain.

At month 24, statistically comparable (p>0.05) baseline-adjusted values (the least square means: LSM) were observed for ADA- vs. csDMARD-treated patients for TJC [LSM (95%CI): 1.8 (1.2, 2.4) vs. 3.0 (2.1, 3.8)], SJC [1.2 (0.8, 1.7) vs. 2.1 (1.5, 2.7)], morning stiffness [32.4 (19.1, 45.6) vs. 29.9 (11.1, 48.6) min/day], PtGA [31.6 (28.1, 35.2) vs. 36.9 (31.8, 41.9) mm], pain [35.3 (31.5, 39.0) vs. 38.4 (33.1, 43.7) mm], DLQI [2.9 (2.2, 3.6) vs. 2.9 (2.0, 3.8)], and HAQ-DI [0.7 (0.6, 0.8) vs. 0.9 (0.8, 1.0)].

Achievement of mMDA at month 24 was reported by 34.1% and 34.9% of ADA- and csDMARD-treated patients, respectively (p=0.892). Rates of dactylitis (10.6% vs. 10.0%) and enthesitis (9.6% vs. 14.4%) were comparable in the ADA vs. csDMARDs groups respectively.

Conclusion:

The results of this real-world Canadian study indicate a physician selection bias for treatment with ADA for PsA patients with more severe disease burden, indicated by greater baseline disease activity and PROs. ADA-treated patients experienced a greater treatment effect over 24 months compared to csDMARD-treated patients. However, despite the greater treatment effect of ADA, residual disease burden in the two groups was comparable at 24 months.

Acknowledgements:

The authors wish to acknowledge JSS Medical Research for their contribution to the statistical analysis, medical writing, and editorial support during the preparation of this abstract. AbbVie provided funding to JSS Medical Research for this work.

Disclosure of Interests:

Majed Khraishi Speakers bureau: Speaker for AbbVie, Consultant of: Consultant for AbbVie, Grant/research support from: Principal Investigator for AbbVie, Samuel Silverberg Consultant of: Consultant for AbbVie, Janssen, and Pfizer, Yatish Setty Consultant of: Advisory Board meetings with AbbVie and Janssen, Marie-Claude Laliberté Employee of: Employee of AbbVie, Louis Bessette Speakers bureau: Speaker for Amgen, BMS, Janssen, UCB, AbbVie, Pfizer, Merck, Celgene, Lilly, Novartis, Gilead, Sandoz, Fresenius Kabi, Consultant of: Consultant for Amgen, BMS, Janssen, UCB, AbbVie, Pfizer, Celgene, Lilly, Novartis, Gilead, Sandoz, Samsung Bioepis, Fresenius Kabi, Grant/research support from: Investigator for Amgen, BMS, Janssen, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis, Gilead.

AB0557 ACHIEVING TREATMENT TARGETS IN PSORIATIC ARTHRITIS WITH APREMILAST IN CANADIAN PRACTICE: REAL WORLD RESULTS FROM APPRAISE

Background:

Real-world evidence on achieving treatment targets with apremilast (APR) in patients (pts) with PsA is limited. In the phase 3 PALACE trials, pts reached remission (REM)/low disease activity (LDA) targets at 52 wks most frequently when early APR treatment was initiated and pts were in moderate disease activity, as measured by Clinical Disease Activity Index for PsA (cDAPSA) score. In APPRAISE, we assessed APR effectiveness/tolerability in pts with PsA in routine clinical practice in Canada.

Objectives:

This interim efficacy analysis focused on the available data on APR effectiveness measuring rate of achieving cDAPSA REM or LDA at 12 mos and Pt Acceptable Symptom Status (PASS) results.

Methods:

The prospective, multicenter, observational APPRAISE study assessed APR effectiveness/tolerability in adults with active PsA in routine clinical care enrolled from July 2018-March 2020. Pts were followed from treatment initiation to 12 mos, with visits suggested every 4 mos. The primary effectiveness endpoint was the rate of achieving at least LDA (cDAPSA <14) at 12 mos. Pt-reported outcome measures were assessed. Data reported are as observed in pts continuing APR treatment.

Results:

In total, 101 pts were enrolled in APPRAISE. Mean age was 52 yrs; 56% were women. Mean (SD) PsA duration at baseline (BL) was 6 (8) yrs. Oligoarticular disease (≤4 joint involvement) was most common (41%), followed by polyarticular (35%). Most pts (92%) received prior conventional DMARDs and 17% received prior biologic therapy; concomitant MTX was reported in 41% at BL. By 12 mos, 41/101 enrolled pts discontinued, 35 reached 12 mos follow-up (4 mos: n=92; 8 mos: n=61), and 25 have yet to reach 12 mos. The majority (92%) of discontinuations due to lack/loss of effectiveness or AEs occurred within 4-8 mos. AEs were primarily GI related early in treatment. The proportion of pts with continued APR achieving cDAPSA REM/LDA treatment targets increased significantly over time (Figure 1). Significant reductions were seen over 12 mos in swollen/tender joint counts and plaque psoriasis, with reduced mean (SD) body surface area of −4% (9%) (Table 1). Prevalence of dactylitis/enthesitis at BL, 4, 8, and 12 mos was 17%/33%, 9%/24%, 5%/19%, and 0%/21%, respectively. Pain assessment (VAS) significantly improved over time. The proportion of pts achieving PASS with continued APR increased significantly over 12 mos (BL: 27%; 12 mos: 65%) (Figure 1). COVID restrictions impacted in-office assessment visits, necessitating reliance on virtual visits.

Conclusion:

Pts with PsA receiving APR were assessed at regular intervals in routine clinical care in Canada. This interim analysis revealed a greater number of pts receiving APR (66%) who completed the 12-mo follow-up achieved REM or LDA, as measured by cDAPSA over 12 mos. A majority of pts (65%) reported satisfaction with their disease state, as measured by PASS. No new safety signals were observed.

Table 1.

Change in Clinical Parameters and Pt-Reported Outcomes From BL to 4, 8, and 12 Mos

Outcome Measure*, Mean (SD)BL (n = 101)4 Mos (n = 92)8 Mos (n = 61)12 Mos (n = 35)Disease/Clinical Parameters Tender joint count (0-68)7.5 (6.7)−2.5 (6.3)*−3.9 (5.2)*−2.2 (6.4) Swollen joint count (0-66)5.4 (5.4)−3.0 (4.5)*−3.1 (4.3)*−3.1 (4.4)* PhGA42.9 (18.8)−19.0 (24.6)*−24.2 (24.2)*−21.2 (26.3)* Body surface area, %3.1 (6.1)−2.2 (6.0)*−2.7 (7.5)*−4.2 (9.1)* cDAPSA22.2 (13.3)−7.9 (12.1)*−10.1 (13.5)*−6.9 (12.0)*Pt-Reported Outcomes PtGA, mm50.0 (24.6)−10.2 (27.5)*−9.1 (31.9)*−3.6 (39.7) Pain, mm48.3 (25.3)−9.5 (26.2)*−12.2 (28.7)*−7.3 (26.0) HAQ-DI0.9 (0.7)−0.13 (0.5)*−0.15 (0.6)−0.1 (0.7)

*Denotes significant change from BL (P<0.05) from paired-sample t-tests; note that mean change from BL may be greater than the mean BL value when improvements of large magnitude, for pts with relatively elevated BL values, are observed in samples with lower n’s. HAQ-DI = Health Assessment Questionnaire-Disability Index; PhGA = Physician’s Global Assessment; PtGA = Patient’s Global Assessment.

Acknowledgements:

This study was funded by Celgene and Amgen Inc. Writing support was funded by Amgen Inc. and provided by Kristin Carlin, RPh, MBA, of Peloton Advantage, LLC, an OPEN Health company.

Disclosure of Interests:

Vinod Chandran Consultant of: AbbVie, Amgen, BMS, Celgene Corporation, Eli Lilly, Janssen, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Amgen, BMS, Celgene Corporation, Eli Lilly, Janssen, Novartis, Pfizer, UCB, Louis Bessette Consultant of: AbbVie, Amgen, BMS, Celgene Corporation, Eli Lilly, Janssen, Merck, Pfizer, Sanofi, Novartis, UCB, Grant/research support from: AbbVie, Amgen, BMS, Celgene Corporation, Eli Lilly, Janssen, Merck, Pfizer, Sanofi, Novartis, UCB, Carter Thorne Speakers bureau: AbbVie, Amgen, Celgene Corporation, Eli Lilly, Medexus/Medac, Merck, Novartis, Pfizer, Sandoz, Sanofi, Consultant of: Centocor, Medexus/Medac, Merck, Grant/research support from: Novartis, Pfizer, Maqbool Sheriff Speakers bureau: AbbVie, Celgene Corporation, Eli Lilly, Janssen, Merck, Pfizer, Sandoz, Proton Rahman Speakers bureau: AbbVie, Amgen, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, UCB, Dafna D Gladman Consultant of: AbbVie, Amgen, BMS, Celgene Corporation, Eli Lilly, Galapagos, Gilead, Janssen, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Amgen, BMS, Celgene Corporation, Eli Lilly, Galapagos, Gilead, Janssen, Novartis, Pfizer, UCB, Sabeen Anwar Consultant of: AbbVie, Amgen Inc., BMS, Novartis, and Pfizer, Grant/research support from: AbbVie, Amgen Inc., Eli Lilly, Janssen, and Pfizer, Jennifer Jelley Employee of: Amgen Canada Inc., Anne-Julie Gaudreau Employee of: Amgen Canada Inc., Manprit Chohan Employee of: Amgen Canada Inc., John S. Sampalis Employee of: JSS Medical Research.

POS0531 FACTORS ASSOCIATED WITH BASELINE HYPERTENSION IN EARLY RHEUMATOID ARTHRITIS: DATA FROM A REAL-WORLD LARGE INCIDENT COHORT

Background:

It is not well understood why hypertension (HTN) is so common in rheumatoid arthritis (RA) patients. Reported prevalence of HTN in RA patients ranges from 4-73%.(1)

Objectives:

This study explored the prevalence of HTN at time of RA diagnosis and which demographic, behavioural and clinical factors were associated with HTN.

Methods:

Data from the Canadian Early Arthritis Cohort (CATCH), a prospective inception cohort of patients with RA <1 year duration, were used to analyze baseline demographic, behavioural and clinical characteristics associated with HTN, which was reported by physicians. Univariate logistic regression models were created to explore associations with baseline HTN. A multivariate logistic regression model was built based on goodness of fit indicated by likelihood ratio tests. Variables included in the model were age, sex, race, body mass index (BMI), education, smoking, alcohol servings, seropositivity, disease activity and comorbidities.

Results:

In total, 2052 subjects were included with mean (±SD) age of 55 (±14) years and symptom duration 5.60(5.47, 5.73) months, 71% of subjects were female and 85% were Caucasian. HTN was reported in 26% of subjects at baseline. Hypertensive subjects were older and more likely to be male. Other factors significantly associated with HTN at baseline were lower education, ever smoking, high BMI, diabetes, hyperlipidemia, worse RA disease activity, longer duration of RA symptoms, being seropositive, as well as the use of NSAIDs and/or corticosteroids (Table 1). In multivariable analysis HTN was associated with older age, overweight and obese BMI, diabetes, and hyperlipidemia. Expression of anti-citrullinated protein antibodies was inversely associated with HTN (Table 1). Other RA disease factors and treatments were not significantly associated with HTN on multivariable analysis.

Table 1.

Results of univariate and multivariate logistic regression analyses exploring the association between baseline characteristics and HTN in early RA.

Univariate Logistic RegressionMultivariable Logistic RegressionVariableCrude OR (95% CI)Adjusted OR (95% CI)Socio-Demographic20-39 years old0.15 (0.07, 0.26)0.14(0.05, 0.34)40-59 years oldReference60-79 years old2.81 (2.26, 3.50)2.26(1.65, 3.11)80-99 years old5.87 (3.36,10.25)3.80(1.53, 9.41)Female0.55 (0.45, 0.68)1.10(0.78, 1.54)Lifestyle/BehaviouralNormal weight (18.5- 24.9kg/m2)ReferenceOverweight (25-29.9 kg/m2)2.33(1.74, 3.11)1.63(1.10, 2.43)Obese (30+ kg/m2)3.19(2.38, 4.27)2.84(1.91, 4.23Ever-smoking1.41(1.15, 1.73)1.02(0.75, 1.40)Post-secondary education0.58(0.47, 0.71)0.88(0.65, 1.20)Clinical CharacteristicsSymptom duration0.99(0.99, 0.99)1.00(1.00, 1.00)DAS-281.09(1.09, 1.17)1.02(0.92, 1.13)ACPA+0.68(0.56, 0.85)0.64(0.44, 0.92)Corticosteroid use pre-baseline1.37(1.04, 1.81)OmittedNSAID use at baseline0.68(0.55, 0.84)OmittedDiabetes5.62(4.09, 7.73)3.20(1.99, 5.15)Hyperlipidemia4.75(3.74, 6.03)2.80(1.94, 4.02),CVD15.59(3.35, 72.64)Omitted

DAS-28; Disease activity score 28, ACPA; Anti-citrullinated protein antibody, CVD; Cardiovascular disease. Pre-baseline is 29 to 365 days before entering the cohort. Baseline is within 28 days before entering the cohort. Omitted variables either failed likelihood ratio test or were colinear. Additional variables tested but found insignificant: race, alcohol servings, depression, RF+, and use of DMARDs.

Conclusion:

Approximately 1 in 4 diagnosed with RA had HTN reported by their rheumatologists, which is similar to that of the general population. This suggests that increased risk of HTN in RA patients may develop as RA disease or treatment time progresses. Factors that may be predictive of this excess risk will be explored in further analysis.

References:

[1]Panoulas VF, Metsios GS, Pace AV, et al. Hypertension in rheumatoid arthritis. Rheumatology (Oxford) 2008;47:1286-98.

Acknowledgements:

The CATCH study was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada - Founding sponsors since January 2007; AbbVie Corporation and Hoffmann-LaRoche since 2011; Medexus Inc. since 2013;, Merck Canada since 2017, Sandoz Canada, Biopharmaceuticals since 2019,Gilead Sciences Canada since 2020 and Fresenius Kabi Canada Ltd. since 2021. Previously funded by Janssen Biotech from 2011-2016, UCB Canada and Bristol-Myers Squibb Canada from 2011-2018, Sanofi Genzyme from 2016-2017, and Eli Lilly Canada from 2016-2020.

Disclosure of Interests:

Brook Hadwen: None declared, Saverio Stranges: None declared, Neil Klar: None declared, Kuriya Bindee: None declared, Janet Pope Speakers bureau: UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, BMS, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead, Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB;, Grant/research support from: Abbvie, BMS, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Susan J. Bartlett Consultant of: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Gilles Boire Speakers bureau: Merck, BMS, Pfizer, Janssen, Grant/research support from: Amgen, Abbvie, BMS, Eli Lilly, Merck, Novartis, Pfizer, Sandoz, Louis Bessette Speakers bureau: Amgen, BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis, Consultant of: Amgen, BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis., Grant/research support from: Amgen, BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis., Carol Hitchon Grant/research support from: Pfizer and UCB Canada, Glen Hazlewood: None declared, Edward Keystone Speakers bureau: Amgen, AbbVie, Bristol-Myers Squibb, F. Hoffmann-La Roche Inc., Janssen Inc., Merck, Pfizer Pharmaceuticals, Sanofi Genzyme, UCB, Consultant of:: AbbVie, Amgen, AstraZeneca Pharma, Bristol-Myers Squibb Company, Celltrion, Myriad Autoimmune, F. Hoffmann-La Roche Inc, Genentech Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, Sanofi-Genzyme, Samsung Bioepsis, Grant/research support from: AbbVie, Amgen, Gilead Sciences, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, PuraPharm, Sanofi, Orit Schieir: None declared, Carter Thorne Speakers bureau: Medexus/Medac, Consultant of: Abbvie, Centocor, Janssen, Lilly, Medexus/Medac, Pfizer, Grant/research support from: Amgen, Pfizer, Abbvie, Celgene, CaREBiodam, Novartis, Diane Tin: None declared, Marie-France Valois: None declared, Vivian Bykerk Consultant of: Amgen, BMS, Gilead, Sanofi-Genzyme/Regeneron, Scipher, Pfizer Pharmaceuticals, UCB, NIH, Lillian Barra: None declared

POS0220 INTEGRATED SAFETY PROFILE OF UPADACITINIB WITH UP TO 4.5 YEARS OF EXPOSURE IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

The safety and efficacy of the oral Janus kinase inhibitor upadacitinib (UPA) has been evaluated across a spectrum of patients with rheumatoid arthritis (RA) in the phase 3 SELECT clinical program.1–6

Objectives:

To describe the long-term integrated safety profile of UPA relative to active comparators (cutoff date: June 30, 2020) in patients with RA treated in the SELECT clinical program.

Methods:

This analysis included updated data from 6 randomized controlled UPA RA trials.1–6 Treatment-emergent adverse events (TEAEs; onset after first dose and ≤30 days after last dose of study drug or ≤70 days for adalimumab [ADA]) including AEs of special interest were summarized as follows: pooled UPA 15 mg once daily (QD; UPA15, 6 trials); pooled UPA 30 mg QD (UPA30, 4 trials); methotrexate (MTX, 1 trial), and ADA (1 trial). TEAEs were reported as exposure-adjusted adverse event rates (EAERs; events/100 patient-years [E/100 PY]), which included both incident and recurrent events.

Results:

4413 patients (UPA15, n=3209; UPA30, n=1204) received ≥1 dose of UPA, providing 10,115.4 PY of exposure. EAERs for AEs, serious AEs (SAEs), and AEs leading to discontinuation were similar for UPA15, MTX, and ADA; rates for UPA30 were numerically higher than UPA15 (Table 1). The most common AEs were upper respiratory tract infection, nasopharyngitis, and urinary tract infection for both UPA doses, and for UPA30 only, increased creatine phosphokinase (CPK). Pneumonia was the most common SAE for both UPA15 and UPA30. Serious infection rates were similar for UPA15, MTX, and ADA but higher for UPA30 (Figure 1). Rates of herpes zoster (HZ) were higher for both UPA groups (dose-dependent) vs MTX and ADA. Most HZ cases with UPA were non-serious (94%) and involved a single dermatome (74%). CPK elevations, which were mostly asymptomatic, were more common for both UPA groups (dose-dependent) vs MTX and ADA. EAERs of adjudicated gastrointestinal perforations were <0.1 and 0.2 E/100 PY for UPA15 and UPA30, respectively. Rates of non-melanoma skin cancer (due in part to more recurrent events with UPA30), anemia, and neutropenia were higher with UPA30 vs other treatment groups. Events of anemia and neutropenia were generally mild/moderate and treatment discontinuation due to these events was uncommon (<0.4%). Rates of other AEs of special interest, including major adverse cardiovascular and venous thromboembolic events, were broadly similar across treatment groups. The rate of deaths in UPA-treated patients with RA was not higher than expected for the general population (standardized mortality ratio [95% confidence interval (CI)]: UPA15, 0.43 [0.29, 0.63]; UPA30, 0.68 [0.40, 1.08]).

Table 1.

TEAEs in patients treated with UPA, MTX, and ADA

UPA 15 mg QDUPA 30 mg QDADA 40 mg EOWMTXn32091204579314ExposureTotal, PY7023.83091.61051.8637.4Mean (SD), weeks114 (64)134 (66)95 (70)106 (67)Median (range), weeks136 (0, 232)160 (0, 231)118 (2, 231)144 (1, 221)E/100 PY (95% CI)Any AE230.7 (227.2, 234.3)283.6 (277.7, 289.6)216.6 (207.8, 225.7)227.8 (216.2, 239.8)Any SAE13.0 (12.2, 13.9)18.8 (17.3, 20.4)13.3 (11.2, 15.7)10.4 (8.0, 13.2)Any AE leading to discontinuation of study drug5.6 (5.0, 6.1)8.5 (7.5, 9.6)6.8 (5.3, 8.5)6.3 (4.5, 8.5)Deathsa0.4 (0.3, 0.6)0.6 (0.3, 0.9)0.9 (0.4, 1.6)0.5 (0.1, 1.4)

aBoth treatment and non-treatment-emergent deaths

EOW, every other week

Conclusion:

The updated safety profile of UPA with up to 4.5 years of exposure in patients with RA was comparable to previous analyses,7 with no new safety signals reported. With the exception of HZ and elevated CPK, the safety profile of UPA15, the approved dose for RA, was similar to that observed for ADA.

References:

[1]Burmester GR, et al. Lancet 2018;391:2503–12;

[2]Smolen JS, et al. Lancet 2019;393:2303–11;

[3]Fleischmann R, et al. Arthritis Rheumatol 2019;71:1788–800;

[4]Genovese MC, et al. Lancet 2018;391:2513–24;

[5]van Vollenhoven R, et al. Arthritis Rheumatol 2020;72:1607–20;

[6]Rubbert-Roth A, et al. N Engl J Med 2020;383:1511–21;

[7]Cohen SB, et al. Ann Rheum Dis 2020;79(Suppl 1):319–20.

Acknowledgements:

AbbVie funded this study; contributed to its design; participated in data collection, analysis, and interpretation of the data; and participated in the writing, review, and approval of the abstract. No honoraria or payments were made for authorship. Medical writing support was provided by Hilary Wong, PhD, of 2 the Nth (Cheshire, UK), and was funded by AbbVie.

Disclosure of Interests:

Stanley B. Cohen Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Gilead, Pfizer, Roche, and Sandoz, Grant/research support from: AbbVie, Amgen, Boehringer Ingelheim, Gilead, Pfizer, Roche, and Sandoz, Ronald van Vollenhoven Consultant of: AbbVie, AstraZeneca, Biotest, Bristol-Myers Squibb, Celgene, Eli Lilly, GSK, Janssen, Medac, MSD, Novartis, Pfizer, Roche, and UCB, Grant/research support from: AbbVie, Arthrogen, Bristol-Myers Squibb, Eli Lilly, GSK, Pfizer, and UCB, Jeffrey R. Curtis Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Crescendo, Janssen, Pfizer, Sanofi/Regeneron, and UCB, Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Crescendo, Janssen, Pfizer, Sanofi/Regeneron, and UCB, Leonard Calabrese Speakers bureau: AbbVie, Crescendo, Genentech, Horizon, Janssen, Novartis, and Sanofi, Consultant of: AbbVie, Bristol-Myers Squibb, Crescendo, Genentech, Gilead, GSK, Horizon, Janssen, Novartis, and Sanofi, Cristiano Zerbini Speakers bureau: MSD, Pfizer, and Sanofi, Consultant of: MSD, Pfizer, and Sanofi, Grant/research support from: Amgen, Eli Lilly, GSK, MSD, Novartis, Pfizer, Roche, Sanofi, and Servier, Yoshiya Tanaka Speakers bureau: AbbVie, Asahi Kasei, Astellas, Bristol-Myers Squibb, Chugai, Daiichi Sankyo, Eisai, Eli Lilly, Gilead, GSK, Janssen, Mitsubishi Tanabe, Novartis, Pfizer, Sanofi, and YL Biologics, Grant/research support from: Asahi Kasei, Chugai, Daiichi Sankyo, Eisai, Mitsubishi Tanabe, Takeda, and UCB, Louis Bessette Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer, Roche, Sanofi, and UCB, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer, Roche, Sanofi, and UCB, Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer, Roche, Sanofi, and UCB, Christophe Richez Speakers bureau: AbbVie, Amgen, AstraZeneca, Biogen, Bristol-Myers Squibb, Eli Lilly, GSK, MSD, and Pfizer, Consultant of: AbbVie, Amgen, AstraZeneca, Biogen, Bristol-Myers Squibb, Eli Lilly, GSK, MSD, and Pfizer, Ivan Lagunes-Galindo Shareholder of: May own stock or options in AbbVie, Employee of: AbbVie, Jianzhong Liu Shareholder of: May own stock or options in AbbVie, Employee of: AbbVie, Heidi Camp Shareholder of: May own stock or options in AbbVie, Employee of: AbbVie, Yanna Song Shareholder of: May own stock or options in AbbVie, Employee of: AbbVie, Samuel Anyanwu Shareholder of: May own stock or options in AbbVie, Employee of: AbbVie, Gerd Rüdiger Burmester Speakers bureau: AbbVie, Eli Lilly, Gilead, Janssen, MSD, Pfizer, Roche, and UCB, Consultant of: AbbVie, Eli Lilly, Gilead, Janssen, MSD, Pfizer, Roche, and UCB

Health Assessment Questionnaire at One Year Predicts All-Cause Mortality in Patients With Early Rheumatoid Arthritis

OBJECTIVE

Higher self-reported disability (high Health Assessment Questionnaire [HAQ] score) has been associated with hospitalizations and mortality in established rheumatoid arthritis (RA), but associations in early RA are unknown.

METHODS

Patients with early RA (symptom duration <1 year) enrolled in the Canadian Early Arthritis Cohort who initiated disease-modifying antirheumatic drugs and had completed HAQ data at baseline and 1 year were included in the study. Discrete-time proportional hazards models were used to estimate crude and multi-adjusted associations of baseline HAQ and HAQ at 1 year with all-cause mortality in each year of follow-up.

RESULTS

A total of 1,724 patients with early RA were included. The mean age was 55 years, and 72% were women. Over 10 years, 62 deaths (3.6%) were recorded. Deceased patients had higher HAQ scores at baseline (mean ± SD 1.2 ± 0.7) and at 1 year (0.9 ± 0.7) than living patients (1.0 ± 0.7 and 0.5 ± 0.6, respectively; P < 0.001). Disease Activity Score in 28 joints (DAS28) was higher in deceased versus living patients at baseline (mean ± SD 5.4 ± 1.3 versus 4.9 ± 1.4) and at 1 year (mean ± SD 3.6 ± 1.4 versus 2.8 ± 1.4) (P < 0.001). Older age, male sex, lower education level, smoking, more comorbidities, higher baseline DAS28, and glucocorticoid use were associated with mortality. Contrary to HAQ score at baseline, the association between all-cause mortality and HAQ score at 1 year remained significant even after adjustment for confounders. For baseline HAQ score, the unadjusted hazard ratio (HR) was 1.46 (95% confidence interval [95% CI] 1.02-2.09), and the adjusted HR was 1.25 (95% CI 0.81-1.94). For HAQ score at 1 year, the unadjusted HR was 2.58 (95% CI 1.78-3.72), and the adjusted HR was 1.75 (95% CI 1.10-2.77).

CONCLUSION

Our findings indicate that higher HAQ score and DAS28 at 1 year are significantly associated with all-cause mortality in a large early RA cohort.

THU0396 IMPACT OF IXEKIZUMAB ON WORK PRODUCTIVITY IN PATIENTS WITH ANKYLOSING SPONDYLITIS: RESULTS FROM THE COAST-V AND COAST-W TRIALS AT 52 WEEKS

Background:

Patients with ankylosing spondylitis (AS) are burdened with decreased work productivity.1Ixekizumab (IXE), a high-affinity monoclonal antibody selectively targeting interleukin-17A, has been shown to improve disease signs and symptoms in 2 phase 3 trials assessing patients with active AS.2, 3

Objectives:

This study investigated the effect of IXE treatment for 52 weeks on work productivity and activity impairment as measured by absenteeism, presenteeism, overall work impairment, and activity impairment in patients with active AS.

Methods:

COAST-V (NCT02696785) and COAST-W (NCT02696798) were phase 3, multicenter, randomized, double-blind, placebo (PBO)-controlled (COAST-V active-controlled with adalimumab) trials investigating the efficacy of IXE every 4 weeks (Q4W) and every 2 weeks (Q2W) in 341 patients with active AS naïve to biologic disease-modifying antirheumatic drugs (bDMARDs; COAST-V) and in 316 patients who were inadequate responders or intolerant to 1 or 2 tumor necrosis factor inhibitors (TNFi; COAST-W). Patients receiving PBO were switched to IXE Q4W or Q2W at Week 16; patients receiving adalimumab (ADA) were switched to IXE Q4W or Q2W at Week 20. Data for IXE Q4W and Q2W were combined for PBO/IXE and ADA/IXE groups. Changes from baseline in work productivity were measured for those reporting full- or part-time work at Weeks 16 and 52 with the Work Productivity and Activity Impairment (WPAI) Questionnaire for Spondyloarthritis.

Results:

Compared to bDMARD-naïve patients (COAST-V), TNFi-experienced patients (COAST-W) were slightly older, had longer disease duration, reported less paid employment, and had greater scores for impaired work productivity, signifying more severe baseline disease. At Week 16, bDMARD-naïve patients treated with IXE Q4W or Q2W had significant improvements in activity impairment compared to placebo (p<0.01); TNFi-experienced patients treated with IXE Q4W or Q2W had significant improvements in presenteeism (p<0.05) and overall work impairment (p<0.05; Figure). TNFi-experienced patients treated with IXE Q2W also had significant improvement in activity impairment at Week 16 (p<0.05; Figure). Improvements were sustained through Week 52 (Figure).

Conclusion:

Both bDMARD-naïve and TNFi-experienced patients with AS receiving IXE had greater improvements in aspects of work productivity compared to placebo. Improvements were sustained through Week 52.

References:

[1]Boonen, van der Linden. (2006).J Rheumatol Suppl.78:4-11.

[2]Van der Heijde, et al. (2018)Lancet. 392(10163):2441-51.

[3]Deodhar, et al. (2019)Arthritis Rheumatol.71(4):599-611.

Disclosure of Interests:

Helena Marzo-Ortega Grant/research support from: Janssen, Novartis, Consultant of: Abbvie, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, UCB, Speakers bureau: Abbvie, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, Takeda, UCB, Philip J Mease Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Janssen, Eli Lilly, Novartis, Pfizer, Sun Pharma, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Janssen, Eli Lilly, Galapagos, Gilead, Novartis, Pfizer, Sun Pharma, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Genentech, Janssen, Novartis, Pfizer, UCB Pharma, Proton Rahman Grant/research support from: Janssen and Novartis, Consultant of: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, and Pfizer., Speakers bureau: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, Pfizer, Victoria Navarro-Compán Consultant of: Abbvie, Lilly, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Lilly, Novartis, Pfizer, UCB, Vibeke Strand Consultant of: AbbVie, Amgen, Biogen, Celltrion, Consortium of Rheumatology Researchers of North America, Crescendo Bioscience, Eli Lilly, Genentech/Roche, GlaxoSmithKline, Hospira, Janssen, Merck, Novartis, Pfizer, Regeneron Pharmaceuticals, Inc., Sanofi, UCB, Maxime Dougados Grant/research support from: AbbVie, Eli Lilly, Merck, Novartis, Pfizer and UCB Pharma, Consultant of: AbbVie, Eli Lilly, Merck, Novartis, Pfizer and UCB Pharma, Speakers bureau: AbbVie, Eli Lilly, Merck, Novartis, Pfizer and UCB Pharma, Bernard Combe Grant/research support from: Novartis, Pfizer, Roche-Chugai, Consultant of: AbbVie; Gilead Sciences, Inc.; Janssen; Eli Lilly and Company; Pfizer; Roche-Chugai; Sanofi, Speakers bureau: Bristol-Myers Squibb; Gilead Sciences, Inc.; Eli Lilly and Company; Merck Sharp & Dohme; Pfizer; Roche-Chugai; UCB, James Cheng-Chung Wei Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Novartis, Pfizer Inc, UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Chugai, Eisai, Janssen, Novartis, Pfizer Inc, Sanofi-Aventis, UCB Pharma, Xenofon Baraliakos Grant/research support from: Grant/research support from: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Consultant of: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Speakers bureau: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Theresa Hunter Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, David Sandoval Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Xiaoqi Li Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Baojin Zhu Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Louis Bessette Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Sanofi, Atul Deodhar Grant/research support from: AbbVie, Eli Lilly, GSK, Novartis, Pfizer, UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB

Figure.

Changes from baseline in Overall Work Impairment in A) bDMARD-naïve (COAST-V) and B) TNFi-experienced (COAST-W) patients and Activity Impairment in C) bDMARD-naïve and D) TNFi-experienced patients.

SAT0127 REAL-WORLD PREDICTORS OF STARTING DIFFERENT ADVANCED DMARD TREATMENTS IN RHEUMATOID ARTHRITIS: A PROSPECTIVE INVESTIGATION FROM THE CANADIAN EARLY ARTHRITIS COHORT (CATCH) GROUP

Background:

RA patients with inadequate DMARD response may be treated with a TNF inhibitor (TNFi), non-TNFi or janus kinase inhibitor (JAKi) [1].

Objectives:

Compare characteristics of real-world early RA (ERA) patients starting TNFi, non-TNFi, and JAKi post DMARD failure.

Methods:

Data were analyzed from early RA patients (symptoms < 1 year) enrolled in CATCH who started TNFi, non-TNFi or JAKi as first line advanced therapy from 2014 to 2019. Descriptive statistics, t-tests and chi-square tests summarized and compared secular trends and patient characteristics initiating each class of therapy. Multinomial logistic regression analyses were done.

Results:

246 participants started advanced therapy during the study period; (75%) female, mean(SD) age 50(14) years. First line prescriptions for JAKi increased and TNFi decreased (Fig. 1). Those receiving JAKi had longer disease duration, fewer tender joints, and lower DAS28, CDAI, ESR, MD global (all p <0.05) (Table 1). The strongest predictor of starting JAKi was province (Ontario where access is preferential for JAKi and biosimilar TNFi) (Table 2). Those prescribed TNFi had shorter disease duration, younger age, fewer comorbidities, and treatment location outside Ontario (Table 1,2). Those starting non-TNFi had higher DAS28; predictors included older age, higher education, and more comorbidities (Table 1,2).

Table 1.

Characteristics prior to starting advanced therapy

VariableTotal Sample(N = 246)JAKi(N = 61)TNFi(N = 153)Non-TNFi(N = 32)p-value£Disease duration (months) mean (SD)39 (34.1)50.8 (39.3)32.5 (29.1)48 (38.6)0.0006DAS28 (ESR - CRP if ESR was missing) mean (SD)4.2 (1.4)3.6 (1.4)4.3 (1.4)4.8 (1.5)0.0012CDAI mean (SD)21.5 (14.8)16.5 (13.7)22.9 (14.8)24.8 (14.9)0.0089Tender joint count (0-28), median (IQR)§4 (7)2 (6)5 (8)6 (9)0.0224ESR median (IQR)§13 (20)12 (13)13 (20)28.0 (23.5)0.0448MD Global (0-10) mean (SD)4.2 (2.7)3.2 (2.7)4.4 (2.6)4.8 (2.8)0.0030

§IQR: 75 – 25 percentile

£p-value: ANOVA for continuous variable, chi-square for categorical

Table 2.

Multinomial regression for initiating advanced DMARD therapy

Disease stage & Clinical Disease ActivityAdvanced DMARDAdjusted for Age, sex, education, comorbidityFullyAdjustedφNon-TNF vs TNFJAK vsTNFNon-TNF vs TNFJAK vsTNFAge1.01 (0.98, 1.05)1.01 (0.99, 1.04)1.01 (0.97, 1.05)1.02 (0.99, 1.05)Women vs Men1.98 (0.71, 5.58)1.33 (0.63, 2.80)2.35 (0.76, 7.27)1.72 (0.73, 4.02)Education(< HS vs ≥ HS)2.92 (1.28, 6.63)1.49 (0.78, 2.86)2.83 (1.12, 7.15)2.08 (0.97, 4.47)RDCI baseline1.35 (1.01, 1.81)1.21 (0.95, 1.53)1.30 (0.95, 1.78)1.23 (0.94, 1.60)Private Insurance(No vs Yes)NINI1.26 (0.47, 3.40)0.99 (0.44, 2.25)RF PositiveNINI1.47 (0.56, 3.85)1.84 (0.82, 4.12)CDAININI1.01 (0.98, 1.04)0.97 (0.94, 1.00)RegionQuebec vs Ontario (ON)NINI0.59 (0.20, 1.72)0.44 (0.20, 0.94)West vs ONNINI1.32 (0.29, 5.98)0.11 (0.01, 0.99)

φAdjusted for; baseline age, sex, education, RDCI; province; RF positive in first year; private insurance; CDAI at visit prior to initiation

Conclusion:

Patient and physician related factors (location of practice) determined which advanced therapeutic was prescribed. JAKi use is increasing in ERA.

Reference:

[1]Smolen JS, Landewé RBM, Bijlsma JWJ, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Annals of the Rheumatic Diseases Published Online First: 22 January 2020

Disclosure of Interests:

Madina Weiler: None declared, Orit Schieir: None declared, Marie-France Valois: None declared, Susan J. Bartlett Consultant of: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Speakers bureau: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Louis Bessette Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Sanofi, Gilles Boire Grant/research support from: Merck Canada (Registry of biologices, Improvement of comorbidity surveillance)

Amgen Canada (CATCH, clinical nurse)

Abbvie (CATCH, clinical nurse)

Pfizer (CATCH, Registry of biologics, Clinical nurse)

Hoffman-LaRoche (CATCH)

UCB Canada (CATCH, Clinical nurse)

BMS (CATCH, Clinical nurse, Observational Study Protocol IM101664. SEROPOSITIVITY IN A LARGE CANADIAN OBSERVATIONAL COHORT)

Janssen (CATCH)

Celgene (Clinical nurse)

Eli Lilly (Registry of biologics, Clinical nurse), Consultant of: Eli Lilly, Janssen, Novartis, Pfizer, Speakers bureau: Merck, BMS, Pfizer, Glen Hazlewood: None declared, Carol Hitchon Grant/research support from: UCB Canada; Pfizer Canada, Edward Keystone Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, F. Hoffmann-La Roche Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Pfizer Pharmaceuticals, Sanofi-Aventis, Consultant of: AbbVie, Amgen, AstraZeneca Pharma, Biotest, Bristol-Myers Squibb Company, Celltrion,

Crescendo Bioscience, F. Hoffmann-La Roche Inc, Genentech Inc, Gilead, Janssen Inc, Lilly

Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, UCB., Speakers bureau: Amgen, AbbVie, Bristol-Myers Squibb Canada, F. Hoffmann-La Roche Inc., Janssen Inc., Merck, Pfizer Pharmaceuticals, Sanofi Genzyme, UCB, Diane Tin: None declared, Carter Thorne Consultant of: Abbvie, Centocor, Janssen, Lilly, Medexus/Medac, Pfizer

, Speakers bureau: Medexus/Medac, Vivian Bykerk: None declared, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB

THU0197 SAFETY PROFILE OF UPADACITINIB UP TO 3 YEARS OF EXPOSURE IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

The safety and efficacy of upadacitinib (UPA), an oral JAK inhibitor, was evaluated in the phase 3 SELECT clinical program, which included 5 randomized, double-blind, controlled trials across a spectrum of rheumatoid arthritis (RA) patients (pts)1-5.

Objectives:

To describe the long-term integrated safety profile of UPA relative to active comparators in pts with RA treated in the SELECT program up to a cut-off date of 30 June 2019.

Methods:

Treatment-emergent adverse events (TEAEs: AE onset ≥first dose and ≤30 days after last dose) were summarized for the following: methotrexate (MTX, 1 trial, mean exposure 76 wks); adalimumab (ADA, 1 trial, mean exposure 69 wks); pooled UPA 15 mg (5 trials, mean exposure 90 wks); pooled UPA 30 mg (4 trials, mean exposure 100 wks). TEAEs are reported as exposure-adjusted event rates (EAERs; events/100 patient years [E/100PYs]).

Results:

3833 pts received ≥1 dose of UPA 15 mg [n=2629, 4565.8 PYs] or 30 mg [n=1204, 2309.7 PYs] QD, with no option to switch doses. More than half of pts received UPA for ≥96 wks (median: UPA 15, 101.9 wks; UPA 30: 111.7 wks). The EAERs of overall SAEs and AEs leading to discontinuation on UPA 15 mg were comparable to MTX and ADA; rates on UPA 30 mg were numerically higher than UPA 15 mg (Table). The most common AEs (≥5 E/100 PYs) reported with UPA 15 mg were upper respiratory tract infection (URTI), nasopharyngitis, urinary tract infection (UTI), bronchitis, increased CPK, and increased ALT. For UPA 30 mg, the most common AEs reported were URTI, UTI, increased CPK, nasopharyngitis, bacterial bronchitis, and herpes zoster (HZ). Overall rates of serious infections and opportunistic infections were comparable between UPA 15 mg, MTX, and ADA groups but were higher on UPA 30 mg (Figure). Rates of HZ were higher in both UPA groups (30 mg higher than 15 mg) vs MTX and ADA. The majority of HZ cases were non-serious (96%) and involved a single dermatome (74%). Rates of VTE were comparable across treatment groups (0.3-0.5/100 PYs), as were rates of adjudicated MACE and malignancies (excluding NMSC). Rates of NMSC in UPA 15 mg and ADA were similar, with numerically higher rates on UPA 30 mg. SMR analysis demonstrated that the number of deaths in pts with RA exposed to UPA was not higher than what would be expected for the general population.

Conclusion:

Through long-term follow-up, the integrated safety profile of UPA remained consistent with previous analyses, with no new signals identified.

References:

[1]Burmester,et al.Lancet2018;391:2503-12.

[2]Genovese,et al.Lancet2018;391:2513-24.

[3]Smolen,et al.Lancet2019;393:2303-11.

[4]Fleischmann,et al.Arthritis Rheumatol2019;71:1788-1800.

[5]van Vollenhoven,et al.Arthritis Rheumatol2018;70(Suppl 10).

Table.

Overall TEAEs for UPA and Active Comparators (E/100 PYs [95% CI])

MTXn=314(456.0 PYs)ADA 40 mg eown=579(768.6 PYs)UPA 15 mg QDn=2629(4565.8 PYs)UPA 30 mg QDn=1204(2309.7 PYs)Any AE271.7 (256.8, 287.3)242.3 (231.4, 253.5)247.7 (243.2, 252.3)310.6 (303.5, 317.9)Any SAE12.7 (9.7, 16.4)14.6 (12.0, 17.5)12.9 (11.9, 14.0)19.8 (18.0, 21.7)Any AE leading to discontinuation7.7 (5.3, 10.7)8.2 (6.3, 10.5)6.3 (5.6, 7.1)10.0 (8.8, 11.4)Deathsa0.4 (0.1, 1.6)0.8 (0.3, 1.7)0.4 (0.2, 0.6)0.7 (0.4, 1.1)

aDeaths included non-treatment emergent deaths: ADA, 1; UPA 15 mg, 3; UPA 30 mg, 3.

Disclosure of Interests:

Stanley B. Cohen Grant/research support from: Amgen, Abbvie, Boehringer Ingelheim, Pfizer and Sandoz, Consultant of: Amgen, Abbvie, Boehringer Ingelheim, Pfizer and Sandoz, Ronald van Vollenhoven Grant/research support from: AbbVie, Arthrogen, Bristol-Myers Squibb, GlaxoSmithKline, Lilly, Pfizer, and UCB, Consultant of: AbbVie, AstraZeneca, Biotest, Bristol-Myers Squibb, Celgene, GSK, Janssen, Lilly, Medac, Merck, Novartis, Pfizer, Roche, and UCB, Jeffrey R. Curtis Grant/research support from: Abbvie, Amgen, BMS, Corrona, Crescendo, Janssen, Pfizer, Regeneron/Sanofi, and UCB, Consultant of: AbbVie, Amgen, BMS, Corrona, Crescendo, Janssen, Pfizer, Sanofi/Regeneron, and UCB, Leonard Calabrese Consultant of: AbbVie, GSK, Bristol-Myers Squibb, Genentech, Janssen, Novartis, Sanofi, Horizon, Crescendo, and Gilead, Speakers bureau: Sanofi, Horizon, Crescendo, Novartis, Genentech, Janssen, and AbbVie, Cristiano Zerbini Grant/research support from: Amgen, GSK, Lilly, Merck, Novartis, Pfizer, Sanofi-Aventis, Servier and Roche, Consultant of: Pfizer, Speakers bureau: Merck, Pfizer, Sanofi-Aventis, Yoshiya Tanaka Grant/research support from: Asahi-kasei, Astellas, Mitsubishi-Tanabe, Chugai, Takeda, Sanofi, Bristol-Myers, UCB, Daiichi-Sankyo, Eisai, Pfizer, and Ono, Consultant of: Abbvie, Astellas, Bristol-Myers Squibb, Eli Lilly, Pfizer, Speakers bureau: Daiichi-Sankyo, Astellas, Chugai, Eli Lilly, Pfizer, AbbVie, YL Biologics, Bristol-Myers, Takeda, Mitsubishi-Tanabe, Novartis, Eisai, Janssen, Sanofi, UCB, and Teijin, Louis Bessette Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Sanofi, Casey Schlacher Shareholder of: AbbVie, Employee of: AbbVie, Tim Shaw Shareholder of: AbbVie, Employee of: AbbVie, Jianzhong Liu Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Jose Jeffrey Enejosa Shareholder of: AbbVie, Employee of: AbbVie, Yanna Song Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Gerd Rüdiger Burmester Consultant of: AbbVie Inc, Eli Lilly, Gilead, Janssen, Merck, Roche, Pfizer, and UCB Pharma, Speakers bureau: AbbVie Inc, Eli Lilly, Gilead, Janssen, Merck, Roche, Pfizer, and UCB Pharma

FRI0331 COMPARISON OF THE THERAPEUTIC TRAJECTORIES OF PATIENTS WITH OLIGO AND POLYARTICULAR PSORIATIC ARTHRITIS. A REPORT FROM THE RHUMADATA® CLINICAL DATABASE AND REGISTRY

Background:

Psoriatic Arthritis (PsA) most frequently presents as a polyarthritis or (less often) as an oligoarthritis [1]. Most of the patients in the original description of Moll and Wight had an oligoarticular presentation [2]. However, other studies have not found the same distribution in all patient populations [3]. Treatment response over time across presentation types has not been explored thoroughly in recent medical literature.

Objectives:

Using our proposed definition of oligo and polyarticular PsA status, based on the (rounded) mean of the first four available joint counts, we examine treatment sequences in each group.

Methods:

Data from patients participating in the RHUMADATA® clinical database and registry diagnosed with PsA were extracted on January 5th, 2020. Joint count classification (oligo vs. poly) was assessed from the average of the first four available 66/68 joint counts. Patients were classified as having a polyarticular form of PsA if the (rounded) average, five or more of their joints were assessed as being swollen and/or tender. Subjects with four or less swollen or tender joints were classified as patients having oligoarticular PsA. Time spent treated with non-DMARDs, csDMARDs and bDMARDs, time to treatment (to csDMARDs and bDMARDs) and treatment selection were assessed from the entire PsA cohort. Continuous variables were tested using t-tests and binary variables using Fisher’s exact test.

Results:

The data from all patients diagnosed with PsA (n=1029) was extracted from the RHUMADATA® clinical database and registry. All but 151 (15%) were classifiable, 470 (46%) were classified as oligoarticular PsA patients and 408 (39%) as polyarticular. Time from the first symptoms to the first clinic visit was 4.6 ± 6.5 years and 3.7 ± 6.6 (p-value=0.1311) years for the patients classified as oligo and poly respectively. A total oh 951 patients were treated with a csDMARD (144 of those could not be classified as oligo or poly). For those, time from diagnosis to first csDMARD (prior to any bDMARD) treatment was 1.7 ± 5.3 (oligo) years and 2.0 ± 7.0 (poly) years (p-value=0.4114). Methotrexate (MTX), hydroxychloroquine (HCQ) and leflunomide (LEF) were more frequently prescribed to polyarticular than oligoarticular PsA patients (MTX: 70% (poly) vs. 48% (oligo), p-value<.0001, HCQ: 41% vs. 25%, p-value <.0001, LEF: 17% vs. 8%, p-value<.0001, Sulfasalazine (SSZ): 17% vs. 19%, p-value=0.5232, Other csDMARDs: 5% vs. 4.5%, p-value=0.8688). A total of 648 patients were treated with a bDMARD (151 of those could not be classified as oligo or poly). For those, time from first csDMARD Rx to first bDMARD treatment was 6.3 ± 4.6 (oligo) years and 7.0 ± 4.7 years (p-value=0.0865). On average, over the entire treatment history, oligoarticular patients received 1.7 ± 1.2 biologic agents and polyarticular 2.0 ± 1.4, p-value=0.0110. bDMARDs were administered over 3.6 ± 3.6 years for oligo and 4.5 ± 3.9 years for poly, p-value=0.2122.

Conclusion:

Polyarticular PsA patients appear to be more aggressively treated than oligoarticular patients during the csDMARDs period. Although durations on bDMARDs are statistically similar, polyarticular patients change biotreatment more frequently.

References:

[1]Gladman DD, Ritchlin C, et al. Clinical manifestations and diagnosis of psoriatic arthritis. Update 2019.

[3]Wright V, Moll JM. Psoriatic arthritis. Bull Rheum Dis 1971; 21:627.

[3]Gladman DD. Psoriatic arthritis. Baillieres Clin Rheumatol 1995; 9:319.

Disclosure of Interests:

Denis Choquette Grant/research support from: Rhumadata is supported by grants from Pfizer, Amgen, Abbvie, Gylead, BMS, Novartis, Sandoz, eli Lilly,, Consultant of: Pfizer, Amgen, Abbvie, Gylead, BMS, Novartis, Sandoz, eli Lilly,, Speakers bureau: Pfizer, Amgen, Abbvie, Gylead, BMS, Novartis, Sandoz, eli Lilly,, Loïc Choquette Sauvageau: None declared, Louis Bessette Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Sanofi, Isabelle Ferdinand Consultant of: Pfizer, Abbvie, Amgen, Novartis, Speakers bureau: Pfizer, Amgen, Paul Haraoui Grant/research support from: AbbVie, Amgen, BMS, Janssen, Pfizer, Roche, and UCB, Consultant of: AbbVie, Amgen, BMS, Celgene, Eli Lilly, Janssen, Merck, Pfizer, Roche, and UCB, Speakers bureau: Pfizer, Speakers bureau: Amgen, BMS, Janssen, Pfizer, and UCB, Frédéric Massicotte Consultant of: Abbvie, Janssen, Lilly, Pfizer, Speakers bureau: Janssen, Jean-Pierre Pelletier Shareholder of: ArthroLab Inc., Grant/research support from: TRB Chemedica, Speakers bureau: TRB Chemedica and Mylan, Jean-Pierre Raynauld Consultant of: ArthroLab Inc., Marie-Anaïs Rémillard Consultant of: Abbvie, Amgen, Eli Lilly, Novartis, Pfizer, Sandoz, Paid instructor for: Abbvie, Amgen, Eli Lilly, Novartis, Pfizer, Sandoz, Speakers bureau: Abbvie, Amgen, Eli Lilly, Novartis, Pfizer, Sandoz, Diane Sauvageau: None declared, Édith Villeneuve Consultant of: Abbvie, Amgen, BMS, Celgene, Pfizer, Roche, Sanofi-Genzyme,

UCB, Paid instructor for: Abbvie, Speakers bureau: AbbVie, BMS, Pfizer, Roche, Louis Coupal: None declared

FRI0030 MORE THAN HALF OF NEWLY DIAGNOSED RA PATIENTS ARE NOT CONVINCED OF THE NECESSITY OF RA MEDICINES: ASSOCIATIONS WITH RA CHARACTERISTICS, SYMPTOMS, AND FUNCTION IN THE CANADIAN EARLY ARTHRITIS COHORT (CATCH)

Background:

Although DMARDs are essential for early aggressive control of RA to reduce symptoms and disability, medication adherence is variable. Beliefs about the necessity of medications and safety concerns predict adherence and are modifiable.

Objectives:

To examine associations among RA medication necessity beliefs and concerns, sociodemographics, RA characteristics, symptom level and function in newly diagnosed RA patients.

Methods:

Baseline data were analyzed from participants in the Canadian Early Arthritis Cohort (CATCH) who enrolled between 2017-2020 and completed the Beliefs about Medicine Questionnaire (BMQ) and PROMIS-29. All met ACR1987 or 2010 ACR/EULAR criteria and had active RA at enrollment. BMQ Necessity (N) and Concerns (C) scores were classified ashigh(≥20) orlow(<20) and categorized into: Accepting (↑N ↓C); Ambivalent (↑N↑C); Sceptical (↓N↑C); and 4) Indifferent (↓N↓C). Groups were compared using ANOVA and chi-square tests.

Results:

The 362 patients were mostly white (83%) women (66%) with a mean (SD) age of 56 (15), symptom duration of 6 (3) months, and 32% were obese (BMI≥30). More than half (56%) were DMARD-naive or minimally exposed. Mean N and C scores were similar between men and women; 54% were classified asIndifferent, 31%Accepting, 9%Ambivalent,and 6%Sceptical.

As compared to those classified asAccepting, moreIndifferent participantssmoked, had a healthy weight, lower TJCs, and trend for lower CDAI (Table). Groups were similar by sociodemographics, symptom duration, and DMARD/steroid use, except fewerIndifferentpatients received MTX.Indifferentpatients had statistically and meaningfully lower patient global, depression, anxiety, fatigue and pain interference, and higher function and participation scores (Table).

Conclusion:

Many new RA patients had low medication necessity beliefs and concerns, and only 31% had high necessity beliefs and low concerns around diagnosis. Lifestyle and lower CDAI, TJCs, symptoms and functional impacts were associated with RA medication indifference. Identifying medication indifference can prompt discussions about medication beliefs/concerns to facilitate shared decision-making and adherence.

Disclosure of Interests:

Viviane Ta: None declared, Orit Schieir: None declared, Marie-France Valois: None declared, Glen Hazlewood: None declared, Carol Hitchon Grant/research support from: UCB Canada; Pfizer Canada, Louis Bessette Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Sanofi, Diane Tin: None declared, Carter Thorne Consultant of: Abbvie, Centocor, Janssen, Lilly, Medexus/Medac, Pfizer, Speakers bureau: Medexus/Medac, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB, Gilles Boire Grant/research support from: Merck Canada (Registry of biologices, Improvement of comorbidity surveillance)

Amgen Canada (CATCH, clinical nurse)

Abbvie (CATCH, clinical nurse)

Pfizer (CATCH, Registry of biologics, Clinical nurse)

Hoffman-LaRoche (CATCH)

UCB Canada (CATCH, Clinical nurse)

BMS (CATCH, Clinical nurse, Observational Study Protocol IM101664. SEROPOSITIVITY IN A LARGE CANADIAN OBSERVATIONAL COHORT)

Janssen (CATCH)

Celgene (Clinical nurse)

Eli Lilly (Registry of biologics, Clinical nurse), Consultant of: Eli Lilly, Janssen, Novartis, Pfizer, Speakers bureau: Merck, BMS, Pfizer, Edward Keystone Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, F. Hoffmann-La Roche Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Pfizer Pharmaceuticals, Sanofi-Aventis, Consultant of: AbbVie, Amgen, AstraZeneca Pharma, Biotest, Bristol-Myers Squibb Company, Celltrion, Crescendo Bioscience, F. Hoffmann-La Roche Inc, Genentech Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, UCB., Speakers bureau: Amgen, AbbVie, Bristol-Myers Squibb Canada, F. Hoffmann-La Roche Inc., Janssen Inc., Merck, Pfizer Pharmaceuticals, Sanofi Genzyme, UCB, Vivian Bykerk: None declared, Susan J. Bartlett Consultant of: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Speakers bureau: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie

THU0201 LONG-TERM SAFETY AND EFFECTIVENESS OF UPADACITINIB OR ADALIMUMAB IN PATIENTS WITH RHEUMATOID ARTHRITIS: RESULTS AT 72 WEEKS FROM THE SELECT-COMPARE STUDY

Background:

In the SELECT-COMPARE study in rheumatoid arthritis (RA) patients with inadequate response to methotrexate (MTX), upadacitinib (UPA), a Janus Kinase (JAK) 1-selective inhibitor, showed significant improvements in treatment of signs and symptoms when compared to placebo (PBO) and adalimumab (ADA) up to 48 weeks.1

Objectives:

To report safety and efficacy of UPA vs ADA up to 72 weeks in patients with RA from the ongoing long-term extension (LTE) of SELECT-COMPARE.

Methods:

Patients were randomized to once daily (QD) UPA 15 mg, PBO, or ADA 40 mg every other week, with all patients continuing background MTX. The study was double-blind for 48 weeks. Between Weeks 14-26, patients were rescued (from PBO to UPA, UPA to ADA, or ADA to UPA) if there was <20% improvement in tender/swollen joint count at Weeks 14/18/22 or if Clinical Disease Activity Index (CDAI) was >10 at Week 26; all PBO patients who were not rescued were switched to UPA at Week 26. Patients continued UPA or ADA in a blinded manner until the last patient completed the Week 48 visit; patients received open-label treatment thereafter. Study visits occurred at Week 60, 72, and every 12 weeks thereafter. Treatment-emergent adverse events (TEAEs) per 100 patient years (PY) were summarized up to December 26, 2018. Efficacy was analyzed by randomized group.

Results:

In total, 651, 651 and 327 patients were randomized at baseline to receive UPA, PBO, and ADA, respectively. Subsequently, 252 patients were switched from UPA to ADA, 159 were switched from ADA to UPA, and all PBO patients were switched to UPA. 1403 patients entered the LTE at Week 48 (UPA: 1091 [565 switched from PBO; 66 rescued from ADA; 460 on continued UPA]; ADA: 312 [110 rescued from UPA; 202 on continued ADA]). The cumulative exposures were 1396.7 and 515.1 PYs for UPA and ADA, respectively. UPA + MTX was generally well-tolerated as assessed by the frequency of AEs, including serious AEs, AEs leading to discontinuation of study drug, and AEs of special interest ([AESIs] including serious and opportunistic infections, malignancy, adjudicated major adverse cardiac events or venous thromboembolism; Figure 1). The event rates of AESIs were generally comparable between UPA + MTX and ADA + MTX, except for herpes zoster, lymphopenia, hepatic disorder, and CPK elevation, which were numerically higher with UPA + MTX. At both Weeks 60 and 72, significantly greater proportions of patient receiving UPA + MTX achieved ACR20/50/70 (P ≤.01/.001/.001), low disease activity (P ≤.001) and remission (P ≤.001) compared to those receiving ADA + MTX; Figure 2). Similarly, improvements in pain and function were significantly greater in the UPA vs ADA group through Week 72 (P ≤.01).

Conclusion:

The safety profile for UPA + MTX was consistent with that reported previously and with the integrated Phase 3 safety analysis.1,2UPA + MTX maintained significantly higher levels of clinical response, including remission compared to ADA + MTX through Week 72.

References:

[1]Fleischmann R, et al.Annals of the Rheumatic Diseases.2019;78:744-745.

[2]Cohen SB, et al. Thu0167.Annals of the Rheumatic Diseases. 2019;78:357.

Disclosure of Interests: :

Roy Fleischmann Grant/research support from: AbbVie, Akros, Amgen, AstraZeneca, Bristol-Myers Squibb, Boehringer, IngelhCentrexion, Eli Lilly, EMD Serono, Genentech, Gilead, Janssen, Merck, Nektar, Novartis, Pfizer, Regeneron Pharmaceuticals, Inc., Roche, Samsung, Sandoz, Sanofi Genzyme, Selecta, Taiho, UCB, Consultant of: AbbVie, ACEA, Amgen, Bristol-Myers Squibb, Eli Lilly, Gilead, GlaxoSmithKline, Novartis, Pfizer, Sanofi Genzyme, UCB, In-Ho Song Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Jeffrey Enejosa Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Eduardo Mysler Grant/research support from: AbbVie, Amgen, Bristol Myers Squibb, Roche, Eli Lilly, Novartis, Janssen, Sanofi, and Pfizer., Speakers bureau: AbbVie, Amgen, Bristol Myers Squibb, Roche, Eli Lilly, Novartis, Janssen, Sanofi, and Pfizer, Louis Bessette Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Sanofi, Patrick Durez Speakers bureau: AbbVie, Bristol-Myers Squibb, Celltrion, Eli Lilly, Pfizer, Sanofi, Andrew Ostor Consultant of: MSD, Pfizer, Lilly, Abbvie, Novartis, Roche, Gilead and BMS, Speakers bureau: MSD, Pfizer, Lilly, Abbvie, Novartis, Roche, Gilead and BMS, Jerzy Swierkot Grant/research support from: AbbVie, Sandoz, Pfizer, Roche, BMS, UCB, MSD, Accord, Janssen, Consultant of: AbbVie, Sandoz, Pfizer, Roche, BMS, UCB, MSD, Accord, Janssen, Speakers bureau: AbbVie, Sandoz, Pfizer, Roche, BMS, UCB, MSD, Accord, Janssen, Yanna Song Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Mark C. Genovese Grant/research support from: Abbvie, Eli Lilly and Company, EMD Merck Serono, Galapagos, Genentech/Roche, Gilead Sciences, Inc., GSK, Novartis, Pfizer Inc., RPharm, Sanofi Genzyme, Consultant of: Abbvie, Eli Lilly and Company, EMD Merck Serono, Genentech/Roche, Gilead Sciences, Inc., GSK, Novartis, RPharm, Sanofi Genzyme

OP0263-HPR MAJOR STRESSORS IN THE YEAR PRIOR TO RA DIAGNOSIS: IMPACT ON PATIENT-REPORTED OUTCOMES ONE YEAR LATER

Background:

Stress is implicated in RA onset and poorer prognoses through changes in neuro-endocrine and autoimmune function. Although many people with RA link disease onset to recent stressful life events, results from retrospective studies are unclear.

Objectives:

To describe the incidence of major stressors(+STRESS) in year prior to diagnosis and compare characteristics and patient-reported outcomes (PROs) of newly diagnosed RA patients with and without+STRESSat 0 and 12 months.

Methods:

Data were from early RA patients (symptoms <1 yr) enrolled in the Canadian Early Arthritis Cohort (CATCH) from 2007-17 who met 1987/2010 ACR/EULAR criteria and had ≥12 months of follow-up. Patients reported major psychological (death, divorce/separation, family, financial, other) and physical (motor vehicle accident, surgery, major illness/infection, other) stressors in previous year. We used independent t-tests and chi square to compare characteristics by stressors at baseline, and multivariable regression to examine the impact of+STRESSon disease activity and PROs at 1 year, adjusting for age, sex, education, fibromyalgia, and SJC.

Results:

The 1933 adults were mostly female (72%), with a mean (SD) age of 55 (15) years. 52% reported 1+ stressors in previous year; family (48%), financial stress (36%), death (35%), surgery (28%), and major illness (26%) were the most common stressors. Patients with +STRESS were more likely to be women, younger, have more comorbidities including fibromyalgia, and higher mean DAS28. Patients with +STRESS also had significantly higher mean pain, fatigue, depression, sleep disturbance, patient global, and HAQ scores at baseline.

At 1 year, SJC and the proportion in DAS28 REM was similar between groups. However, PROs (pain, HAQ, Fatigue, Pt Global, Depression, Poor Sleep) remained higher in+STRESS, with evidence of an additive effect for number of stressors and having both physical and psychological stressors (Table). The greatest impacts were on mood, sleep disturbance, and fatigue.

Conclusion:

In this pan-Canadian early RA cohort, more than half reported 1+ stressful life events in the year prior to diagnosis. Individuals reporting major stressors had significantly worse pain, patient global, disability, depression, fatigue, and sleep disturbance at diagnosis; 1 year later, though disease activity was similar between groups, the effects of +STRESS on PROs persisted. Early RA patients with recent major stressors may benefit from emotional support and stress reduction to optimize how they feel and function.

Mean (SD) or N (%)No Stress(N=928; 48%)Physical(N=131; 7%)Psychological(N=658; 34%)Both(N=216; 11%)Age56 (15)56 (15)53 (14)52 (15)Women622 (67%)82 (63%)512 (78%)174 (81%)College Education464 (50%)76 (58%)345 (52%)126 (58%)Rheum Dis Comorbid Index1.1 (1.2)1.4 (1.4)1.1 (1.3)1.4 (1.3)OA or Spinal pain168 (18%)35 (27%)117 (18%)55 (25%)Fibromyalgia diagnosis15 (2%)2 (2%)13 (2%)11 (5%)Symptom duration (months)5.6 (3.0)5.7 (3.0)5.9 (3.0)5.9 (3.0)DAS28 – mean5.0 (1.4)5.1 (1.5)5.0 (1.5)5.2 (1.4)MTX ±csDMARDs679 (73%)100 (76%)489 (74%)166 (77%)Oral Steroids295 (32%)40 (31%)215 (33%)55 (25%)Pain (0-10)5.3 (2.8)5.5 (2.9)5.7 (2.8)6.2 (2.8)HAQ-DI1.0 (0.7)1.2 (0.7)1.1 (0.7)1.3 (0.7)Fatigue (0-10)4.7 (3.1)5.0 (3.0)5.7 (2.9)5.9 (2.9)Patient Global (0-10)5.6 (2.9)6.0 (2.9)6.0 (2.9)6.4 (3.0)Depression (SF12 MCS < 45.6)329 (35%)54 (41%)356 (54%)123 (57%)Poor sleep (0-10)4.5 (3.4)4.8 (3.3)5.3 (3.2)6.0 (3.1)

Disclosure of Interests:

Nicole Andersen: None declared, Orit Schieir: None declared, Marie-France Valois: None declared, Gilles Boire Grant/research support from: Merck Canada (Registry of biologices, Improvement of comorbidity surveillance)

Amgen Canada (CATCH, clinical nurse)

Abbvie (CATCH, clinical nurse)

Pfizer (CATCH, Registry of biologics, Clinical nurse)

Hoffman-LaRoche (CATCH)

UCB Canada (CATCH, Clinical nurse)

BMS (CATCH, Clinical nurse, Observational Study Protocol IM101664. SEROPOSITIVITY IN A LARGE CANADIAN OBSERVATIONAL COHORT)

Janssen (CATCH)

Celgene (Clinical nurse)

Eli Lilly (Registry of biologics, Clinical nurse), Consultant of: Eli Lilly, Janssen, Novartis, Pfizer, Speakers bureau: Merck, BMS, Pfizer, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB, Glen Hazlewood: None declared, Louis Bessette Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Sanofi, Carol Hitchon Grant/research support from: UCB Canada; Pfizer Canada, Diane Tin: None declared, Carter Thorne Consultant of: Abbvie, Centocor, Janssen, Lilly, Medexus/Medac, Pfizer

Speakers bureau: Medexus/Medac, Edward Keystone Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, F. Hoffmann-La Roche Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Pfizer Pharmaceuticals, Sanofi-Aventis, Consultant of: AbbVie, Amgen, AstraZeneca Pharma, Biotest, Bristol-Myers Squibb Company, Celltrion,

Crescendo Bioscience, F. Hoffmann-La Roche Inc, Genentech Inc, Gilead, Janssen Inc, Lilly

Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, UCB., Speakers bureau: Amgen, AbbVie, Bristol-Myers Squibb Canada, F. Hoffmann-La Roche Inc., Janssen Inc., Merck, Pfizer Pharmaceuticals, Sanofi Genzyme, UCB, Vivian Bykerk: None declared, Susan J. Bartlett Consultant of: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Speakers bureau: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie

FRI0024 HOW OFTEN DOES REACHING TARGET MISS THE MARK? LONGITUDINAL PATTERNS OF REMISSION IN REAL-WORLD EARLY RHEUMATOID ARTHRITIS PATIENTS

Background:

Early diagnosis and rapid initiation of DMARDs following a treat-to-target approach have made remission a realizable goal for many with RA. Yet, some patients are unable to sustain remission over time.

Objectives:

To describe longitudinal patterns of remission and identify predictors of sustained vs transient remission in real-world early RA patients.

Methods:

Data were from the Canadian Early Arthritis Cohort (CATCH), a prospective study of early RA patients (symptoms < 1 year) treated in rheumatology clinics across Canada from 2007- 2019. The sample was limited to patients with active disease at enrolment who later reached remission (SDAI<=3.3) and were followed for 12-24 months thereafter. Patients were classified as in sustained remission (Pattern 1) or transient remission with transient remission patients divided into those who transitioned from REM to LDA only (Pattern 2) and those who transitioned from REM to MDA or HDA (Pattern 3), over FU. Multi-adjusted multinomial regression was used to identify predictors of transient remission patterns.

Results:

The study included 1,419 (46%) CATCH participants that reached remission. At enrolment, most (70%) were female, mean(sd) SDAI was high (27(15)) and 92% were treated with csDMARDs. Only 47% remained in sustained remission by 12-months and, only 40% by 24 months (Pattern 1) (Figure). Among patients with transient remission patterns, transitions to LDA only (Pattern 2) were more common than to MDA/HDA over FU (Pattern 3) (Fig 1). Older age, female sex, smoking, higher comorbidity index and positive serology, were significantly associated with transient remission patterns (Table). There were also borderline significant associations between transient remission patterns and longer time to remission, lack of early MTX treatment and reducing treatment after remission (Table).

Table .

Adjusted Multinomial Regression Results of Predictors of Transient Remission Patterns over 24-Month Follow Up

Pattern 2 vs, Pattern 1OR (95% CI)Pattern 3 vs. Pattern 1OR (95% CI)Age1.01 (1.00, 1.02)1.01 (0.99, 1.02)Women vs Men1.78 (1.33, 2.39)1.63 (1.09, 2.44)Current smoker1.57 (1.09, 2.28)1.53 (0.95, 2.47)RDCI at baseline1.11 (0.99, 1.25)1.30 (1.13, 1.50)Seropositive1.38 (1.03, 1.85)1.21 (0.81, 1.80)MTX first 3 months1.18 (0.85, 1.63)0.76 (0.51, 1.12)Time to remission (months)1.01 (1.00, 1.01)1.01 (1.00, 1.02)Treatment reduction after REM vs. No Change1.33 (0.96, 1.86)1.01 (0.99, 1.02)

  Pattern 1: Sustained REM

  Pattern 2: Transient REM: Transitions to LDA only

  Pattern 3: Transient REM: Transitions to MDA/HDA

   RDCI: Rheumatic Disease Comorbidity Index (range 0-9)

  Treatment reduction: Change from biologic or JAK to csDMARD(s) OR reduction in number of csDMARDs OR change from MTX +/- csDMARDs to non-MTX csDMARD

Figure.

Distribution of Disease Activity States over 12-24 After First Achieving SDAI REM

Conclusion:

Results of this large longitudinal analysis of real-world data suggests that < 50% of patients that reach remission sustain remission for 12-24months. Closer monitoring of patients with prognostic indicators for transient remission and additional research focusing on why remission is lost may help improve the rates of sustained remission.

References:

[1]Ajeganova S, Huizinga T. Sustained remission in rheumatoid arthritis: latest evidence and clinical considerations. Ther Adv Musculoskelet Dis. 2017;9(10):249-62.

Disclosure of Interests:

Orit Schieir: None declared, Glen Hazlewood: None declared, Susan J. Bartlett Consultant of: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Speakers bureau: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Marie-France Valois: None declared, Louis Bessette Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Sanofi, Gilles Boire Grant/research support from: Merck Canada (Registry of biologices, Improvement of comorbidity surveillance)

Amgen Canada (CATCH, clinical nurse)

Abbvie (CATCH, clinical nurse)

Pfizer (CATCH, Registry of biologics, Clinical nurse)

Hoffman-LaRoche (CATCH)

UCB Canada (CATCH, Clinical nurse)

BMS (CATCH, Clinical nurse, Observational Study Protocol IM101664. SEROPOSITIVITY IN A LARGE CANADIAN OBSERVATIONAL COHORT)

Janssen (CATCH)

Celgene (Clinical nurse)

Eli Lilly (Registry of biologics, Clinical nurse), Consultant of: Eli Lilly, Janssen, Novartis, Pfizer, Speakers bureau: Merck, BMS, Pfizer, Carol Hitchon Grant/research support from: UCB Canada; Pfizer Canada, Edward Keystone Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, F. Hoffmann-La Roche Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Pfizer Pharmaceuticals, Sanofi-Aventis, Consultant of: AbbVie, Amgen, AstraZeneca Pharma, Biotest, Bristol-Myers Squibb Company, Celltrion, Crescendo Bioscience, F. Hoffmann-La Roche Inc, Genentech Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, UCB., Speakers bureau: Amgen, AbbVie, Bristol-Myers Squibb Canada, F. Hoffmann-La Roche Inc., Janssen Inc., Merck, Pfizer Pharmaceuticals, Sanofi Genzyme, UCB, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB, Carter Thorne Consultant of: Abbvie, Centocor, Janssen, Lilly, Medexus/Medac, Pfizer, Speakers bureau: Medexus/Medac, Diane Tin: None declared, Vivian Bykerk: None declared

AB0337 TOFACITINIB MONOTHERAPY OR COMBINED WITH METHOTREXATE IN PATIENTS WITH RHEUMATOID ARTHRITIS SHOW SIMILAR RETENTION OVER FOUR YEARS. REPORT FROM RHUMADATA ®

Background:

Since the introduction of biologic agents around the turn of the century, the scientific evidence shows that the majority of agents, independent of the therapeutic target, have a better outcome when used in combination with methotrexate (MTX). In 2014, tofacitinib (TOFA), an agent targeting Janus kinase 1 and 3, has reached the Canadian market with data showing that the combination with MTX may not be necessary [1,2].

Objectives:

To evaluate the efficacy and retention rate of TOFA in real-world patients with rheumatoid arthritis (RA).

Methods:

Two cohorts of patients prescribed TOFA was created. The first cohort was formed of patients who were receiving MTX concomitantly with TOFA (COMBO) and the other of patients using TOFA in monotherapy (MONO). MONO patients either never use MTX or were prescribed MTX post-TOFA initiation for at most 20% of the time they were on TOFA. COMBO patients received MTX at the time of TOFA initiation or were prescribed MTX post-TOFA initiation for at least 80% of the time. For all those patients, baseline demographic data definitions. Disease activity score and HAQ-DI were compared from the initiation of TOFA to the last visit. Time to medication discontinuation was extracted, and survival was estimated using Kaplan-Meier calculation for MONO and COMBO cohorts.

Results:

Overall, 194 patients were selected. Most were women (83%) on average younger than the men (men: 62.6 ± 11.0 years vs. women: 56.9 ± 12.1 years, p-value=0.0130). The patient’s assessments of global disease activity, pain and fatigue were respectively 5.0 ± 2.7, 5.2 ± 2.9, 5.1 ± 3.1 in the COMBO group and 6.2 ± 2.5, 6.5 ± 2.6, 6.3 ± 2.8 in the MONO group all differences being significant across groups. HAQ-DI at treatment initiation was 1.3 ± 0.7 and 1.5 ± 0.7 in the COMBO and MONO groups, respectively, p-value=0.0858. Similarly, the SDAI score at treatment initiation was 23.9 ± 9.4 and 25.2 ± 11.5, p-value=0.5546. Average changes in SDAI were -13.4 ± 15.5 (COMBO) and -8.9 ± 13.5 (MONO), p-value=0.1515, and changes in HAQ -0.21 ± 0.63 and -0.26 ± 0.74, p-value 0.6112. At treatment initiation, DAS28(4)ESR were 4.4 ± 1.4 (COMBO) and 4.6 ± 1.3 (MONO), p-value 0.5815, with respective average changes of -1.06 ± 2.07 and -0.70 ± 1.96, p-value=0.2852. The Kaplan-Meier analysis demonstrated that the COMBO and MONO retention curves were not statistically different (log-rank p-value=0.9318).

Conclusion:

Sustainability of TOFA in MONO or COMBO are not statistically different as are the changes in DAS28(4)ESR and SDAI. Despite this result, some patients may still benefit from combination with MTX.

References:

[1]Product Monograph - XELJANZ ® (tofacitinib) tablets for oral administration Initial U.S. Approval: 2012.

[2] Reed GW, Gerber RA, Shan Y, et al. Real-World Comparative Effectiveness of Tofacitinib and Tumor Necrosis Factor Inhibitors as Monotherapy and Combination Therapy for Treatment of Rheumatoid Arthritis [published online ahead of print, 2019 Nov 9].Rheumatol Ther. 2019;6(4):573–586. doi:10.1007/s40744-019-00177-4.

Disclosure of Interests:

Denis Choquette Grant/research support from: Rhumadata is supported by grants from Pfizer, Amgen, Abbvie, Gylead, BMS, Novartis, Sandoz, eli Lilly,, Consultant of: Pfizer, Amgen, Abbvie, Gylead, BMS, Novartis, Sandoz, eli Lilly,, Speakers bureau: Pfizer, Amgen, Abbvie, Gylead, BMS, Novartis, Sandoz, eli Lilly,, Louis Bessette Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Sanofi, Loïc Choquette Sauvageau: None declared, Isabelle Ferdinand Consultant of: Pfizer, Abbvie, Amgen, Novartis, Speakers bureau: Pfizer, Amgen, Boulos Haraoui Grant/research support from: Abbvie, Amgen, Pfizer, UCB, Grant/research support from: AbbVie, Amgen, BMS, Janssen, Pfizer, Roche, and UCB, Consultant of: Abbvie, Amgen, Lilly, Pfizer, Sandoz, UCB, Consultant of: AbbVie, Amgen, BMS, Celgene, Eli Lilly, Janssen, Merck, Pfizer, Roche, and UCB, Speakers bureau: Pfizer, Speakers bureau: Amgen, BMS, Janssen, Pfizer, and UCB, Frédéric Massicotte Consultant of: Abbvie, Janssen, Lilly, Pfizer, Speakers bureau: Janssen, Jean-Pierre Pelletier Shareholder of: ArthroLab Inc., Grant/research support from: TRB Chemedica, Speakers bureau: TRB Chemedica and Mylan, Jean-Pierre Raynauld Consultant of: ArthroLab Inc., Marie-Anaïs Rémillard Consultant of: Abbvie, Amgen, Eli Lilly, Novartis, Pfizer, Sandoz, Paid instructor for: Abbvie, Amgen, Eli Lilly, Novartis, Pfizer, Sandoz, Speakers bureau: Abbvie, Amgen, Eli Lilly, Novartis, Pfizer, Sandoz, Diane Sauvageau: None declared, Édith Villeneuve Consultant of: Abbvie, Amgen, BMS, Celgene, Pfizer, Roche, Sanofi-Genzyme,

UCB, Paid instructor for: Abbvie, Speakers bureau: AbbVie, BMS, Pfizer, Roche, Louis Coupal: None declared

FRI0032 REGIONAL AND WIDESPREAD PATTERNS OF NON-ARTICULAR PAIN ARE COMMON AT RA DIAGNOSIS AND CONTRIBUTE TO POOR OUTCOMES AT 12 MONTHS: A PROSPECTIVE STUDY OF PAIN PATTERNS IN CANADIANS WITH RA

Background:

Persistent pain can occur in early RA patients, despite improvement in synovitis and may be due to coexisting non-articular pain (NAP). Though NAP is often attributed to fibromyalgia and widespread NAP, regional NAP syndromes may be more common and under-recognized.

Objectives:

To describe patterns of NAP, predictors of persistent NAP and impact on outcomes in the first year following early RA diagnosis.

Methods:

Data were from participants enrolled in the Canadian Early Arthritis Cohort (CATCH) between2017-2019who completed 0,6,12-month evaluations with patient-reported outcomes [PROs] and clinical data available. We used the McGill Body Pain Diagram (BPD) to classify patients as experiencing no NAP, regional (RP:1-2 regions) or widespread NAP (WP:3-5 regions). Multinomial regression was used to identify baseline predictors of persistent RP and WP at 12-months. Multi-adjusted GEE with linear and logit links were used to estimate time-varying associations of NAP patterns with outcomes updated at each time point.

Results:

Study included 421 participants: 66% were female, with a mean(sd) age 56 (14); 72% were seropositive and 90% were treated with MTX ± csDMARDs as initial therapy. NAP at baseline was common (55%), with majority (62%) reporting regional NAP. NAP prevalence was 33% at 12 months (Figure). Female sex and baseline depressive symptoms were independent predictors of widespread NAP at 12 months while poorer function and lack of early MTX treatment independently predicted regional NAP, at 12 mos. Regional and widespread NAP were associated with lower likelihood of remission in adjusted models that accounted for changes in NAP and remission over time (Table).

Figure.

Point prevalence of regional and widespread NAP at baseline, 6 and 12 months.

Table .

Results of Multi-Adjusted GEE Logistic Regression showing Regional and Widespread NAP is associated with a reduced likelihood of achieving Stringent Remission Targets

Conclusion:

NAP is commonly reported in early RA pts seen in real world settings. Regional NAP was more common than WSP at all time-points, but both NAP patterns were associated lower odds of achieving remission targets by 12 months. These data support considering the role of NAP when assessing RA treatment efficacy during clinical visits and warrant different treatment approaches to reduce symptoms in RA patients receiving target-based care.

Disclosure of Interests:

Vivian Bykerk: None declared, Orit Schieir: None declared, Marie-France Valois: None declared, Louis Bessette Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Sanofi, Gilles Boire Grant/research support from: Merck Canada (Registry of biologices, Improvement of comorbidity surveillance)

Amgen Canada (CATCH, clinical nurse)

Abbvie (CATCH, clinical nurse)

Pfizer (CATCH, Registry of biologics, Clinical nurse)

Hoffman-LaRoche (CATCH)

UCB Canada (CATCH, Clinical nurse)

BMS (CATCH, Clinical nurse, Observational Study Protocol IM101664. SEROPOSITIVITY IN A LARGE CANADIAN OBSERVATIONAL COHORT)

Janssen (CATCH)

Celgene (Clinical nurse)

Eli Lilly (Registry of biologics, Clinical nurse), Consultant of: Eli Lilly, Janssen, Novartis, Pfizer, Speakers bureau: Merck, BMS, Pfizer, Glen Hazlewood: None declared, Carol Hitchon Grant/research support from: UCB Canada; Pfizer Canada, Edward Keystone Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, F. Hoffmann-La Roche Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Pfizer Pharmaceuticals, Sanofi-Aventis, Consultant of: AbbVie, Amgen, AstraZeneca Pharma, Biotest, Bristol-Myers Squibb Company, Celltrion,

Crescendo Bioscience, F. Hoffmann-La Roche Inc, Genentech Inc, Gilead, Janssen Inc, Lilly

Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, UCB., Speakers bureau: Amgen, AbbVie, Bristol-Myers Squibb Canada, F. Hoffmann-La Roche Inc., Janssen Inc., Merck, Pfizer Pharmaceuticals, Sanofi Genzyme, UCB, Diane Tin: None declared, Carter Thorne Consultant of: Abbvie, Centocor, Janssen, Lilly, Medexus/Medac, Pfizer, Speakers bureau: Medexus/Medac, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB, Susan J. Bartlett Consultant of: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Speakers bureau: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie

SAT0053 ESTIMATING REAL-WORLD UNMET NEEDS FOR REACHING REMISSION IN THE FIRST YEAR FOLLOWING EARLY RA DIAGNOSIS: RESULTS FROM THE CANADIAN EARLY ARTHRITIS COHORT (CATCH)

Background:

Several composite RA disease activity indices are commonly used in clinical practice and research. Different disease activity indices however can be inconsistent in classifying remission (REM).

Objectives:

1) Compare remission prevalence across 4 common RA indices; 2) compare changes in remission across indices; and, 3) Identify predictors of persistent active disease across all indices, in real-world early RA patients over 1 year follow up.

Methods:

Data were from patients with early RA (symptoms < 1 year) enrolled in the Canadian Early Arthritis Cohort (CATCH) between 2007 and 2018. Participants had active disease at enrolment, were treated with csDMARDs and completed standardized clinical assessments every 3-months. Remission status was assessed using 4 indices: 1) DAS28< 2.6 OR DAS28CRP < 2.5, 2) CDAI ≤ 2.8, 3) SDAI≤ 3.3, and 4) ACR/EULAR Boolean remission – SJC28, TJC28, CRP, PGA all ≦1. T-tests/ chi-squared tests were used to compare differences in remission prevalence by 1 year, and changes in remission before and after a QI program. Logistic regression was used to identify predictors of persistent active disease on all 4 indices.

Results:

1202 adults were eligible for this analysis. At enrolment, 877 (73%) were women, mean (sd) age was 55 (14), average disease activity was high (DAS28 5.1 (1.4); CDAI 27 (14); SDAI 29 (15)). Prevalence of remission by 12-months follow up was 14-21% higher when estimated with the DAS28 compared with CDAI, SDAI and Boolean criteria, and 378 (31%) did not achieve remission according to any of the 4 indices (Fig 1). Improvement in remission after a QI program however was similar across all 4 indices(~+15-17%). In adjusted logistic regression, Persistent active disease across all measures was most strongly associated with positive serostatus and smoking in men, and with obesity and more tender joints in women. Pain and lower education were predictors in BOTH men and women (Table 2)

Table 1.

Multivariable Logistic Regression Predicting Persistent Active Disease by 12-months across ALL RA indices

Conclusion:

In the absence of a single “best measure” that also takes in to account the patient’s perspective, we estimate unmet needs for achieving remission in the first year of follow up in 1 in 3 ERA patients who did not achieve remission by ANY of the 4 indices.

References:

[1] Kuriya B, Sun Y, Boire G, Haraoui B, etal. Remission in Early Rheumatoid Arthritis – A Comparison of New ACR/EULAR Remission Criteria to Established Criteria.J Rheumatol2012;39:1155-1158.

Disclosure of Interests:

Orit Schieir: None declared, Susan J. Bartlett Consultant of: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Speakers bureau: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Marie-France Valois: None declared, Louis Bessette Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Sanofi, Gilles Boire Grant/research support from: Merck Canada (Registry of biologices, Improvement of comorbidity surveillance)

Amgen Canada (CATCH, clinical nurse)

Abbvie (CATCH, clinical nurse)

Pfizer (CATCH, Registry of biologics, Clinical nurse)

Hoffman-LaRoche (CATCH)

UCB Canada (CATCH, Clinical nurse)

BMS (CATCH, Clinical nurse, Observational Study Protocol IM101664. SEROPOSITIVITY IN A LARGE CANADIAN OBSERVATIONAL COHORT)

Janssen (CATCH)

Celgene (Clinical nurse)

Eli Lilly (Registry of biologics, Clinical nurse), Consultant of: Eli Lilly, Janssen, Novartis, Pfizer, Speakers bureau: Merck, BMS, Pfizer, Glen Hazlewood: None declared, Carol Hitchon Grant/research support from: UCB Canada; Pfizer Canada, Edward Keystone Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, F. Hoffmann-La Roche Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Pfizer Pharmaceuticals, Sanofi-Aventis, Consultant of: AbbVie, Amgen, AstraZeneca Pharma, Biotest, Bristol-Myers Squibb Company, Celltrion,

Crescendo Bioscience, F. Hoffmann-La Roche Inc, Genentech Inc, Gilead, Janssen Inc, Lilly

Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, UCB., Speakers bureau: Amgen, AbbVie, Bristol-Myers Squibb Canada, F. Hoffmann-La Roche Inc., Janssen Inc., Merck, Pfizer Pharmaceuticals, Sanofi Genzyme, UCB, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB, Carter Thorne Consultant of: Abbvie, Centocor, Janssen, Lilly, Medexus/Medac, Pfizer

, Speakers bureau: Medexus/Medac, Diane Tin: None declared, Vivian Bykerk: None declared

FRI0131 SUSTAINABILITY OF RESPONSE BETWEEN UPADACITINIB AND ADALIMUMAB AMONG PATIENTS WITH RHEUMATOID ARTHRITIS AND PRIOR INADEQUATE RESPONSE TO METHOTREXATE

Background:

The primary treatment goal for patients (pts) with rheumatoid arthritis (RA) is a state of sustained clinical remission (REM) or low disease activity (LDA).1,2

Objectives:

To assess the long-term sustainability of response to upadacitinib (UPA), a JAK inhibitor, and adalimumab (ADA), both with background methotrexate (MTX), among pts with RA and prior inadequate response to MTX.

Methods:

In the phase 3, randomized, placebo (PBO) and active-controlled SELECT-COMPARE trial, pts on stable background MTX received UPA 15 mg once daily, PBO, or ADA 40 mg every other week. Pts not achieving 20% improvements in tender/swollen joint counts (Weeks 14-22) or LDA (CDAI ≤10 at Week 26) were rescued from UPA to ADA or PBO/ADA to UPA; all non-rescued PBO pts were switched to UPA at Week 26. This post hoc analysis evaluated clinical REM (CDAI ≤2.8; SDAI ≤3.3), LDA (CDAI≤10; SDAI≤11), and DAS28(CRP) <2.6/≤3.2 at first occurrence before Week 72 or prior to treatment switch; additionally, these measures were evaluated at 3, 6, and 12 months after the first occurrence for the total number of pts randomized to UPA (n=651) or ADA (n=327). Sustainability of response was evaluated by Kaplan-Meier only for those pts who achieved REM/LDA and was defined as time to the earliest date of losing response at two consecutive visits, discontinuation of study drug, or losing response at the time of rescue. The predictive ability of time to clinical REM/LDA was assessed using Harrell’s concordance (c)-index (for reference, an index ~ 0.5, indicates no ability to predict; an index of 1 or -1 would be a perfect prediction). The date of the last follow up was 6 July, 2018, when all pts had reached the Week 72 visit.

Results:

Through Week 72, a significantly higher proportion of pts receiving UPA + MTX vs ADA + MTX achieved CDAI REM (41% vs 31%, p=.0035) as well as CDAI LDA (70% vs 59%, p=.0007). 26%/22% of pts randomized to UPA + MTX and 16%/14% of pts randomized to ADA + MTX achieved sustained CDAI REM at 6/12 months after the first occurrence. Additionally, 49%/46% of pts randomized to UPA + MTX and 36%/34% of pts randomized to ADA + MTX achieved sustained CDAI LDA at 6/12 months after the first occurrence (Figure 1). Time to initial clinical REM/LDA did not appear to be associated with sustained disease control. The c-indices (95% CI) for CDAI REM in the UPA +MTX and ADA + MTX groups were 0.528 (0.48, 0.58) and 0.510 (0.43, 0.59) and that of LDA were 0.601 (0.56, 0.64) and 0.555 (0.50, 0.61), respectively. Through last follow-up visit, 51% of UPA + MTX pts and 45% of ADA + MTX pts remained in CDAI REM while 65% of UPA + MTX pts and 58% of ADA + MTX pts remained in CDAI LDA, respectively (Figure 2). Similar results were observed across other disease activity measures (SDAI REM/LDA and DAS28(CRP) <2.6/≤3.2).

Conclusion:

A significantly greater proportion of pts with RA and prior inadequate response to MTX receiving UPA + MTX vs ADA + MTX achieved clinical REM or LDA across disease activity measures. REM and LDA were sustained through Week 72 in both treatment arms, with numerically higher proportions retaining response among UPA-treated pts.

References:

[1]EULAR: Smolen JS, et al. Ann Rheum Dis 2017;76:960–977.

[2]ACR: Singh et al. Arthritis & Rheumatology Vol. 68, No. 1, January 2016, pp 1–26.

Disclosure of Interests:

Peter Nash Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Arthur Kavanaugh Grant/research support from: Abbott, Amgen, AstraZeneca, BMS, Celgene Corporation, Centocor-Janssen, Pfizer, Roche, UCB – grant/research support, Maya H Buch Grant/research support from: Pfizer, Roche, and UCB, Consultant of: Pfizer; AbbVie; Eli Lilly; Gilead Sciences, Inc.; Merck-Serono; Sandoz; and Sanofi, Bernard Combe Grant/research support from: Novartis, Pfizer, Roche-Chugai, Consultant of: AbbVie; Gilead Sciences, Inc.; Janssen; Eli Lilly and Company; Pfizer; Roche-Chugai; Sanofi, Speakers bureau: Bristol-Myers Squibb; Gilead Sciences, Inc.; Eli Lilly and Company; Merck Sharp & Dohme; Pfizer; Roche-Chugai; UCB, Louis Bessette Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Sanofi, In-Ho Song Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Yanna Song Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Jessica Suboticki Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Roy Fleischmann Grant/research support from: AbbVie, Akros, Amgen, AstraZeneca, Bristol-Myers Squibb, Boehringer, IngelhCentrexion, Eli Lilly, EMD Serono, Genentech, Gilead, Janssen, Merck, Nektar, Novartis, Pfizer, Regeneron Pharmaceuticals, Inc., Roche, Samsung, Sandoz, Sanofi Genzyme, Selecta, Taiho, UCB, Consultant of: AbbVie, ACEA, Amgen, Bristol-Myers Squibb, Eli Lilly, Gilead, GlaxoSmithKline, Novartis, Pfizer, Sanofi Genzyme, UCB

FRI0037 ALL-CAUSE MORTALITY IN EARLY RHEUMATOID ARTHRITIS PREDICTED BY HEALTH ASSESSMENT QUESTIONNAIRE AT ONE YEAR

Background:

Patients with RA are at greater risk of mortality than the general population. Higher HAQ disability has been associated with hospitalizations and mortality in established RA; whether HAQ disability predicts mortality in early RA (ERA) is unknown.

Objectives:

The objective of this study is to analyze how well the HAQ can predict future mortality in patients with early RA.

Methods:

Data were from adult early RA patients (symptoms <1 year) enrolled in the Canadian Early Arthritis Cohort (CATCH) between 2007 and 2017; who initiated treatment with 1 or more DMARDs and had completed HAQ data at baseline and 1 year. Descriptive statistics, t-tests and chi-square tests were used to summarize and compare baseline patient characteristics including sociodemographic variables, RA characteristics and comorbidities amongst deceased and non-deceased patients. Discrete-time proportional hazards models were used to estimate crude and multi-adjusted associations between HAQ at baseline and 1 year, respectively, with all-cause mortality in each year of follow up.

Results:

This study included 1724 patients with early RA; mean age was 55 years and 72% were female. In 10 years of follow up, 62 deaths (2.4%) occurred. Deceased patients had higher HAQ scores and DAS28 scores at baseline and at 1 year versus the non-deceased group. Age, male sex, lower education, smoking, more comorbidities, higher baseline disease activity and steroid use were associated with mortality in unadjusted survival models (Table 1). Contrary to HAQ at baseline, the association between all-cause mortality and HAQ at 1 year remained significant even after adjusting for age, gender, comorbidities, disease activity, smoking, education, seropositivity, symptom duration and steroid use in adjusted survival models (Table 2).

Table 1.

Unadjusted survival model: Association of each variable with all-cause mortality

Baseline VariableUnadjustedHazard OR95% CISocio-DemographicAge (years)1.101.07 – 1.13Female0.370.22 – 0.62Caucasian (white or European)1.010.46 – 2.24Aboriginal1.710.61 – 4.76Education > high school degree0.480.28 – 0.82Current Smoker1.811.01 – 3.24Rheumatic Disease Comorbidity Index (0-9)1.601.36 – 1.87RA CharacteristicsSymptom duration (months)0.990.91 – 1.08Seropositivity in first year1.110.55 – 2.23DAS28 ESR or CRP if ESR is missing1.261.06 – 1.51Oral Steroid use1.751.03 – 2.98Table 2.

Multivariable discrete-time survival models: HAQ baseline vs 1 year

ModelModel 1:Crude(Time + HAQ-DI)Model 2:Adjusted for age + sexModel 3:Adjusted for Model 2 + DAS28 + RDCIModel 4:Adjusted for Model 3 + education, smoking, seropositivity, symptom duration and oral steroids useModel 5:Adjusted for Model 3 + smoking, symptom duration onlyHAQ-DI (0-3) (at baseline)1.461.02 – 2.091.370.96 – 1.951.250.81 – 1.941.320.85 – 2.041.300.84 – 2.00HAQ-DI (0-3) (at 1 year)2.581.78 – 3.722.401.63 – 3.521.751.10 – 2.771.871.16 – 3.021.731.09 – 2.74

*Hazard OR, 95% CI

~HAQ-DI: (Health Assessment Questionnaire Disability Index); RDCI: Rheumatic Disease Comorbidity Index; DAS28: Disease Activity Score

Conclusion:

Higher HAQ at 1 year was significantly associated with all-cause mortality in a large early RA cohort suggesting that poorer disease control and function in the first year of RA contributes to higher mortality.

Disclosure of Interests:

Safoora Fatima: None declared, Orit Schieir: None declared, Marie-France Valois: None declared, Susan J. Bartlett Consultant of: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Speakers bureau: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Louis Bessette Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Sanofi, Gilles Boire Grant/research support from: Merck Canada (Registry of biologices, Improvement of comorbidity surveillance)

Amgen Canada (CATCH, clinical nurse)

Abbvie (CATCH, clinical nurse)

Pfizer (CATCH, Registry of biologics, Clinical nurse)

Hoffman-LaRoche (CATCH)

UCB Canada (CATCH, Clinical nurse)

BMS (CATCH, Clinical nurse, Observational Study Protocol IM101664. SEROPOSITIVITY IN A LARGE CANADIAN OBSERVATIONAL COHORT)

Janssen (CATCH)

Celgene (Clinical nurse)

Eli Lilly (Registry of biologics, Clinical nurse), Consultant of: Eli Lilly, Janssen, Novartis, Pfizer, Speakers bureau: Merck, BMS, Pfizer, Glen Hazlewood: None declared, Carol Hitchon Grant/research support from: UCB Canada; Pfizer Canada, Edward Keystone Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, F. Hoffmann-La Roche Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Pfizer Pharmaceuticals, Sanofi-Aventis, Consultant of: AbbVie, Amgen, AstraZeneca Pharma, Biotest, Bristol-Myers Squibb Company, Celltrion,

Crescendo Bioscience, F. Hoffmann-La Roche Inc, Genentech Inc, Gilead, Janssen Inc, Lilly

Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, UCB., Speakers bureau: Amgen, AbbVie, Bristol-Myers Squibb Canada, F. Hoffmann-La Roche Inc., Janssen Inc., Merck, Pfizer Pharmaceuticals, Sanofi Genzyme, UCB, Diane Tin: None declared, Carter Thorne Consultant of: Abbvie, Centocor, Janssen, Lilly, Medexus/Medac, Pfizer, Speakers bureau: Medexus/Medac, Vivian Bykerk: None declared, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB

Palindromic Rheumatism Frequently Precedes Early Rheumatoid Arthritis: Results From an Incident Cohort

Background

This multicenter incident cohort aimed to characterize how often early rheumatoid arthritis (ERA) patients self‐report episodic joint inflammation (palindromic rheumatism) preceding ERA diagnosis and which characteristics differentiate these patients from those without prior episodic symptoms.

Methods

Data were from patients with early confirmed or suspected RA (more than 6 weeks and less than 12 months) enrolled in the Canadian Early ArThritis CoHort (CATCH) between April 2017 to March 2018 who completed study case report forms assessing joint pain and swelling prior to ERA diagnosis. Chi‐square and t tests were used to compare characteristics of patients with and without self‐reported episodic joint inflammation prior to ERA diagnosis. Multivariable logistic regression was used to identify sociodemographic and clinical measures associated with past episodic joint inflammation around the time of ERA diagnosis.

Results

A total of 154 ERA patients were included; 66% were female, and mean (SD) age and RA symptom duration were 54 (15) years and 141 (118) days. Sixty‐five (42%) ERA patients reported a history of episodic joint pain and swelling, half of whom reported that these symptoms preceded ERA diagnosis by over 6 months. ERA patients with past episodic joint inflammation were more often female, had higher income, were seropositive, had more comorbidities, fewer swollen joints, and lower Clinical Disease Activity Index (CDAI) around the time of ERA diagnosis (P < 0.05). These associations remained significant in multivariable regression adjusting for other sociodemographic and RA clinical measures.

Conclusion

Almost half of ERA patients experienced episodic joint inflammation prior to ERA diagnosis. These patients were more often female, had higher income, and presented with milder disease activity at ERA diagnosis.

Prevalence and Characteristics of Metabolic Syndrome Differ in Men and Women with Early Rheumatoid Arthritis

Objective

Metabolic syndrome (MetS) prevalence in early rheumatoid arthritis (ERA) is conflicting. The impact of sex, including menopause, has not been described. We estimated the prevalence and factors associated with MetS in men and women with ERA.

Methods

A cross‐sectional study of the Canadian Early Arthritis Cohort (CATCH) was performed. Participants with baseline data to estimate key MetS components were included. Sex‐stratified logistic regression identified baseline variables associated with MetS.

Results

The sample included 1543 participants; 71% were female and the mean age was 54 (SD 15) years. MetS prevalence was higher in men 188 (42%) than women 288 (26%, P < 0.0001) and increased with age. Frequent MetS components in men were hypertension (62%), impaired glucose tolerance (IGT, 40%), obesity (36%), and low high‐density lipoprotein cholesterol (36%). Postmenopausal women had greater frequency of hypertension (65%), IGT (32%), and high triglycerides (21%) compared with premenopausal women (P < 0.001). In multivariate analysis, MetS was negatively associated with seropositivity and pulmonary disease in men. Increasing age was associated with MetS in women. In postmenopausal women, corticosteroid use was associated with MetS. Psychiatric comorbidity was associated with MetS in premenopausal women. MetS status was not explained by disease activity or core RA measures.

Conclusion

The characteristics and associations of MetS differed in men and women with ERA. Sex differences, including postmenopausal status, should be considered in comorbidity screening. With this knowledge, the interplay of MetS, sex, and RA therapeutic response on cardiovascular outcomes should be investigated.

Performance of predictive tools to identify individuals at risk of non-traumatic fracture: a systematic review, meta-analysis, and meta-regression

There is no consensus on which tool is the most accurate to assess fracture risk. The results of this systematic review suggest that QFracture, Fracture Risk Assessment Tool (FRAX) with BMD, and Garvan with BMD are the tools with the best discriminative ability. More studies assessing the comparative performance of current tools are needed.

INTRODUCTION

Many tools exist to assess fracture risk. This review aims to determine which tools have the best predictive accuracy to identify individuals at high risk of non-traumatic fracture.

METHODS

Studies assessing the accuracy of tools for prediction of fracture were searched in MEDLINE, EMBASE, Evidence-Based Medicine Reviews, and Global Health. Studies were eligible if discrimination was assessed in a population independent of the derivation cohort. Meta-analyses and meta-regressions were performed on areas under the ROC curve (AUCs). Gender, mean age, age range, and study quality were used as adjustment variables.

RESULTS

We identified 53 validation studies assessing the discriminative ability of 14 tools. Given the small number of studies on some tools, only FRAX, Garvan, and QFracture were compared using meta-regression models. In the unadjusted analyses, QFracture had the best discriminative ability to predict hip fracture (AUC = 0.88). In the adjusted analysis, FRAX with BMD (AUC = 0.81) and Garvan with BMD (AUC = 0.79) had the highest AUCs. For prediction of major osteoporotic fracture, QFracture had the best discriminative ability (AUC = 0.77). For prediction of osteoporotic or any fracture, FRAX with BMD and Garvan with BMD had higher discriminative ability than their versions without BMD (FRAX: AUC = 0.72 vs 0.69, Garvan: AUC = 0.72 vs 0.65). A significant amount of heterogeneity was present in the analyses.

CONCLUSIONS

QFracture, FRAX with BMD, and Garvan with BMD have the highest discriminative performance for predicting fracture. Additional studies in which the performance of current tools is assessed in the same individuals may be performed to confirm this conclusion.

The current economic burden of illness of osteoporosis in Canada

We estimate the current burden of illness of osteoporosis in Canada is double ($4.6 billion) our previous estimates ($2.3 billion) due to improved data capture of the multiple encounters and services that accompany a fracture: emergency room, admissions to acute and step-down non-acute institutions, rehabilitation, home-assisted or long-term residency support.

INTRODUCTION

We previously estimated the economic burden of illness of osteoporosis-attributable fractures in Canada for the year 2008 to be $2.3 billion in the base case and as much as $3.9 billion. The aim of this study is to update the estimate of the economic burden of illness for osteoporosis-attributable fractures for Canada based on newly available home care and long-term care (LTC) data.

METHODS

Multiple national databases were used for the fiscal-year ending March 31, 2011 (FY 2010/2011) for acute institutional care, emergency visits, day surgery, secondary admissions for rehabilitation, and complex continuing care, as well as national dispensing data for osteoporosis medications. Gaps in national data were supplemented by provincial and community survey data. Osteoporosis-attributable fractures for Canadians age 50+ were identified by ICD-10-CA codes. Costs were expressed in 2014 dollars.

RESULTS

In FY 2010/2011, the number of osteoporosis-attributable fractures was 131,443 resulting in 64,884 acute care admissions and 983,074 acute hospital days. Acute care costs were $1.5 billion, an 18 % increase since 2008. The cost of LTC was 33.4 times the previous estimate ($31 million versus $1.03 billion) because of improved data capture. The cost for rehabilitation and secondary admissions increased 3.4 fold, while drug costs decreased 19 %. The overall cost of osteoporosis was over $4.6 billion, an increase of 83 % from the 2008 estimate.

CONCLUSION

Since the 2008 estimate, new Canadian data on home care and LTC are available which provided a better estimate of the burden of osteoporosis in Canada. This suggests that our previous estimates were seriously underestimated.

Denosumab compared to other treatments to prevent or treat osteoporosis in individuals at risk of fracture: a systematic review and meta-analysis

The aim of this review is to compare the efficacy and safety of denosumab over other treatments for osteoporosis. The results of this study suggest that the safety of denosumab and its efficacy in reducing fractures is not significantly different from bisphosphonates. Denosumab was, however, more effective in increasing bone mineral density.

INTRODUCTION

This study was conducted to compare the efficacy and safety of denosumab over other pharmacological treatments for osteoporosis in individuals at risk of fracture.

METHODS

Randomised controlled trials comparing denosumab with another pharmacological treatment for osteoporosis were searched in MEDLINE, EMBASE and CENTRAL. Identified articles were screened by two independent reviewers and assessed for inclusion. Data from included studies were extracted and meta-analyses were conducted using random effects models.

RESULTS

Nine studies including a total of 4890 postmenopausal women were identified. The follow-up period varied from 12 to 24 months. In all studies except one, the comparator treatment was a bisphosphonate. There was no statistically significant difference between patients receiving denosumab and those receiving a bisphosphonate in terms of fracture risk (RR[95 % CI] = 1.15 [0.84-1.58]), adverse events (RR[95 % CI] = 0.99 [0.96-1.02]) or deaths (OR[95 % CI] = 0.58 [0.12-2.71]). Withdrawals due to adverse events were less frequent in denosumab than in other treatment groups but the difference did not reach statistical significance (OR[95 % CI] = 0.68 [0.45-1.04]). The percent change in bone mineral density at the total hip, lumbar spine, femoral neck and one-third radius was significantly higher in participants who received denosumab (e.g. mean difference [95 % CI] at the total hip: 1.06 [0.86-1.25]).

CONCLUSIONS

These results suggest that, after 12 to 24 months, the safety and efficacy of denosumab for reducing fracture risk is not significantly different from bisphosphonates despite higher gains in bone mineral density. In a clinical setting, denosumab may demonstrate greater effectiveness.