The ASAS Health Index and Environmental Factors Item Set: validity and reliability of the Swedish translations in Swedish patients with ankylosing spondylitis

OBJECTIVES

To translate the Assessment of SpondyloArthritis international Society (ASAS) Health Index (HI) Environmental Factors Item Set (EFIS) into Swedish and culturally adapt it for a Swedish context, and to assess the construct validity of the Swedish version of the ASAS HI and test-retest reliability in ASAS HI and EFIS in Swedish patients with ankylosing spondylitis (AS).

METHOD

Translation and cross-cultural adaptation of the EFIS were carried out according to a forward-backward procedure consisting of five steps. The construct validity of the ASAS HI was tested using Spearman correlation with standard health outcomes for axial spondyloarthritis (axSpA). Reliability was analysed by internal consistency with the Cronbach's alpha coefficient for ASAS HI, and test-retest reliability with intraclass correlation coefficients (ICCs) for ASAS HI and kappa agreement for the individual items of EFIS.

RESULTS

The translation of EFIS showed acceptable face and content validity. ASAS HI showed an acceptable internal consistency (Cronbach's alpha 0.79), and excellent test-retest reliability (ICC 0.87). Test-retest reliability for EFIS showed varied results, with kappa agreement for the individual items ranging from poor (-0.027) to good (0.80).

CONCLUSIONS

The Swedish version of ASAS HI proved to be valid and reliable and is recommended for assessing the impact of AS on global functioning and health. A Swedish version of EFIS has been produced and uploaded on the ASAS website. The EFIS proved to have acceptable face and content validity, and may contribute to the contextual interpretation of the ASAS HI.

[Effect of multimodal rheumatologic complex treatment in patients with axial spondylarthritis : A systematic evaluation with standardized outcome parameters, such as the ASAS Health Index]

BACKGROUND

Multimodal rheumatologic complex treatment (MRCT) is based on an acute inpatient treatment concept for patients with clinically relevant functional impairments and exacerbation of pain, which are caused by rheumatic and musculoskeletal diseases. Patients with axial spondylarthritis (axSpA) including ankylosing spondylarthritis (AS) often suffer from such health problems. Regular movement exercises and physical therapy measures are an important pillar of treatment management. The ASAS Health Index (ASAS-HI) can be used to document the global functional ability and health of axSpA patients. The selectivity of the ASAS HI for nonpharmacological treatment changes has so far not yet been proven.

OBJECTIVE

Evaluation of the MRCT and ASAS HI for nonpharmacological treatment measures of patients with axSpA carried out in the Ruhr Area Rheumatism Center. The primary endpoint was an improvement of the ASDAS≥ 1.1. It was assumed that > 25% of the patients would achieve this threshold.

METHODS

Consecutively included patients with active axSpA and relevant functional impairments received inpatient treatment for 14 days during MRCT. On days 1 (V1) and 14 (V2) all patients completed questionnaires on pain (NRS), disease activity (BASDAI, ASDAS) and function (BASFI, ASAS HI). The clinical examination was carried out using BASMI and measurement of C‑reactive protein (CRP) at both times.

RESULTS

The 66 prospectively included patients had an average age of 47.2 years (SD 14.2 years), a duration of symptoms of ca. 20 years, 65.3% were male, 75% were positive for HLA B27 and CRP was elevated in 41.3%. The disease activity at V1 was elevated: BASDAI 5.6 (1.8), ASDAS 3.1 (0.9), whereas functional ability and mobility were reduced: BASFI 3.5 (1.8), BASMI 5.6 (2.1), ASAS-HI 8.4 (3.4). During the course the global patient verdict improved (NRS 0-10) from 6.9 (1.7) at V1 to 4.8 (1.8) at V2 and the pain from 6.9 (1.9) to 4.7 (2.0) (all p < 0.001). The disease activity also decreased at V2: BASDAI 4.1 (1.9), ASDAS 2.4 (1.0), function and mobility were also improved: BASFI 4.3 (2.4), BASMI 2.7 (1.6), ASAS HI 6.5 (3.8) (all p < 0.001).

CONCLUSION

In this study the effectiveness of a 2‑week MRCT according to OPS 8-983.1 with respect to important patient-centered outcomes (PCO) could be proven and the results of previous studies could be confirmed. In this context ASAS-HI was also sensitive to change.

[Nonpharmacological treatment measures, rehabilitation services and membership in patient support groups in axial spondylarthritis (The ATTENTUS axSpA study)]

BACKGROUND

The treatment of axial spondylarthritis (axSpA) includes pharmacological treatment measures (PTM) and nonpharmacological treatment measures (NPTM) as well as supporting resources, such as rehabilitation services (RS) and membership in patient support groups (PSG). Nevertheless, there are significant participation restrictions in patients with axSpA in Germany.

OBJECTIVE

Investigation of functional deficits, participation restrictions and utilization of PTM, NPTM, RS and PSG membership in patients with axSpA.

MATERIAL AND METHODS

Multicentric, observational study of 770 axSpA patients in Germany (ATTENTUS-axSpA).

RESULTS

Substantial functional deficits and participation restrictions were observed in axSpA patients. Of the patients 39% did not receive treatment with biological disease-modifying antirheumatic drugs (bDMARD). In the NPTM 54% received physiotherapy less than once per week and 29% once per week. Physical activities were regularly performed by 86% of patients, mainly in the form of home exercises. Training in a gym (14%) or sports club (7%) was carried out much less frequently. Of the patients 54% received RS, one third had the last rehabilitation more than 5 years ago and 13% of the patients were members in a PSG. A significantly higher utilization of NPTM and rehabilitation was found in this group.

CONCLUSION

Treatment options and resources were often utilized to a small extent and/or in low intensity by axSpA patients, which could be a possible explanation for persisting restrictions of participation. Membership in a PSG was associated with an increased utilization of NPTM and RS.

[Frequency and severity of sarcopenia in patients with inflammatory and noninflammatory musculoskeletal diseases : Results of a monocentric study in a tertiary care center]

INTRODUCTION

Sarcopenia (SP) is defined as the pathological loss of muscle mass and function. This is a clinically relevant problem, especially in geriatric patients, because SP is associated with falls, frailty, loss of function, and increased mortality. People with inflammatory and degenerative rheumatic musculoskeletal disorders (RMD) are also at risk for developing SP; however, there is little research on the prevalence of this health disorder in this patient group using currently available SP criteria.

OBJECTIVE

To investigate the prevalence and severity of SP in patients with RMD.

METHODS

A total of 141 consecutive patients over 65 years of age with rheumatoid arthritis (RA), spondylarthritis (SpA), vasculitis, and noninflammatory musculoskeletal diseases were recruited in a cross-sectional study at a tertiary care center. The European Working Group on Sarcopenia in Older People (EWGSOP 1 and 2) definitions of presarcopenia, SP, and severe SP were used to determine the prevalence. Lean mass as a parameter of muscle mass and bone density were measured by dual X‑ray absorptiometry (DXA). Handgrip strength and the short physical performance battery (SPPB) were performed in a standardized manner. Furthermore, the frequency of falls and the presence of frailty were determined. Student's T-test and the χ2-test were used for statistics.

RESULTS

Of the patients included 73% were female, the mean age was 73 years and 80% had an inflammatory RMD. According to EWGSOP 2, 58.9% of participants probable had SP due to low muscle function. When muscle mass was added for confirmation, the prevalence of SP was 10.6%, 5.6% of whom had severe SP. The prevalence was numerically but not statistically different between inflammatory (11.5%) and noninflammatory RMD (7.1%). The prevalence of SP was highest in patients with RA (9.5%) and vasculitis (24%), and lowest in SpA (4%). Both osteoporosis (40% vs. 18.5%) and falls (15% vs. 8.6%) occurred more frequently in patients with SP than those without SP.

DISCUSSION

This study showed a relatively high prevalence of SP, especially in patients with RA and vasculitis. In patients at risk, measures to detect SP should routinely be performed in a standardized manner in the clinical practice. The high frequency of muscle function deficits in this study population supports the importance of measuring muscle mass in addition to bone density with DXA to confirm SP.

Treatment overview of axial spondyloarthritis in 2023

The treatment of patients with axial spondyloarthritis (axSpA) is characterized by non-pharmacological and pharmacological treatment options. It may depend on the type and extent of musculoskeletal and extramusculoskeletal manifestations. Recent data on non-pharmacological treatment options, such as physical activity, physiotherapy, and modification of lifestyle factors, are summarized in this review. Moreover, we have provided an overview on non-steroidal anti-inflammatory drugs and the ever-expanding number of biological and targeted synthetic disease-modifying antirheumatic drugs (bDMARDs and tsDMARDs, respectively). In addition to data on efficacy and safety, the review also encompasses data on switching/cycling, tapering, and treatment selection for specific patient subgroups to optimize treatment outcomes.

[Lay version of the 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis : Translation into German and linguistic validation in German-speaking countries with people affected]

BACKGROUND

Physical activity and exercise are beneficial for people with rheumatic diseases; however, recommendations for the management of rheumatoid arthritis (RA), spondyloarthritis (SpA) and hip- and knee osteoarthritis (HOA/KOA) are usually unspecific with respect to mode and dose of exercise. This is why the 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis were formulated. The recommendations consist of 4 overarching principles and 10 recommendations. These were also published as a lay version in the English language.

AIM

Translation of the lay version into German and its linguistic validation in Austria, Germany and Switzerland.

METHODS

A professional translation was reviewed by the authors, including people with, RA, SpA, HOA/KOA from the three German-speaking countries, which provided a prefinal lay version. Subsequently, eight interviews with people with RA, SpA, HOA/KOA were conducted in each country to evaluate understandability, wording, completeness and feasibility of the prefinal lay version. Finally, the authors, i.e. those with RA, SpA, and osteoarthritis, anonymously rated their agreement to the final lay version on a 0-10 scale.

RESULTS

The professional translation was substantially revised by the authors and based on the interviews. Formulations were adapted to increase readability and understandability and specify statements. Comments that would have changed content or structure were not considered. Average agreement with the particular recommendations was between 10 (SD 0) and 7.6 (SD 1.67).

DISCUSSION

For people with RA/SpA/HOA/KOA the EULAR physical activity recommendations should be available in their mother language. The final German lay version is valid and accepted across all three German-speaking countries. Thus, the physical activity recommendations can be provided to people with rheumatic diseases in an understandable and feasible way.

[Development of quality standards for patients with rheumatoid arthritis for use in Germany]

Despite a qualitatively and structurally good care of patients with rheumatoid arthritis (RA) in Germany, there are still potentially amendable deficits in the quality of care. For this reason, the German Society for Rheumatology (DGRh) has therefore decided to ask a group of experts including various stakeholders to develop quality standards (QS) for the care of patients with RA in order to improve the quality of care. The QS are used to determine and quantitatively measure the quality of care, subject to relevance and feasibility. The recently published NICE and ASAS standards and a systematic literature search were used as the basis for development. A total of 8 QS, now published for the first time, were approved with the intention to measure and further optimize the quality of care for patients with RA in Germany.

AB0785 Role of Patient Organizations in Implementation of Recommended Non-pharmacological Treatment Modalities in Spondyloarthritis: Evidence for the Effectiveness of Self-management Strategies

Background

EULAR recommends participation in patient (pt) organizations to improve pt self-management of axial spondyloarthritis (axSpA)1. Non-pharmacological treatment modalities (NPTM)2 are recommended in axSpA treatment guidelines.3

Objectives

To characterize the impact of pt advocacy group membership and its association with NPTM frequency and clinical parameters in axSpA.

Methods

Pts with a confirmed axSpA diagnosis were enrolled in the multicenter, observational ATTENTUS-axSpA survey conducted across Germany (11/2019–07/2020). Demographics, clinical and pt-related data were collected electronically.

Results

Of the 787 enrolled axSpA pts, this analysis was conducted on the working population (n=695)4. Overall, 12.2% (n=85) pts were members of a pt advocacy group and 87.8% (n=610) were not. Pt advocacy group members had higher Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores, increased functional impairment (BASFI, Bath Ankylosing Spondylitis Functional Index) and higher impact of axSpA on health (ASAS-HI, Assessment of SpondyloArthritis International Society-Health Index; Table 1). Despite worse prognostic factors, there was no significant difference in Work Productivity and Activity Impairment (WPAI) score [40.6 (27.0) for pt advocacy group members vs 36.8 (29.9) for non-members; p=0.380]. Membership in a pt advocacy group was associated with increased prescribed, supervised NPTM (57.6% [n=49] vs 34.4% [n=210]). Pts reported to have ever received 2.6 rehabilitation measures, and ≥3.0 different rehabilitation NPTM measures. Cumulatively, 25.0% (N=654) of rehabilitation measures were physiotherapy (Figure 1).

Table 1.

Descriptive characteristics and impact of membership in pt advocacy group

CharacteristicPatient advocacy group member (n=85)Not patient advocacy group member (n=610)Total (n=695)p-valueAge (yrs), mean (SD)50.2 (7.7)44.6 (11.1)45.3 (10.9)<0.001BMI (kg/m2) mean (SD)27.5 (5.0)28.0 (12.7)28.0 (12.0)0.713Male, n (%)45 (52.9)378 (62.0)423 (60.9)0.128Disease duration (yrs) mean (SD)13.7 (10.3)12.5 (11.1)12.6 (11.0)0.303ASAS-HI, 0-177.3 (3.4)6.4 (3.9)6.5 (3.8)0.045BASDAI, 0-104.3 (1.9)3.8 (2.2)3.9 (2.2)0.044BASDAI ≥4, n (%)49 (57.6)275 (45.1)324 (46.6)0.025BASFI, 0-103.9 (2.3)3.2 (2.5)3.3 (2.4)0.015Biologic treatment, n (%)52 (61.2)312 (51.1)364 (52.4)0.072Full time employment, n (%)48 (56.5)410 (67.2)458 (65.9)0.06Absenteeism*, mean (SD)8.4 (21.2)10.9 (26.8)10.6 (26.2)-Presenteeism*, mean (SD)38.4 (24.6)31.8 (25.7)32.6 (25.6)-Overall work impairment score*, mean (SD)40.6 (27.0)36.8 (29.9)37.2 (29.6)0.380Activity impairment, mean (SD)46.7 (21.7)40.5 (26.8)41.3 (26.4)0.058Pts having ever received medicinal rehabilitation measures, mean (SD)67 (78.8)328 (53.8)395 (56.8)<0.001Prescribed supervised group NPTM#, mean (SD)49 (57.6)210 (34.4)259 (37.3)<0.001Regular physical training†, mean (SD)76 (89.4)515 (84.4)591 (85.0)0.231

*Work-related questions of WPAI-score have been calculated for pts in employment (N=340); †regular physical training in the context of axSpA; #rehabilitation sport and/or functional training. ASAS-HI, Assessment of SpondyloArthritis International Society-Health Index; BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; BASFI, Bath Ankylosing Spondylitis Functional Index; BMI, Body Mass Index; n, number of pts; pts, patients; SD, Standard Deviation; WPAI, Work Productivity and Activity Impairment; yrs, years.

Conclusion

Pt advocacy group membership was associated with increased prescribed NPTM in axSpA. Pt organizations may support the implementation of guidelines and improvement of self-management strategies in pts with axSpA, which may influence work participation.

References

[1]Nikiphorou E, et al. Ann Rheum Dis 2021;0:1–8

[2]Rausch Osthoff A-K, et al. Ann Rheum Dis 2018;77:1251–1260

[3]van der Heijde D, et al. Ann Rheum Dis 2017;76:978–991

[4]Kiltz et al. 2021. EULAR eposter; POS0983

Disclosure of Interests

Dirk Meyer-Olson Speakers bureau: Speakers bureau: Abbvie, Amgen,Berlin Chemie, Bristol Myers Squibb, Cellgene, Chugai, Fresenius Kabi, GSK, Jansen Cilag, Lilly, Medac, Merck Sharp & Dome, Mylan, Novartis, Pfizer, Sandoz Hexal, Sanofi and UCB, Consultant of:Abbvie, Amgen, Berlin Chemie, Bristol Myers Squibb, Cellgene, Chugai, Fresenius Kabi, GSK, Jansen Cilag, Lilly, Medac, Merck Sharp & Dome, Mylan, Novartis, Pfizer, Sandoz Hexal, Sanofi and UCB, Kirsten Hoeper Speakers bureau: Speakers bureau: Abbvie, Chugai, Gilead, Lilly, Novartis, Sandoz Hexal and Sanofi., Consultant of: Abbvie, Chugai, Gilead, Lilly, Novartis, Sandoz Hexal and Sanofi., Ludwig Hammel: None declared, Sebastian Lieb Employee of: Employee of Novartis, Andreas Haehle Employee of: Employee of Novartis, Uta Kiltz Speakers bureau: Speakers bureau: AbbVie, Biocad, Chugai, Eli Lilly, Grünenthal, Janssen, MSD, Novartis, Pfizer, Roche and UCB, Consultant of: AbbVie, Biocad, Chugai, Eli Lilly, Grünenthal, Janssen, MSD, Novartis, Pfizer, Roche and UCB, Grant/research support from: Abbvie, Amgen, Biogen, Fresenius, GSK, Novartis and Pfizer

AB1190 SOURCES OF INFORMATION ABOUT SARS-CoV-2 USED BY PATIENTS WITH CHRONIC INFLAMMATORY RHEUMATIC DISEASES (CIRD)

Background

Patients with chronic inflammatory rheumatic diseases (CIRD) may be at increased risk of Corona Virus Disease 2019 (COVID-19).1 The quality of information obtained plays a crucial role for patients’ decision to be vaccinated. Knowing patients’ needs for information and which sources are used is important for the management of CIRD patients by rheumatologists and other physicians.

Objectives

To identify main sources of information on SARS-CoV-2 used by patients with CIRD and to analyze their influence on opinions and willingness to be vaccinated.

Methods

CIRD patients presenting to our tertiary rheumatology hospital were, after informed consent, consecutively included in the study once the vaccination campaign in Germany had started, to fill out a questionnaire. Next to sociodemographic and disease-specific data, vaccination willingness and knowledge regarding SARS-CoV-2 were assessed. Furthermore, patients’ sources of information and their concerns about accuracy of information were evaluated. A numerical rating scale (NRS) ranging from 0 (completely disagree) to 10 (completely agree) was used. Values between ≥7 were taken as positive answer. Nonparametric tests and multivariate linear regression analyses were performed.

Results

In early 2021, a total of 514 patients were interviewed (Table 1). The majority (63.9 %) reported to be well-informed (NRS ≥7), whereas 18% had doubts regarding information on SARS-CoV-2. The most often used source of information was television, and only 8.6% reported to have been informed by a rheumatologist (Figure 1). About 20% of patients were no longer interested in receiving any information on SARS-CoV-2 through media. Information from rheumatologists, general practitioners, public health authorities or health related web sites did not reach 30.5% of patients. Of interest, 16% of subjectively well-informed patients were hesitant towards vaccination. As many as 43.6% of patients with doubts regarding information about SARS-CoV-2 indicated that they were not willing to be vaccinated. No source of information showed a strong correlation with SARS-CoV-2 vaccination willingness or with knowledge on SARS-CoV-2. Weak positive correlations were found between age and education level on the one hand and information sources about SARS-CoV-2 on the other hand. A weak negative correlation was found between doubts about information and health authorities, whereas positive correlations were found with social networks, friends and family.

Table 1.

Sociodemographic and disease characteristics

Age (years)54.7 ± 12.8Women, No.* (%)315 (61.3%)Educational level, No.* (%) < 8 years50 (10.4 %) 8-12 years275 (57.4 %) >12 years154 (32.2 %)Occupation, No.* (%) Full time198 (38.5 %) Pensioner157 (30.5 %) Part-time80 (15.6 %) Housewife/husband37 (7.2 %) Occupational incapacity29 (5.6 %) In training7 (1.4 %) Healthcare5 (1 %)CIRD, No.* (%)Rheumatoid arthritis192 (37.3 %)Axial spondyloarthritis134 (26.1 %)Connective tissue disease and vasculitis106 (22.6 %)Psoriatic arthritis72 (14.0 %)Disease duration, mean (years)Therapy, No.* (%)9.8 ± 8.9 bDMARD316(61.5 %) csDMARD147(28.6 %) tsDMARD33 (6.4 %) no DMARDs18 (3.5 %)

*Number of patients

Figure 1.

Sources of information of CIRD patients about SARS-CoV-2

Conclusion

Most CIRD patients think that they are well-informed about SARS-CoV-2. However, their information rarely comes from expert-based sources and rarely from rheumatologists. Thus, there is an unmet need for CIRD patients to receive appropriate and comprehensive information about SARS-CoV-2, its influence on rheumatic diseases, and about vaccination of patients with CIRD.

References

[1]Strangfeld A et al. Ann Rheum Dis 2021

Disclosure of Interests

None declared

POS0684 IS UPADACITINIB CAPABLE OF IMPROVING PATIENT-REPORTED OUTCOMES OF RHEUMATOID ARTHRITIS IN A REAL-WORLD SETTING? RESULTS FROM THE POST-MARKETING OBSERVATIONAL UPwArds STUDY

Background

The efficacy of Upadacitinib (UPA), a selective Janus kinase inhibitor, has been evaluated in the SELECT clinical program 1-6. In addition, recent results from the non-interventional UPwArds study further confirmed UPAs clinical effectiveness regarding standard disease activity scores for rheumatoid arthritis (RA) in a real-world setting 7. However, patient-reported outcomes (PROs) as another cornerstone of clinical decision making yet remain to be addressed in the context of a post-marketing setting. This interim analysis, conducted after 250 patients had completed the 6-month follow-up visit, aims to fill this gap.

Objectives

To evaluate the change of selected PROs over 6 months in patients treated with UPA in a real-world data environment.

Methods

UPwArds is a prospective, open-label, multicenter, non-interventional, post-marketing study including adult patients with moderate-to-severe RA (swollen joint count [SJC28] ≥ 3 and inadequate response or intolerance to at least one previous disease-modifying antirheumatic drug). According to the German label, patients were treated with UPA 15 mg once daily, as monotherapy or in combination with methotrexate. For this analysis, the following PROs were included: 0-10 numerical rating scales (NRS) for pain and fatigue, the Health Assessment Questionnaire Disability Index (HAQ-DI), the duration and severity of morning stiffness, the Patient Health Questionnaire 9 (PHQ-9), and the Rheumatoid Arthritis Impact of Disease Questionnaire (RAID). Changes from baseline were evaluated for follow-up periods of 1 month, 3 months, and 6 months. Results are presented for the total sample using descriptive measures reflecting sample size (N), average values (standard deviation) for each assessment and average change scores (standard deviation) for follow-up visits. All data were analyzed as observed, with no imputation of missing data.

Results

483 patients (369 female, 114 male) were included in the study, with available baseline PRO information for 481 patients. 6-months follow-up data were yet available from 279 patients The baseline average age and disease duration were 58.0 (12.3) years and 9.0 (8.0) years, respectively, whereas the mean initial DAS28-CRP was 4.6 (1.0). At baseline, 60.8% of enrolled patients had previously been treated with biologic or targeted synthetic disease-modifying antirheumatic drugs. Overall, PRO scores improved from baseline throughout month 6 with a considerable amelioration at month 3, which was maintained at month 6. Responses were rapid, with improvement already evident at month 1 (Table 1). The NRS pain as a crucial PRO in RA confirmed the previously described pattern of results seen for most of the other PROs (Figure 1).

Table 1.

Baseline scores and average changes from baseline scores

NBaseline scores (SD)NChange from baseline - month 1 (SD)NChange from baseline - month 3 (SD)NChange from baseline - month 6(SD)Pain (NRS)4816.2 (2.2)393-2.2 (2.3)392-2.5 (2.5)258-2.4 (2.4)Fatigue (NRS)4815.5 (2.6)393-1.4 (2.3)393-1.6 (2.4)259-1.5 (2.3)HAQ-DI4711.3 (0.6)380-0.2 (0.3)376-0.2 (0.4)253-0.2 (0.4)Morning stiffness (duration, minutes)43968.9 (63.9)313-25.0 (55.3)296-29.6 (54.9)179-31.6 (51.7)Morning stiffness (severity)4785.2 (2.7)386-1.8 (2.3)393-2.2 (2.6)258-2.2 (2.9)PHQ-94778.7 (5.2)383-1.9 (3.9)381-2.3 (4.0)255-2.2 (3.8)RAID4815.6 (2.0)393-1.7 (1.8)392-2.0 (2.0)258-1.9 (1.9)

Conclusion

This interim analysis confirmed a meaningful improvement regarding included PROs that cover various RA-related symptoms, depressiveness and the impact of symptoms of RA on daily life.

References

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

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

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

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

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

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

[7]Witte T et al. P0833 at ACR, Nov 5–9, 2021

Acknowledgements

AbbVie funded this study; contributed to its design; participated in data collection, analysis, and interpretation of the data; and 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. The medical writing support was provided by Matthias Englbrecht, Freelance Healthcare Data Scientist (Eckental, Germany) and was funded by AbbVie. Statistical analyses were provided by Dr. Daniela Adolf of StatConsult GmbH (Magdeburg, Germany) which was funded by AbbVie.

Disclosure of Interests

Torsten Witte Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Chugai, Gilead, Janssen, Lilly, MSD, Mylan, Novartis, Pfizer, Roche, and UCB, Uta Kiltz Consultant of: AbbVie, Biocad, Eli Lilly and Company, Grünenthal, Hexal, Janssen, MSD, Novartis, Pfizer, Roche, and UCB, Grant/research support from: AbbVie, Amgen, Biogen, Fresenius, GSK, Hexal, Novartis, and Pfizer, Florian Haas Consultant of: AbbVie, Celgene, Novartis, and Pfizer, Grant/research support from: AbbVie, BMS, Celgene, Chugai, MSD, Novartis, Pfizer, Roche, and Sanofi Genzyme, Elke Riechers Consultant of: AbbVie, Chugai, Novartis, and UCB, Grant/research support from: AbbVie, Chugai, Lilly, Janssen, Novartis, Pfizer, Roche, and UCB, Ulrich Prothmann Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Chugai, Glaxo Smith Kline, Novartis, Pfizer, Roche, Sanofi, SOBI, and UCB, Daniela Adolf Shareholder of: Employee of StatConsult and may own stock or options, Employee of: Employee of StatConsult, Carsten Holland Shareholder of: Employee of AbbVie and may own stock or options, Employee of: Employee of AbbVie, Alexander Roessler Shareholder of: Employee of AbbVie and may own stock or options, Employee of: Employee of AbbVie, Kirsten Famulla Shareholder of: Employee of AbbVie and may own stock or options, Employee of: Employee of AbbVie, Konrad Götz Shareholder of: Employee of AbbVie and may own stock or options, Employee of: Employee of AbbVie, Klaus Krueger Grant/research support from: AbbVie, Biogen, BMS, Celltrion, Gilead, Hexal, Janssen, Lilly, Medac, MSD, Novartis, Pfizer, Roche, and UCB

POS0976 IMPACT OF PATIENT AND DISEASE CHARACTERISTICS ON GLOBAL FUNCTIONING AND HEALTH IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS: A BAYESIAN NETWORK ANALYSIS OF DATA FROM AN EARLY axSpA COHORT

Background

Current knowledge on the health status of patients (pts.) with axial spondyloarthritis (axSpA) mainly focusses on physical function and disease activity. Using a generic measure for physical- or mental health (SF36), a hierarchical relationship between disease activity, spinal damage, spinal mobility, physical function and overall health has been demonstrated in pts. with radiographic axSpA (r-axSpA) 1. Disease-specific global functioning and health can be assessed in pts. with axSpA using the ASAS Health Index (ASAS HI), which encompasses physical function, as well as aspects of emotional and social functioning and aspects of activity and participation.

Objectives

To build a structural model that visualizes interrelationships of different patient- and disease characteristics with global functioning and health in pts. with early axSpA.

Methods

Data of pts. with axSpA from the DESIR cohort was analyzed, which included information on socio-demographics (age, BMI), disease activity (ASDAS), physical function (BASFI), spinal mobility (BASMI), structural damage (mSASSS), disease-specific global functioning (ASAS HI), and comorbidity count. Information on patient- and disease characteristics was retrieved from the visit performed 72 months after inclusion, which was the first time point of ASAS HI collection. A Bayesian network (BN) was used to obtain insight of the underlying structural model. BNs are probabilistic graphical models consisting of “nodes” (representing specific variables) joined by “edges” (lines representing directions of effects). They are capable of capturing complex relationships between variables and allow the incorporation of existing (prior) knowledge from previous studies.

Results

The DESIR cohort contained data from 582 pts. at month 72, of whom 398 had data for ASAS HI. Descriptive information of these pts. is shown in Table 1. The mean ASAS HI was 5.7 (range: 0 - 16). Applying existing cut-offs for ASAS HI, 51% had ‘good’ global functioning (ASAS HI ≥5), 40% had ‘moderate’ global functioning (5< ASAS HI <12) and 9% had ‘bad’ global functioning (ASAS HI ≥12). The structural model that was constructed from combining data and prior expert knowledge is visualized in Figure 1. It suggests that ASDAS and BASFI have a direct impact on ASAS HI and that ASDAS has an indirect impact via BASFI. The model also suggests that ASDAS has an impact on the number of co-morbidities via BMI and that BASFI determines BASMI, which is in turn also influenced by age and mSASSS. In addition, it suggests a direct effect of age, BMI and ASAS HI on the comorbidity count. The model denies a relationship between BASMI or mSASSS and ASAS HI.

Table 1.

Patient and disease characteristics at month 72

N = 398Gender (male), N (%)181 (45%)Age (years)40.7 (8.7)Symptom duration (years)7.5 (0.9)BMI (kg/m2)25.0 (4.6)ASDAS2.0 (1.0)BASFI (0–10)2.3 (2.1)BASMI (0–10)2.5 (1.0)mSASSS (0-72)1.0 (3.6)ASAS HI (0-17)5.7 (3.9)good global functioning: ASAS HI ≤5, N (%)201 (51%)moderate global functioning: 5< ASAS HI <12, N (%)160 (40%)bad global functioning: ASAS HI ≥12, N (%)37 (9%)Comorbidity count1.4 (0.7)Figure 1.

Structural model on interrelationships of different patient- and disease characteristics with global functioning and health (ASAS HI) in patients with early axSpA

Conclusion

The BN-analysis approach, that combines prior knowledge and measured data, serves to better understand the construct of global functioning and health in pts. with early axSpA. Our model shows that global functioning (ASAS-HI) is determined both by patient-reported physical function (BASFI) and by disease activity (ASDAS), which confirms the hierarchical model once proposed by Machado et al. The observed directional relationship between ASAS HI and comorbidity count is counterintuitive and requires further investigation.

References

[1]Machado P, ARD 2011.

Disclosure of Interests

Imke Redeker: None declared, Robert B.M. Landewé Speakers bureau: AbbVie, BMS, GSK Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, UCB, Consultant of: AbbVie, BMS, GSK Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, UCB, Désirée van der Heijde Speakers bureau: AbbVie, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Lilly, Novartis, Pfizer, UCB Pharma, Consultant of: AbbVie, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Lilly, Novartis, Pfizer, UCB Pharma, Grant/research support from: AbbVie, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Lilly, Novartis, Pfizer, UCB Pharma, Sofia Ramiro Speakers bureau: Eli Lilly, MSD, Novartis, UCB, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, UCB, Sanofi, Grant/research support from: AbbVie, Galapagos, Novartis, Pfizer, UCB, Annelies Boonen Speakers bureau: Abbvie / Galapagos, Consultant of: Galapagos, Grant/research support from: Abbvie, Maxime Dougados: None declared, Juergen Braun Speakers bureau: Abbvie, Amgen, Biogen, BMS, Boehringer, Celltrion, Chugai, Fresenius, Hexal, Janssen, Lilly, Medac, MSD, Mylan, Mundipharma, Novartis, Pfizer und UCB, Consultant of: Abbvie, Amgen, Biogen, BMS, Boehringer, Celltrion, Chugai, Fresenius, Hexal, Janssen, Lilly, Medac, MSD, Mylan, Mundipharma, Novartis, Pfizer und UCB, Grant/research support from: Abbvie, Amgen, Biogen, BMS, Boehringer, Celltrion, Chugai, Fresenius, Hexal, Janssen, Lilly, Medac, MSD, Mylan, Mundipharma, Novartis, Pfizer und UCB, Uta Kiltz Speakers bureau: AbbVie, Biocad, Biogen, Chugai, Eli Lilly, Hexal, Janssen, MSD, Novartis, Pfizer, Roche, UCB, Consultant of: AbbVie, Biocad, Biogen, Chugai, Eli Lilly, Hexal, Janssen, MSD, Novartis, Pfizer, Roche, UCB, Grant/research support from: AbbVie, Biogen, Fresenius, Amgen, Hexal, Novartis, Pfizer

POS1076 OBESITY IS ASSOCIATED WITH LESS LIKELIHOOD OF REMISSION/ LOW DISEASE IN PSORIATIC ARTHRITIS, A CROSS-SECTIONAL STUDY OF 414 PATIENTS

Background

Obesity is a risk factor for psoriatic arthritis (PsA) and is associated with higher disease activity [1].

Objectives

We aimed to evaluate whether obese patients with PsA were less likely to achieve remission/low disease in a real-life multi-centre cohort.

Methods

We used data from the ReFlap study (NCT03119805)[2], which recruited consecutive adult patient with definite PsA for more than 2 years of disease duration from 14 countries. We collected demographic characteristics, self-reported weight and height, clinical data and patient reported outcomes. Remission/low disease was defined as Disease Activity in PSoriatic Arthritis (DAPSA) ≤ 4, or Minimal disease activity (MDA). Obesity was defined as body mass index (BMI) ≥ 30kg/m2. We compared patient characteristics, disease activity parameters and impact scores between patients with obesity versus non-obese. A multivariable regression model was performed for demographic variables associated with reaching each definition of remission/low disease, adjusted on age, sex, level of education, disease duration, current use of conventional (c-) and biological (b-) disease modifying anti-rheumatic drugs (DMARDs).

Results

Among 414 patients (49.3% women, mean disease duration 11.0 ±8.2 years), 119 (28.7%) had BMI ≥ 30kg/m2 (obese). Obese patients were more likely to be female, had higher swollen joint and enthesitis counts, higher self-reported pain, poorer physical function, more fatigue and poorer mental health (Table 1). Obese patients were half as likely to achieve MDA or DAPSA remission in multivariable analysis with odd ratios of 0.6 (95% confidence interval, CI: 0.3, 0.8, p=0.049) and 0.4 (95% CI: 0.2, 0.8, p=0.012), respectively for obese compared to non-obese patients (Figure 1).

Table 1.

Patient characteristics and remission achievement between obese and non-obese patients with psoriatic arthritis

Non-obese (n=295)BMI ≥30 (n=119)pFemale, %44.361.50.002Number of comorbidities1.61 (0.93)2.83 (2.01)<0.001Tender joints, 0-683.56 (7.81)5.75 (10.0)0.018Swollen joints, 0-662.19 (7.29)1.46 (2.39)0.285Leeds enthesitis index, 0-60.48 (1.23)0.86 (1.70)0.012PGA disease activity, 0-103.90 (2.73)4.76 (2.67)0.004DAPSA14.9 (15.5)18.3 (16.1)0.045HAQ-DI, 0-30.56 (0.65)0.89 (0.70)<0.001PsAID-12, 0-103.11 (2.36)3.96 (2.50)0.001pain, 0-103.80 (2.81)4.54 (2.83)0.017fatigue, 0-103.93 (3.01)4.68 (3.17)0.025work or leisure activities, 0-103.39 (3.01)4.75 (3.11)<0.001functional capacity, 0-103.36 (2.97)4.40 (3.16)0.002depression, 0-101.88 (2.70)2.75 (3.26)0.006

Mean (SD) shown unless specified otherwise. HAQ-DI: Health Assessment Questionnaire – Disability Index; PsA: psoriatic arthritis; PGA: patient global assessment of disease activity; DAPSA: Disease Activity in PSoriatic Arthritis; PsAID: Psoriatic Arthritis Impact of Disease.

Conclusion

In this real-life data from 14 countries, obesity was frequent and PsA patients with BMI ≥ 30kg/m2 were more likely to be female, and had higher subjectively reported disease activity and illness impact compared to those with lower BMI. Obese patients had a two-fold lower likelihood of achieving remission/low disease defined by both MDA and DAPSA compared to non-obese patients. PsA patients with comorbid obesity may have different disease profiles from non-obese patients, and require specific management.

References

[1]Eder, L., et al., Obesity is associated with a lower probability of achieving sustained minimal disease activity state among patients with psoriatic arthritis. Ann Rheum Dis, 2015. 74(5): p. 813-7.

[2]Gorlier, C., et al., Comparing patient-perceived and physician-perceived remission and low disease activity in psoriatic arthritis: an analysis of 410 patients from 14 countries. Ann Rheum Dis, 2019. 78(2): p. 201-208.

Acknowledgements

This study was funded by Pfizer.

Disclosure of Interests

None declared

POS1053 LONG-TERM RETENTION, EFFECTIVENESS AND SAFETY OF SECUKINUMAB IN PATIENTS WITH ACTIVE PSORIATIC ARTHRITIS OR ANKYLOSING SPONDYLITIS: RESULTS FROM THE OBSERVATIONAL SERENA STUDY

Background

SERENA is an ongoing, longitudinal, observational study of more than 2900 patients (pts) with moderate to severe psoriasis, active psoriatic arthritis (PsA), and ankylosing spondylitis (AS) conducted at 438 sites across Europe with an expected duration of up to 5 years.1,2

Objectives

We report long-term results (at least 3 years follow up) on secukinumab (SEC) retention, effectiveness and safety in pts with active PsA or AS from the SERENA study.

Methods

This analysis includes data of 524 PsA and 473 AS pts enrolled in the study and followed up for at least 3 years. Pts (aged ≥18 years) with active PsA or AS were required to have received at least 16 weeks of SEC treatment before enrolment in the study. Retention rate was defined as the percentage of pts who have not discontinued SEC treatment. Effectiveness assessments included swollen and tender joint counts (SJC and TJC) in pts with PsA, and BASDAI score in pts with AS. Safety assessments included the number of pts with any adverse events (AEs) and serious AEs, treatment-emergent AEs, AEs of special interest and their incidence rates.

Results

The mean (SD) treatment duration prior to enrolment in the study for PsA and AS pts was 1.0 (0.5) years and 0.9 (0.5) years, while time since diagnosis was 8.7 (7.4) and 9.8 (9.5) years, respectively. Prior to SEC initiation, 67.4% of pts with PsA and 63.0% of pts with AS received a biologic therapy, with lack of efficacy reported as major reason for discontinuation (PsA: 89.5%; AS: 87.6%). SEC retention rates after at least 3 years since enrolment in the study were 67.3% for pts with PsA and 72.1% for pts with AS. Survival probabilities for individual indications are presented in Figure 1. Over 3 years of observation, SEC showed sustained effectiveness in pts with PsA [SJC, mean (SD): baseline, 3.2 (5.6); Year 3, 1.7 (2.7) and TJC: baseline, 6.4 (9.4); Year 3, 4.9 (6.4)] and AS [BASDAI, mean (SD): baseline, 3.2 (2.3); Year 3, 2.7 (2.2)]. No new or unexpected safety signals were reported; 11.0% of pts with PsA (N=574) and 12.9% of pts with AS (N=505) reported serious AEs (Table 1).

Table 1.

Overall safety profile within the study period (Safety set)

Variable, n (%) unless otherwise specifiedPsA (N=574)AS (N=505)Pts with AE (≥1)327 (57.0)291 (57.6)Pts with SAE (≥1)63 (11.0)65 (12.9)AE leading to death3 (0.5)3 (0.6)AE leading to discontinuation119 (20.7)81 (16.0)Treatment emergent AE leading to discontinuation (in >1% pts in any group)n (%)IRn (%)IRGeneral disorders and administration site conditions74 (12.9)4.9050 (9.9)3.75Skin and subcutaneous tissue disorders13 (2.3)0.863 (0.6)0.22Musculoskeletal and connective tissue disorders26 (4.5)1.729 (1.8)0.67Infections and infestations2 (0.3)0.137 (1.4)0.52Gastrointestinal disorders2 (0.3)0.133 (0.6)0.22Neoplasms benign, malignant and unspecified (incl cysts and polyps)4 (0.7)0.263 (0.6)0.22Injury, poisoning and procedural complications002 (0.4)0.15Treatment emergent AE of special interest (PT)n (%)IRn (%)IRCandida infections2 (0.3)0.134 (0.8)0.30Malignancy8 (1.4)0.535 (1.0)0.37MACE3 (0.5)0.204 (0.8)0.30Injection site reaction002 (0.4)0.15Inflammatory bowel disease1 (0.2)0.072 (0.4)0.15

Safety set consisted of pts who received at least one dose of SEC treatment after signing the informed consent

AE, adverse event; AS, ankylosing spondylitis; IR, incidence rate; MACE, major adverse cardiac events; N, total number of pts; n, number of pts; PsA, psoriatic arthritis; pts, patients; PT, preferred term; SAE, serious adverse event; SEC, secukinumab

Conclusion

After more than 3 years of observation in the SERENA study, SEC showed sustained retention rates, indicating high persistence in a real-world setting. Responses across effectiveness assessments in both PsA and AS cohorts were maintained or improved during the 3 years of follow up in the study. SEC showed a favourable safety profile, consistent with previous reports.

References

[1]Kiltz, U et al. Adv Ther 2020;37:2865–83

[2]Kiltz, U et al. Ann Rheum Dis 2021;80:337–38

Disclosure of Interests

Uta Kiltz Consultant of: AbbVie, Amgen, Biogen, Chugai, Eli Lilly, Gilead, GSK, Grünenthal, Hexal, Janssen, MSD, Novartis, Pfizer, Roche and UCB, Grant/research support from: AbbVie, Amgen, Biogen, Chugai, Eli Lilly, Gilead, GSK, Grünenthal, Hexal, Janssen, MSD, Novartis, Pfizer, Roche and UCB, Petros Sfikakis Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Celgene, Eli-Lilly, Janssen, Novartis and Pfizer, Grant/research support from: AbbVie, Amgen, Boehringer Ingelheim, Celgene, Eli-Lilly, Janssen, Novartis and Pfizer, Nicola Gullick Speakers bureau: AbbVie, Astra Zeneca, Celgene, Eli Lilly, Izana, Janssen, Novartis, UCB, Consultant of: AbbVie, Astra Zeneca, Celgene, Eli Lilly, Izana, Janssen, Novartis, UCB, Grant/research support from: AbbVie, Astra Zeneca, Celgene, Eli Lilly, Izana, Janssen, Novartis, UCB, PELAGIA KATSIMPRI Speakers bureau: AbbVie, UCB, Genesis Pharma, Janssen, Novartis and Pfizer, Consultant of: AbbVie, UCB, Genesis Pharma, Janssen, Novartis and Pfizer, Grant/research support from: AbbVie, UCB, Genesis Pharma, Janssen, Novartis and Pfizer, Anastassios Kotrotsios: None declared, Jan Brandt-Juergens Speakers bureau: AbbVie, Pfizer, Roche, Sanofi-Aventis, Novartis, Lilly, MSD, UCB, BMS, Janssen, and Medac, Consultant of: AbbVie, Pfizer, Roche, Sanofi-Aventis, Novartis, Lilly, MSD, UCB, BMS, Janssen, and Medac, Eric Lespessailles Speakers bureau: Amgen, Expanscience, Lilly and MSD, and research grants from Abbvie, Amgen, Lilly, MSD and UCB, Consultant of: Amgen, Expanscience, Lilly and MSD, and research grants from Abbvie, Amgen, Lilly, MSD and UCB, Nicola Maiden Consultant of: Eli-Lilly and UCB, Karl Gaffney Speakers bureau: AbbVie, Celgene, Lilly, Pfizer, Gilead, MSD, Novartis and UCB, Consultant of: AbbVie, Celgene, Lilly, Pfizer, Gilead, MSD, Novartis and UCB, Grant/research support from: AbbVie, Celgene, Lilly, Pfizer, Gilead, MSD, Novartis and UCB, Daniel Peterlik Employee of: Novartis, Barbara Schulz Employee of: Novartis, Effie Pournara Shareholder of: Novartis, Employee of: Novartis, Piotr Jagiello Employee of: Novartis

AB0752 HOW DOES TIME TO DIAGNOSIS AND GENDER AFFECT TREATMENT OUTCOMES IN PATIENTS WITH ANKYLOSING SPONDYLITIS OR PSORIATIC ARTHRITIS? – REAL WORLD DATA FROM THE GERMAN AQUILA STUDY WITH SECUKINUMAB

Background

In both, ankylosing spondylitis (AS) and psoriatic arthritis (PsA), women typically have a longer delay in diagnosis.1,2 There is scientific evidence that prognosis for AS and PsA improves when diagnosed early. The German non-interventional study AQUILA provides real-world data on the influence of time to diagnosis and gender on treatment outcomes under secukinumab, a fully human monoclonal antibody that selectively inhibits interleukin-17A.

Objectives

The aims of this interim analysis are to describe selected baseline (BL) demographics of AS and PsA patients (pts) and to evaluate the impact of time to diagnosis and gender on secukinumab treatment outcomes, such as disease activity and global functioning and health.

Methods

AQUILA is an ongoing, multi-center, non-interventional study including up to 3000 pts with AS or PsA. Pts were observed from BL up to week (w) 52 according to clinical routine. Real-world data were assessed prospectively and analyzed as observed. Validated questionnaires were used to collect data on disease activity (Bath Ankylosing Spondylitis Disease Activity Index, BASDAI), global functioning and health (Assessment of SpondyloArthritis-Health Index, ASAS-HI) in AS, and skin and joint-related disease activity (Psoriasis Area and Severity Index, PASI; tender/swollen joint counts, TJC/SJC) and impact of disease (Psoriatic Arthritis Impact of Disease - 12 items, PsAID-12 score) in PsA pts. This interim analysis focused on the subgroups of male and female AS and PsA pts stratified by time to diagnosis after disease onset (˂1 year [y] and ≥1y for early and late diagnosis, respectively).

Results

At BL, 609 AS and 1145 PsA pts were included with information on time to diagnosis (Table 1); only 18.7% of AS and 25.8% of PsA pts were diagnosed within one year. Of interest, both female AS and PsA pts as well as male PsA pts with increased BMI tended to be diagnosed later (Table 1). Regarding BASDAI scores, male AS pts diagnosed late had increased disease activity at BL and throughout the study (Figure 1A); female AS pts diagnosed late showed reduced total treatment effect with increasing time to diagnosis (Figure 1B). Similarly, both male and female AS pts diagnosed late had slightly increased ASAS-HI at BL and throughout the study (Table 1). For PsA pts, there was no difference in skin- (PASI, Figure 1C/D) and joint-related (Figure 1E/F) disease activity with respect to time to diagnosis. Furthermore, there was no difference in PsAID scores (data not shown) between early- and late-diagnosed PsA pts.

Table 1.

Overview of selected BL characteristics in AS and PsA pts stratified by time to diagnosis

AS (N=609)Time to diagnosis ˂1 year (n=114)Time to diagnosis ≥1 year (n=495)Male (n=63)Female (n=51)Male (n=301)Female (n=194)Age, years43.146.345.947.7BMI27.725.927.327.8BASDAI4.75.05.35.2ASAS-HI6.78.07.48.2PsA (N=1145)Time to diagnosis ˂1 year (n=295)Time to diagnosis ≥1 year (n=850)Male (n=126)Female (n=169)Male (n=363)Female (n=487)Age, years50.151.852.353.1BMI28.729.429.328.8PASI6.56.27.07.2PsAID4.65.24.85.3TJC/SJC5.9/3.37.3/3.27.0/3.77.3/3.8

All variables given as mean

Figure 1.

Disease activity in early- and late-diagnosed AS and PsA pts

Conclusion

In a real-world setting, secukinumab improved disease activity and global functioning in both AS and PsA pts. Both, male and female AS pts had a higher treatment response when diagnosed early. Interestingly, delay in diagnosis appeared to be BMI-dependent in female AS pts and PsA pts of both genders. However, in contrast to AS, treatment response of early- and late-diagnosed PsA pts did not differ in the further course.

References

[1]Rusman, T., van Bentum, R.E. & van der Horst-Bruinsma, I.E. Rheumatology59, iv38-iv46 (2020). 2. Passia, E., et al. OP0057. Annals of the Rheumatic Diseases79, 38-39 (2020).

Disclosure of Interests

Karolina Benesova Speakers bureau: Abbvie, BMS, Gilead/Galapagos, Janssen, Lilly, Medac, MSD, Novartis, Roche, Viatris, Consultant of: Gilead/Galapagos, Novartis, Grant/research support from: Abbvie, Novartis, Oliver Hansen Grant/research support from: Novartis, Uta Kiltz Consultant of: AbbVie, Amgen, Biogen, Chugai, Eli Lilly, Gilead, GSK, Grünenthal, Hexal, Janssen, MSD, Novartis, Pfizer, Roche, UCB, Grant/research support from: AbbVie, Amgen, Biogen, Chugai, Eli Lilly, Gilead, GSK, Grünenthal, Hexal, Janssen, MSD, Novartis, Pfizer, Roche, UCB, Jan Brandt-Juergens Consultant of: Abbvie, Affibody, BMS, Gilead, Janssen, Lilly, Medac, MSD, Novartis, Pfizer, Roche, Sanofi-Aventis, UCB, Peter Kästner Consultant of: Chugai, Novartis, Elke Riechers Consultant of: AbbVie, Chugai, Novartis, UCB, Grant/research support from: AbbVie, Chugai, Novartis, UCB, Pfizer, Daniel Peterlik Employee of: Novartis, Christina Budden Employee of: Novartis, Annika Boas Employee of: Novartis, Stefanie Welle Employee of: Novartis, Hans-Peter Tony Consultant of: AbbVie, Astra-Zeneca, BMS, Chugai, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, Sanofi

AB0587 THE RISK OF PATIENTS WITH POLYMYALGIA RHEUMATICA AND GIANT CELL ARTERITIS TO DEVELOP DIABETES AND OSTEOPOROSIS ON FOLLOW UP

Background

Patients with polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are commonly treated with glucocorticoids (GC) in different dosages. Therefore, the most common comorbidities that may develop are osteoporosis (OPO) and diabetes mellitus (DM).

Objectives

To study the development of these comorbidities in the management of PMR and GCA in a real-life setting.

Methods

In a retrospective study design, longitudinal data of patients with a clinical diagnosis of PMR and GCA treated in a tertiary center were studied. Patients and disease characteristics were documented according to clinical routine in patients in whom ≥ 2 documented visits ≥ 3 months apart had been documented.

Results

A total of 550 patients (382 PMR, 168 GCA) was analysed (Table 1). The time period of follow up (FU) ranged between 3 months and 13.6 years (mean 1.4 (0.3) years). The majority of patients received a diagnosis of PMR or GCA in our center while 29.5% of patients came for a second opinion. Their mean age was around 70 years, and most patients were female (Table 1). Eight GCA patients were already blind (4.8%) at first presentation, and 77 and 80 patients had a diagnosis of DM (15.5%) and OPO (16.0), respectively, already at baseline. During FU 56 PMR (16.0%) and 7 GCA patients (4.2%) were diagnosed with another autoimmune disease, mainly with rheumatoid arthritis (n=50 (69.4%)). The mean dose of GC differed substantially between groups (Table 1). On FU, 9 (2.4%) and 5 (3.0%) of PMR and GCA patients developed DM and 17 (4.5%) and 14 (8.4%) OPO, respectively. Thus, about 20% and 25% of patients with PMR or GCA finally had DM and OPO, respectively. Almost all patients received vitamin D and antiresorptive agents.

Table 1.

Patients and disease characteristics

PMR patients (n=382)GCA patients (n=168)SignificanceAge (years)68,2 (9.3)71.1 (8,6)0.9BMI (kg/m2)27.0 (4.9)26.0 (5,3)0.44Female sex, n (%)216 (56.6)121 (72,0)<0.001Time to rheumatologist (months)2.1 (9,7)1.4 (5,4)0,33CRP at baseline (mg/dl)3,8 (4,6)4,5 (5,5)0,07Prednisolone at baseline (mg/d)25.1 (20,2)52.0 (69,7)<0.001Comorbidities at baseline-Number of comorbidities (mean)1.45 (1.12)1.51 (1.12)0.26-Diabetes, n (%)61 (16.0)24 (14.3)0.36-Osteoporosis, n (%)64 (16.8)30 (17.9)0.7-Ischemic heart disease, n (%)38 (9.9)19 (11.4)0.46Organ manifestation and comorbidities at FU-Blindness n (%)6 (1.6)8 (4.8)0.048-Aneurysm n (%)1 (0.3)9 (5.4)<0.001-Diabetes, n (%)70 (18.4)29 (17.3)0.89-Osteoporosis, n (%)81 (21.4)44 (26.3)0.003-Vascular stenosis4,610,10,048

values given as mean (SD)

Conclusion

In this large real-life cohort, patients with PMR and GCA aged around 70 years were seen by rheumatologists about 1-2 months after their first symptom but 8 GCA patients were already blind at first visit. DM and OPO were frequent comorbidities in both, PMR and GCA patients, already at baseline and during follow-up more patients developed these comorbidities despite prophylactic and therapeutic medication. OPO and DM should be a routine concern in the care of PMR and GCA patients - already when glucocorticoids are started.

Disclosure of Interests

None declared

AB1400 ARE COMORBIDITIES IN PATIENTS WITH CHRONIC INFLAMMATORY RHEUMATIC DISEASES ASSOCIATED WITH TREATMENT NON-ADHERENCE TO BIOSIMILARS IN A NON-MEDICAL SWITCH SCENARIO?

Background

The availability of biosimilars has created a financial incentive to encourage non-medical switching if cheaper products are on the market. In patients with chronic inflammatory rheumatic diseases (CIRD), we have previously reported a relatively high retention rate after switching from originator etanercept to its biosimilar. However, this has been different in other studies and the reasons for non-adherence are poorly understood. Comorbidity has recently gained much attention in patients with CIRD and might be a reason for non-adherence.

Objectives

The aim of this study was to analyse the effectiveness and safety of systematic non-medical switching from originator adalimumab (ADA) to ADA ABP501 biosimilar (ABP) over 6 months in patients with CIRD and to investigate the influence of comorbidities on retention rates.

Methods

Patients with CIRD on originator ADA who switched to ABP subsequently from October 2018 onwards were identified from a large routine database and then followed for 6 months. The presence of comorbidities and disease characteristics as well as measures of disease activity, physical function and changes in treatment were documented at baseline (the time of switching from originator ADA to ABP), and at months 3 and 6. Longitudinal data including information on the clinical efficacy and safety of ABP, and the reasons for discontinuation were documented.

Results

A total of 111 CIRD patients on treatment with originator ADA were switched to the biosimilar ABP (Table 1). More than half of the patients (62%) had a Charlson comorbidity score of 0, though there were differences between disease subtypes. RA patients were comparatively older (mean age 65 years) and had the highest mean Charlson score (1.8). Treatment retention varied only slightly between patients with a Charlson score of 0 and those with ≥0 (Figure 1). In both groups, the majority of patients (90% vs 95%) continued therapy with ABP, while only a small proportion either switched back to originator ADA (6% vs 5%), switched to a different biologic (3% vs 0%), or dropped out (1% vs 0%). The main reason for back switch was the occurrence of adverse events, mostly subjective complaints, most frequently pain. Patients with a Charlson comorbidity score > 0 tended to have poorer scores in trajectories of scores for disease activity and physical function stratified by disease subtype.

Figure 1.

Treatment retention after 6 months stratified by the Charlson comorbidity score

Table 1.

Patients and disease characteristics

RAaxSpAPsAOtherN=23N=68N=15N=5Age (years), mean (SD)65.1 (12.0)47.3 (13.1)51.1 (11.2)41.8 (14.2)Women60.9% (14)32.4% (22)53.3% (8)40.0% (2)Disease duration (years), median (IQR)4.0 (3.0-8.0)5.0 (2.0-8.0)4.0 (2.0-13.0)7.0 (4.0-7.0)Duration originator ADA therapy (month), mean (SD)43.8 (28.6)39.4 (26.9)34.7 (29.0)60.9 (27.7)Charlson score, mean (SD)1.8 (2.1)0.6 (1.1)0.7 (1.2)0.2 (0.4)Gastroenterological comorbidities26.1% (6)22.1% (15)6.7% (1)0Hepatic comorbidities17.4% (4)2.9% (2)13.3% (2)0Hematological conditions8.7% (2)2.9% (2)13.3% (2)0Cardiovascular comorbidities60.9% (14)32.4% (22)33.3% (5)60.0% (3)Neurological and psychological comorbidities8.7% (2)17.6% (12)33.3% (5)0Metabolic comorbidities21.7% (5)7.4% (5)26.7% (4)40.0% (2)Osteoporosis43.5% (10)11.9% (8)6.7% (1)20.0% (1)Lung diseases21.7% (5)8.8% (6)040.0% (2)Skin diseases26.1% (6)26.5% (18)80.0% (12)20.0% (1)Eye diseases8.7% (2)23.5% (16)6.7% (1)60.0% (3)Kidney diseases13.0% (3)10.3% (7)040.0% (2)

Conclusion

Comorbidity had no influence on the biosimilar retention rate after 6 months in this study but the majority of patients did not have Charlson scores > 0. However, disease activity and physical function tended to be worse among CIRD patients with comorbidity. Cardiovascular disease and osteoporosis were more often present in RA patients than in axSpA or PsA patients, while neurological and psychological comorbidities were more often observed in the latter.

Disclosure of Interests

Imke Redeker: None declared, Stefan Moustakis: None declared, Styliani Tsiami: None declared, Xenofon Baraliakos Speakers bureau: Abbvie, Pfizer, MSD, UCB, Novartis, Lilly, Galapagos, Hexal, Paid instructor for: Abbvie, Pfizer, MSD, UCB, Novartis, Lilly, Galapagos, Hexal, Consultant of: Abbvie, Pfizer, MSD, UCB, Novartis, Lilly, Galapagos, Hexal, Grant/research support from: Abbvie, Pfizer, MSD, UCB, Novartis, Lilly, Galapagos, Hexal, Ioana Andreica Speakers bureau: UCB, MSD, Novartis, Abbvie, Lilly, Janssen, SOBI, Consultant of: Lilly, Novartis, Galapagos, Amgen, Takkeda, SOBI, Grant/research support from: Lilly, Bjoern Buehring Speakers bureau: UCB, Amgen, Gilad/Galapagos, Biogen, Sanofi/Genzyme, Consultant of: UCB, Theramex, Gilead/Galapagos, Amgen, Abbvie, Juergen Braun Speakers bureau: Abbvie, Amgen, Biogen, BMS, Boehringer, Celltrion, Chugai, Fresenius, Hexal, Janssen, Lilly, Medac, MSD, Mylan, Mundipharma, Novartis, Pfizer und UCB, Consultant of: Abbvie, Amgen, Biogen, BMS, Boehringer, Celltrion, Chugai, Fresenius, Hexal, Janssen, Lilly, Medac, MSD, Mylan, Mundipharma, Novartis, Pfizer und UCB, Grant/research support from: Abbvie, Amgen, Biogen, BMS, Boehringer, Celltrion, Chugai, Fresenius, Hexal, Janssen, Lilly, Medac, MSD, Mylan, Mundipharma, Novartis, Pfizer und UCB, Uta Kiltz Speakers bureau: AbbVie, Biocad, Biogen, Chugai, Eli Lilly, Hexal, Janssen, MSD, Novartis, Pfizer, Roche, UCB, Consultant of: AbbVie, Biocad, Biogen, Chugai, Eli Lilly, Fresenius, Hexal, Janssen, MSD, Novartis, Pfizer, Roche, UCB, Grant/research support from: AbbVie, Amgen, Biogen, Fresenius, GSK, Hexal, Novartis, Pfizer.

POS1281 DIFFERENT HUMORAL BUT SIMILAR CELLULAR RESPONSES OF PATIENTS WITH AUTOIMMUNE INFLAMMATORY RHEUMATIC DISEASES UNDER DISEASE-MODIFYING ANTI-RHEUMATIC DRUGS AFTER COVID-19 VACCINATION

Background

The interplay between humoral and cellular response after vaccination against SARS-CoV-2 in patients (pts.) with autoimmune inflammatory rheumatic diseases (AIRD) remains unknown.

Objectives

To investigate the impact of different immunosuppressive therapies on the development of humoral and cellular immune responses to full 2-dose SARS-CoV-2 vaccination in AIRD pts. with stable low disease activity.

Methods

The immune reactivity to COVID-19 vaccination was investigated in a prospectively recruited AIRD cohort with rheumatoid arthritis, axial spondyloarthritis or psoriatic arthritis which received a therapy with IL-17i, TNFi, JAKi or MTX (alone or in combination). Almost all patients received mRNA-based vaccine, only 4 patients had a heterologous scheme. Anti-spike(S) antibodies(ab.) and sera neutralizing capacity (neutralization dilution 50; ND50) were measured 4 weeks after the first (prime+4w) and 4 weeks after the second vaccination (boost+4w). Vaccine-specific cellular immunity was evaluated by quantifying expression of activation markers on T cells as well as their production of key cytokines, at prime+4w and boost+4w.

Results

Overall, a total of 92 pts. were included in the final cohort. 31 (33.7%) pts. were on TNFi, 24 (26.1%) on IL-17i, 24 (26.1%) on JAKi, each group encompassing pts. receiving drug inhibitors alone or in combination with MTX.13 (14.1%) were treated with MTX alone. The median time between the vaccination and blood sampling was 31 [IQR: 28-34] days after prime+4w and 28 [IRQ: 28-28] days after boost+4w. Although at prime+4w only 34/90 (37.8%) of pts. presented neutralizing ab., the majority (86/91, 94.5%), developed them at boost+4w. The highest neutralization titer developed the pts. on IL-17i both at prime+4w (74 [IQR: 13-91]) and boost+4w (798 [IQR: 511-1344]), while no statistically significant differences were found in the neutralization titer at boost+4w for the TNFi, JAKi, and MTX groups: 207 ND50 [IQR: 120-576], 319 [IQR: 133-461] and 749 [IQR: 264-1920], respectively. 81/90 (90.0%) pts. developed IgG ab. against SARS-CoV-2 S-protein at prime+4w and 91/92 (98.9%) at boost+4w. Pts. receiving IL-17i developed higher ab. titers (8295 U/mL [IQR: 4586-11,237]) compared to the other three groups: JAKi (4405 U/mL [IQR: 1436-7265], TNFi (2313 [IQR: 1156-3630] U/mL) and MTX (2010 U/mL [IQR: 693-9254]). Neutralization capacity correlated well with the titer of anti-S ab. at both timepoints. Co-administration of biologic/tsDMARDs and MTX led to lower titers compared to biologic/tsDMARDs monotherapy. All therapies left frequencies of CD154+CD137+ CD4+ T cells and CD137+ CD8+ T cells at prime+4w and boost+4w unchanged. Polyfunctionality and T cell cytokine profiles across therapies did not significantly vary at boost+4w.

Conclusion

Even after insufficient seroconversion for neutralizing capacity and ab. response against SARS-CoV-2 S-proteins between pts. of different mod of action agents, particularly for MTX and JAKi after first vaccination, a second vaccination covered almost all pts. regardless of DMARDs therapy, with better outcomes in those on IL-17i. T cell immunity revealed similar frequencies of activated T cells in all modes of action after the second vaccination.

Table 1.

Demographics and therapy

AllIL-17iIL-17i+MTXTNFiTNFi+MTXJAKiJAKi+MTXMTXPatients (n)9219527418613Age (years)50 [39-56]42 [36-53]37 [32-38]51 [42-56]58 [54-61]50 [43-56]55 [49-59]54 [37-64]Female sex46 (50.0%)6 (31.6%)3 (60.0%)10 (37.0%)3 (75.0%)13 (72.2%)3 (50.0%)8 (61.5%)Patients with concomitant glucocorticoids (n)13 (14.1%)1 (5.3%)1 (20.0%)0 (0.0%)0 (0.0%)5 (27.8%)3 (50.0%)3 (23.1%)Prednisolone dosage (mg)5.0 [2.5-5.0]5.0[5.0-5.0]3.0 [3.0-3.0]5.0 [2.5-5.0]2.0 [2.0-4.0]5.0 [4.0-5.0]

IL interleukin, i inhibitor, MTX methotrexate: TNF tumor necrosis factor, JAK janus kinase. For quantitative variables, data are provided as median [IQR], for categorical variables the count (% frequency)

Acknowledgements

We thank all the patients who participated in this study. We thank the study nurses Gordana Brnos and Silke Kunkel for their support in the implementation of the study. We thank Toralf Roch, Sarah Skrzypczyk, Jan Zapka, Julia Kurek and Eva Kohut for their technical assistance

Disclosure of Interests

None declared

POS1059 EFFICACY OF UST IN ACTIVE PsA IS INDEPENDENT FROM CONCOMITANT MTX USE, EVEN IN PATIENTS WITH MORE SEVERE SKIN PSORIASIS: SUBGROUP ANALYSIS FROM A RANDOMIZED PLACEBO-CONTROLLED INVESTIGATOR INITIATED CLINICAL TRIAL

Background

The use of bDMARDs treatments in patients with psoriatic arthritis (PsA) usually requires treatment failure or intolerance of csDMARD/MTX before initiation. The value of MTX in combination with bDMARDs is still unclear. We designed an investigator-initiated, randomized, placebo-controlled trial (IIT) in active PsA to examine if outcomes of treatment with ustekinumab (UST) in combination with MTX (either newly initiated or ongoing) were different from UST only (+Placebo; PBO). With known efficacy of MTX on skin psoriasis outcomes may differ in patients with or without significant skin involvement of their psoriatic disease.

Objectives

To compare efficacy outcomes in UST+PBO vs UST+MTX in dependency of skin involvement (Body Surface Area [BSA]) at baseline.

Methods

A total of 186 patients with active PsA (defined as TJC≥4, SJC≥4 [68/66 joint count] and DAS28≥3.2) were screened for eligibility. 173 patients were randomized to UST+MTX (new or ongoing) or UST+PBO.

With this post hoc subgroup analysis outcome parameters were compared between patients with or without skin psoriasis > 3 % BSA. Demographic data and disease activity status of arthritis (joint count [TJC/SJC], DAPSA, DAS28), skin (PASI, BSA), HR-QoL (EQ5D, DLQI) and physical function (HAQ) were compared between groups.

Results

BL data were well-balanced between main treatment groups (UST+MTX, n=86; UST+PBO, n=74) including gender (42.5% vs 40.5% female) and mean values for age (49.2 vs 47.2 years), BMI (29.4 vs 28.9 kg/m2), SJC (8 vs 8), TJC (12 vs 12), DAS28-CRP (4.6 vs 4.4), DAPSA (36.7 vs 34.9) and PASI (2.8 vs 2.4. Disease activity remained well-balanced even after dividing groups according to skin involvement ((a) BSA ≤3% and (b) BSA >3%) with a trend of more severe joint involvement (SJC, TJC) in BSA >3% for UST+MTX compared to UST+PBO. At week 24, relative changes in TJC (-62% vs -62%), change in DAS28 and DAPSA were equal in all treatment groups independent from skin involvement (Table 1). Differences between the groups according to skin involvement were seen for relative changes in SJC (BSA >3%: -74.8% UST+MTX vs -84.3% UST+PBO), subject global assessment (SGA), physician global assessment (PGA), DLQI and EQ5D. Highest levels for changes were detected in the UST+PBO group with high skin involvement (BSA >3%).

Table 1.

Outcomes at Week 24 (LOCF)

UST+MTXUST+PBOBSA ≤3%BSA >3%BSA ≤3%BSA >3%n=46n=40n=51n=23TJC68 change from BL-7.83 (SD 10.3)-9.5 (SD 10.3)-8.9 (SD 9.5)-7.3 (SD 7.4)SJC66 change from BL-6.0 (SD 5.4)-7.1 (SD 3.5)-6.5 (SD 6.2)-6.4 (SD 3.8)PASI change from BL+-1.3 (SD 1.9)-8.5 (SD 9.6)-1.5 (SD 2.4)-9.0 (SD 10.7)DAS-28 ESR [mm/hr] change from BL-1.6 (SD 1.1)-1.8 (SD 1.2)-1.7 (SD 1.4)-1.8 (SD 1.1)DAS-28 CRP [mg/l] change to BL-1.5 (SD 1.2)-1.5 (SD 1.3)-1.6 (SD 1.2)- 1.7 (SD 1.1)DAPSA change from BL-17.4 (SD 16.8)-20.8 (SD 13.2)-20.5 (SD 16.6)-20.4 (SD 15.3)HAQ change from BL-0.1 (SD 0.4)-0.2 (SD 0.5)-0.3 (SD 0.3)-0.3 (SD 0.5)DLQI change from BL-3.1 (SD 5.5)-5.5 (SD 8.2)-2.3 (SD 3.3)-6.4 (SD 7.9)EQ5D VAS Health State change from BL6.7 (SD 24.7)11.7 (SD 23.6)8.0 (SD 24.2)21.3 (SD 25.3)

Conclusion

IL12/23 inhibition with UST is an effective treatment for active PsA independent of MTX use. Data from this IIT indicate that additional MTX has no positive impact on UST efficacy for arthritis, skin, HR-QoL and physical function. This independency of UST effect from MTX can also be demonstrated in patients with active skin involvement despite known efficacy of MTX for skin psoriasis.

Acknowledgements

We thank Janssen for support of the study with a research grant.

Disclosure of Interests

Michaela Köhm Speakers bureau: Janssen, Consultant of: Janssen, Grant/research support from: Janssen, Tanja Rossmanith Grant/research support from: Janssen, Ann Christina Foldenauer Grant/research support from: Janssen, Herbert Kellner Speakers bureau: Janssen, Consultant of: Janssen, Uta Kiltz Speakers bureau: Abbvie, Fresenius, Hexal, Janssen, MSD, Novartis, Pfizer, Roche, UCB, Consultant of: AbbVie, Amgen, Biocad, Biogen, Chugai, Eli Lilly, Hexal, Grünenthal, Janssen, MSD, Novartis, Pfizer, Roche, UCB, Grant/research support from: AbbVie, Amgen, Biogen, Fresenius, GSK, Hexal, Novartis, Pfizer, Jürgen Rech Speakers bureau: Abbvie, Biogen, BMS, Chugai, GSK, Lilly, MSD; Novartis, Roche, Sanofi, Sobi, UCB, Consultant of: Biogen, BMS, Chugai, GSK, Lilly, MSD, Novartis, Roche, Sanofi, Sobi, UCB, Grant/research support from: Novartis, Sobi, Gerd Rüdiger Burmester Speakers bureau: Janssen, Consultant of: Janssen, Grant/research support from: Janssen, David M Kofler Speakers bureau: Janssen, Consultant of: Janssen, Grant/research support from: Janssen, Jan Brandt-Juergens Speakers bureau: Janssen, Consultant of: Janssen, Grant/research support from: Janssen, Christin Jonetzko Grant/research support from: Janssen, Harald Burkhardt Speakers bureau: Janssen, Consultant of: Janssen, Grant/research support from: Janssen, Frank Behrens Speakers bureau: Janssen, Consultant of: Janssen, Grant/research support from: Janssen

AB1114 VACCINATION OF PATIENTS WITH CHRONIC INFLAMMATORY RHEUMATIC DISEASES: AN ANALYSIS OF BARRIERS AND FACILITATORS IN A PROSPECTIVE COHORT

Background

Patients (pts.) with chronic inflammatory rheumatic diseases (CIRD) are often not adequately protected against infectious diseases. As shown in an earlier study, less than 50% of CIRD pts. were vaccinated against pneumococci and influenza before the SARS-CoV2 pandemic started 1. High vaccination rates are critical to achieve herd immunity. Knowledge on barriers and facilitators of vaccine uptake in CIRD pts. is limited.

Objectives

The aim of this study was to characterize barriers and facilitators towards vaccines in general and specifically against pneumococci, influenza and SARS-CoV-2 in adult CIRD pts.

Methods

In early 2021, consecutive CIRD pts. completed a structured questionnaire including knowledge on vaccination, attitudes, and perceived barriers and facilitators towards vaccination. A total of 12 facilitators and 11 barriers towards vaccination was assessed in general, and specifically for vaccination against pneumococci, influenza and SARS-CoV2. The Likert scales had 4 response options, ranging from 1 (completely disagree) to 4 (completely agree). Patient and disease characteristics, their vaccination history and attitudes towards vaccination against SARS-CoV-2 were assessed.

Results

Of 514 prospectively recruited pts., 441 responded (85.8%) to the questionnaire (table 1). Self-reported vaccine uptake was 48.8% against pneumococci and 66.2% against seasonal influenza. The majority (82.2%) was willing to be vaccinated against SARS-CoV-2. The majority (≥70%) had decent knowledge about vaccination, and only <10% doubted its effectiveness. The level of knowledge did not differ between the studied 3 vaccinations. Pts. were more likely to rate statements about facilitators favorably compared to statements about barriers. Facilitators for SARS-CoV-2 vaccination did not different from vaccination in general (Figure 1). Societal and organizational facilitators such as public vaccine campaigns or protection for high-risk pts. were more commonly named compared to inter- or intrapersonal facilitators. Protection of high-risk pts. was by far the most frequently cited facilitator. Most pts. indicated that they were likely to receive a vaccine if their health care professional would recommend it – without preference for GP or rheumatologist. The frequency of barriers was much lower compared to facilitators and more barriers towards SARS-CoV-2 vaccination were reported in comparison to vaccination in general or pneumococci and influenza, respectively. However, pts. frequently cited intrapersonal issues as barriers against vaccination. Importantly, the major barrier was an inadequate risk perception between the severity of COVID-19 and the potential adverse events of the vaccine.

Table 1.

Patient and disease characteristics

Age, y54.1 (12.6)Women, No. (%)272 (61.7)Rheumatoid Arthritis, No. (%)156 (35.4)Axial Spondyloarthritis, No. (%)120 (27.2)Psoriatic Arthritis, No. (%)61 (13.8)Other diagnoses, No. (%)104 (23.6))Treatment, csDMARD, No. (%)121 (27.4)Treatment, bDMARD, No. (%)280 (63.5)Treatment, tsDMARD, No. (%)24 (5.4)CDAI, n=19411.1 (9.0)CRP, mg/L, n=4400.4 (0.7)HAQ score, n=3171.1 (0.7)BASDAI, n=1183.8 (2.2)BASFI, n=1183.8 (2.3)Patient global, NRS 0-104.1 (2.5)HADS-A, n=4366.6 (4.0)HADS-D, n=4365.8 (4.3)

variables as mean (SD)

Figure 1.

Facilitators of vaccine uptake in general and for SARS-CoV-2

Conclusion

A relatively high number of pts. was vaccinated against pneumococci and influenza, – a probable campaign success during the last years. In addition, more than 80% of pts. were willing to be vaccinated against SARS-CoV2. Facilitators were of greater significance than barriers in this scenario. The high number of societal and organizational facilitators enables the implementation of effective strategies to increase future vaccination rates.

References

[1]Kiltz et al. RMD Open 2021

Disclosure of Interests

Ioana Andreica Speakers bureau: UCB, MSD, Novartis, Abbvie, Lilly, Janssen, Sobi, Consultant of: Novartis, Lilly, Sobi, Galapagos, Amgen, Takeda, Grant/research support from: Lilly, Iulia Roman: None declared, Xenofon Baraliakos Speakers bureau: Abbvie, Lilly, Pfizer, UCB, MSD, Novartis, Galapagos, Hexal, Paid instructor for: Abbvie, Lilly, Pfizer, UCB, MSD, Novartis, Galapagos, Hexal, Consultant of: Abbvie, Lilly, Pfizer, UCB, MSD, Novartis, Galapagos, Hexal, Grant/research support from: Abbvie, MSD; Novartis, Lilly, Juergen Braun Speakers bureau: Abbvie, Amgen, Biogen, BMS, Boehringer, Celltrion, Chugai, FResenius, Hexal, Janssen, Lilly, Medac, MSD, Mylan, Mundipharma, Pfizer, UCB, Novartis, Consultant of: Abbvie, Amgen, Biogen, BMS, Boehringer, Celltrion, Chugai, FResenius, Hexal, Janssen, Lilly, Medac, MSD, Mylan, Mundipharma, Pfizer, UCB, Novartis, Grant/research support from: Abbvie, Amgen, Biogen, Fresenius, Hexal, Janssen, Lilly, MSD, Pfizer, UCB, Novartis, Uta Kiltz Consultant of: AbbVie, Chugai, Eli Lilly, Fresenius, Hexal, Janssen, MSD, Novartis, onkowissen.de, Pfizer, Roche and UCB, Grant/research support from: Abbvie, Amgen, Hexal, Fresenius, Novartis und Pfizer.

AB1402 FACILITATORS AND BARRIERS OF VACCINE UPTAKE IN PATIENTS WITH CHRONIC INFLAMMATORY RHEUMATIC DISEASE: A SCOPING REVIEW

Background

Patients with chronic inflammatory rheumatic diseases (CIRD) remain underrepresented in receiving vaccinations despite being disproportionately affected by infectious complications.

Objectives

To systematically review the literature regarding vaccination willingness and vaccination hesitancy in CIRD patients with focus on the perspective of patients and physicians.

Methods

A scoping review was conducted in PUBMED, EMBASE and the Cochrane Library through 2021. Study selection was performed by two independent reviewers, data were extracted using a standardized form and risk of bias was assessed using instruments from the McMaster University. Identified barriers and hurdles were synthesized by categorizing them into the WHO’s Measuring Behavioural and Social Drivers of Vaccination (BeSD) conceptual model.

Results

The search yielded 1,644 hits, of which 30 were included (cross-sectional studies (n=27) based on interviews and 3 intervention studies). The majority of studies reported barriers to influenza and pneumococcal vaccination (n=11), or influenza vaccination only (n=9) from the patients perspective. Two studies assessed the attitudes towards COVID-19 vaccinations. Only one study assessed the view of rheumatologists. Patients mainly mentioned behavioral and social factors that negatively influence their willingness to be vaccinated while physicians see deficits in the organization and lack of time as a major barrier. Coverage of domains matched to the BeSD model suggests a lack of awareness of infection risk by both patients and physicians (Figure 1).

Figure 1.

Coverage of domains matched to the WHO BeSD Model

Conclusion

The view of vaccination in CIRD patients diverges between patients and rheumatologists. Our results show that in-depth counseling on vaccines is important for patients, whereas physicians need support in implementing specific immunization recommendations. The themes identified provide a starting point for future interventions to improve vaccine rates in CIRD patients.

Disclosure of Interests

None declared

POS1451 DISCRIMINATORY CAPACITY OF THE ASAS HEALTH INDEX IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS TREATED IN A TIGHT CONTROL SETTING VERSUS STANDARD OF CARE

Background

Improvement in functioning and health as assessed by the ASAS Health Index (HI) is an important outcome of interventions in patients with axial spondyloarthritis (axSpA). ASAS HI thresholds for measuring improvement have been proposed but not yet tested in an independent intervention trial to study its discriminant capacity.

Objectives

To test the discriminant capacity of the ASAS HI using data from a randomized, active-controlled trial.

Methods

In this post-hoc analysis from the tight-controlled, treat-to-target (T2T) trial TICOSPA [1], data of active axSpA patients randomized to either the T2T arm (visits every 4 weeks, prespecified strategy of treatment intensification until achieving low disease activity) or standard of care (SOC; visits every 12 weeks, treatment at the rheumatologist’s discretion) were compared to test whether different thresholds for improvement or achieved state of ASAS HI could discriminate between treatment arms. Week 48 effect sizes (ES) of improvement from baseline were calculated for each treatment arm as Phi Coefficient (higher means better discrimination) and OR (95% CI).

Results

The table shows the ES between treatment arms for all tested improvements and health states achieved in ASAS HI. Overall, absolute improvement outcomes performed better than percentage changes outcome followed by status outcomes. The absolute improvement of ≥2.0, ≥2.5, and ≥3.0 performed best followed by the 20% improvement. As the ASAS HI ≥3.0 is the smallest detectable change for this outcome, this seem to be the most appropriate proposed outcome.

Table 1.

Thresholds by treatment groups.

Non-responder imputation at 48 weeksEffect size measuresTC/T2TUCPhi Coefficient*OR [95% CI]ASAS HI 20% improvement56.9%45.8%0.11 [0-1.0]0.64 [0.33-1.23]ASAS HI 25% improvement51.4%41.7%0.10 [0-1.0]0.68 [0.35-1.30]ASAS HI 30% improvement43.1%34.7%0.09 [0-1.0]0.70 [0.36-1.38]ASAS HI 35% improvement40.3%31.9%0.09 [0-1.0]0.70 [0.35-1.38]ASAS HI 40% improvement37.5%31.9%0.06 [0-1.0]0.78 [0.39-1.56]ASAS HI 50% improvement29.2%22.2%0.08 [0-1.0]0.69 [0.33-1.47]ASAS HI 60% improvement26.4%18.1%0.10 [0-1.0]0.61 [0.28-1.36]ASAS HI 70% improvement16.7%12.5%0.06 [0-1.0]0.71 [0.28-1.82]ASAS HI 80% improvement13.9%11.1%0.01 [0-1.0]0.78 [0.29-2.09]ASAS HI 90% improvement9.7%9.7%0.0[0-1.0]1.0 [0.33-3.01]ASAS HI improvement ≥1.066.7%61.1%0.06[0-1.0]0.79 [0.40-1.55]ASAS HI improvement ≥2.055.6%41.7%0.14 [0.0-1.0]0.57 [0.30-1.11]ASAS HI improvement of ≥2.544.4%31.9%0.13 [0-1.0]0.59 [0.30-1.16]ASAS HI improvement of ≥3.041.7%29.2%0.13 [0-1.0]0.58 [0.29-1.15]ASAS HI improvement of ≥ 3.529.2%22.2%0.08 [0-1.0]0.69 [0.33-1.47]ASAS HI improvement ≥4.029.2%22.2%0.08 [0-1.0]0.69 [0.33-1.47]ASAS HI improvement ≥5.016.7%12.5%0.06 [0-1.0]0.71 [0.28-1.82]ASASHI, end of study, ≤12.087.5%80.6%0.09 [0.0- 1.0]0.59 [0.24, 1.47]ASASHI, end of study, ≤5.037.5%33.3%0.04 [0.0, 1.0]0.83 [0.42, 1.65]

A value of PHI = 0.1 is considered to be a small effect, 0.3 a medium effect, and 0.5 a large effect.

Conclusion

In this active-controlled trial an absolute improvement in the ASAS HI discriminated best between treatment arms. A similar evaluation is needed in a placebo-controlled trial to be able to propose the best outcome for the ASAS HI in a trial.

References

[1]Molto A et al. Ann Rheum Dis 2021

Disclosure of Interests

Uta Kiltz Speakers bureau: AbbVie, Biocad, Biogen, Chugai, Eli Lilly, Hexal, Janssen, MSD, Novartis, Pfizer, Roche, UCB, Consultant of: AbbVie, Biocad, Amgen, Chugai, Eli Lilly, Hexal, Janssen, MSD, Novartis, Pfizer, Roche, UCB, Grant/research support from: AbbVie, Amgen, Biogen, Fresenius, GSK, Hexal, Novartis, Pfizer., Anna Moltó: None declared, Clementina López-Medina: None declared, Maxime Dougados: None declared, Désirée van der Heijde Speakers bureau: AbbVie, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Lilly, Novartis, Pfizer, UCB Pharma, Consultant of: AbbVie, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Lilly, Novartis, Pfizer, UCB Pharma, Grant/research support from: AbbVie, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Lilly, Novartis, Pfizer, UCB Pharma, Annelies Boonen Speakers bureau: Abbvie / Galapagos, Consultant of: Galapagos, Grant/research support from: Abbvie, Filip van den Bosch Speakers bureau: Abbvie, Amgen, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer and UCB., Consultant of: Abbvie, Amgen, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer and UCB., Grant/research support from: Abbvie, Amgen, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer and UCB., Juergen Braun Speakers bureau: Abbvie, Amgen, Biogen, BMS, Boehringer, Celltrion, Chugai, Fresenius, Hexal, Janssen, Lilly, Medac, MSD, Mylan, Mundipharma, Novartis, Pfizer und UCB, Consultant of: Abbvie, Amgen, Biogen, BMS, Boehringer, Celltrion, Chugai, Fresenius, Hexal, Janssen, Lilly, Medac, MSD, Mylan, Mundipharma, Novartis, Pfizer und UCB, Grant/research support from: Abbvie, Amgen, Biogen, BMS, Boehringer, Celltrion, Chugai, Fresenius, Hexal, Janssen, Lilly, Medac, MSD, Mylan, Mundipharma, Novartis, Pfizer und UCB

AB0184 IDENTIFYING TRAJECTORIES OF REMISSION IN PATIENTS WITH RHEUMATOID ARTHRITIS TREATED IN A TERTIARY CARE CENTRE

Background

The main goal of treatment for patients (pts) with rheumatoid arthritis (RA) is remission to preserve physical function and prevent radiographic damage. However, less than 50% of pts with early RA have achieved remission in clinical studies and inception cohorts 1. Little is known about the course of disease and the clinical patterns when remission is tried to be achieved in pts with RA.

Objectives

To identify subgroups with distinct trajectories of DAS28-CRP in pts with RA.

Methods

Longitudinal data from adult RA pts presenting to a tertiary centre were used. Socio-demographic data, disease characteristics and standard assessments including established outcome parameters for disease activity (DAS28-CRP) and physical function (FFbH) were retrospectively analysed. Group-based trajectory modelling (GBTM) was used to identify homogeneous classes of DAS28-CRP trajectories, where the number of classes was selected using Nagin’s Bayesian information criterion (BIC). Differences between the identified classes and clinical variables were studied.

Results

Data of 134 pts with 849 DAS28-CRP values were analysed. Retrospective chart data were available for a follow-up of 33.7 (SD 18.0) months. One third of pts already had erosions and severe limitations in physical functioning. About half of the pts were on bDMARDS and <20% on steroids. Five distinct classes of DAS28-CRP trajectories were identified (Figure 1). These groups were subsequently categorized as 1) high-increasing, 2) high-stable, 3) low-increasing, 4) low-decreasing disease activity, and 5) remission. Pts.’ characteristics at baseline in each trajectory group are shown in Table 1. Group 4 had a shorter disease duration but more erosions, a better function and a higher educational level than seen in other groups. The increase of disease activity in group 3 was modest.

Table 1.

Patients demographics and disease characteristics at baseline in trajectory groups

Class 1(N=10)Class 2(N=36)Class 3(N=56)Class 4(N=23)Class 5(N=9)Age, years65.8 (12.7)60.6 (10.6)56.7 (16.0)50.5 (15.4)56.8 (12.0)Gender, female80.0% (N=8)77.8% (N=28)82.1% (N=46)52.2% (N=12)66.7% (N=6)Education level university0.0% (N=0)11.1% (N=4)16.1% (N=9)21.7% (N=5)0.0% (N=0)Employment10.0% (N=1)33.3% (N=12)53.6% (N=30)69.6% (N=16)33.3% (N=3)Body mass index30.6 (5.4)27.8 (4.3)27.1 (4.7)25.2 (4.2)29.0 (6.4)Symptom duration, years12.8 (7.3)10.4 (8.3)9.5 (9.6)6.7 (3.6)12.4 (13.2)Anti-CCP49.2 (63.9)101.3 (89.7)98.6 (95.6)94.9 (78.2)114.5 (84.6)CRP1.0 (1.1)0.7 (0.9)0.4 (0.4)0.4 (0.5)1.2 (1.1)Erosions20.0% (N=2)36.1% (N=13)28.6% (N=14)45.5% (N=10)44.4% (N=4)At least one Comorbidity100.0% (N=10)94.4% (N=34)78.6% (N=44)65.2% (N=15)88.9% (N=8)Charlson Comorbidity Index (0-29)1.1 (1.4)1.1 (1.3)0.6 (0.9)0.4 (0.7)1.2 (1.3)No. of patients on steroids0.0% (N=0)0.0% (N=0)2.9% (N=1)15.4% (N=2)0.0% (N=0)No. of patients on bDMARD77.8% (N=7)45.8% (N=11)41.2% (N=14)30.8% (N=4)71.4% (N=5)No. of patients on tsDMARD0.0% (N=0)0.0% (N=0)5.9% (N=2)7.7% (N=1)0.0% (N=0)Pain (NRS 0-10)6.1 (1.8)5.8 (1.8)4.2 (2.0)2.3 (2.6)4.2 (2.0)Patient Global (NRS 0-10)5.8 (2.8)5.3 (1.7)3.7 (2.1)2.8 (3.0)6.3 (2.2)DAS28-CRP5.3 (1.2)3.9 (0.7)2.5 (0.7)2.1 (1.0)4.6 (0.9)FFbH38.5 (29.0)48.8 (21.8)74.2 (18.9)90.4 (8.8)61.1 (19.4)RAID (0-10)6.5 (2.0)5.3 (2.1)3.8 (1.9)1.8 (1.8)4.6 (1.8)Figure 1.

Longitudinal DAS-28-CRP in trajectory groups

Conclusion

Using GBTM five distinct trajectories in pts with RA were identified. Only a small proportion of pts showed a reduction in disease activity over time, whereas the largest proportion of pts showed rather constant high or constant low disease activity. The cohort size may have impacted the modelling and further analyses in larger cohorts are needed. Importantly, even though well established in our hospital it is unclear how consequent the T2T strategy was followed and which intervention was successful to reach remission. The impact of pts global assessment on DAS28 values also needs further study.

References

[1]Nikiphorou Rheumatol 2020

Disclosure of Interests

None declared

AB0751 HOW DOES BODY MASS INDEX AFFECT SECUKINUMAB TREATMENT OUTCOMES AND SAFETY IN PATIENTS WITH ANKYLOSING SPONDYLITIS? – REAL WORLD DATA FROM THE GERMAN AQUILA STUDY

Background

Obesity is a risk factor for worse overall health in people with ankylosing spondylitis (AS)1. The German non-interventional study AQUILA provides real-world data in AS on the influence of body mass index (BMI) on therapeutic effectiveness and safety under treatment with secukinumab, a fully human monoclonal antibody that selectively inhibits IL-17A.

Objectives

The aims of this interim analysis are to describe selected baseline (BL) demographics and to evaluate secukinumab treatment outcomes on disease activity and global functioning and health and to report safety profile depending on the BMI of AS patients (pts).

Methods

AQUILA is an ongoing, multi-center, non-interventional study including up to 3000 pts with active AS or psoriatic arthritis. Pts were observed from BL up to week (w) 52 according to clinical routine. Real-world data were assessed prospectively and analyzed as observed. Validated questionnaires were used to collect data on disease activity (Bath Ankylosing Spondylitis Disease Activity Index, BASDAI) and global functioning and health (Assessment of SpondyloArthritis-Health Index, ASAS-HI). For calculation of proportion of pts that experienced (serious) adverse events ((S)AEs), all AS pts were included that received at least one dose of secukinumab. This interim analysis focuses on BMI subgroups ≤25 kg/m2 (normal weight), >25 to ≤30 kg/m2 (overweight) and >30 kg/m2 (obese) in AS pts.

Results

At BL, BMI data were available for 667 AS pts: 33.6% (n=224) normal weight, 39.9% (n=266) overweight and 26.5% (n=177) obese AS pts (Table 1). In all BMI subgroups the proportion of men was higher, even doubled among overweight AS pts. As BMI increased, so did age and comorbidities/extraarticular manifestations (EAMs, Table 1).

Table 1.

Overview of baseline characteristics in AS pts depending on BMI

DemographicsBMI ≤25 kg/m2 (N=224)BMI >25 to ≤30 kg/m2 (N=266)BMI >30 kg/m2 (N=177)Male*123 (54.9)178 (66.9)94 (53.1)Age, years**43.3 (12.1)47.5 (12.3)49.2 (11.0)BASDAI**4.8 (2.0)5.5 (1.8)5.5 (2.0)ASAS-HI**7.4 (3.7)7.7 (3.3)8.1 (3.6)Comorbidities/EAMs*Heart-related disease4 (1.8)12 (4.5)12 (6.8)Coronary heart disease4 (1.8)10 (3.8)8 (4.5)Stroke1 (0.4)0 (0.0)2 (1.1)Heart insufficiency1 (0.4)4 (1.5)8 (4.5)Uveitis11 (4.9)17 (6.4)13 (7.3)Depression88 (55.3)121 (58.2)73 (54.9)

*variables are given as n (%); **variables given as mean (SD)

Mean BASDAI developed similarly over time with lowest scores for normal weight and highest scores for obese AS pts (Figure 1A). Mean improvement from BL to w52 was 1.3 (27.1%) for normal weight, 1.5 (27.2%) for overweight, and 1.2 (21.8%) for obese AS pts.

Figure 1.

Disease activity and global functioning under secukinumab treatment in AS pts stratified by BMI

Mean ASAS-HI at BL was similar for all BMI subgroups (≤25: 7.4; >25-≤30: 7.7; >30: 8.1); the best improvement was observed in normal weight, the least in obese AS pts (Figure 1B). Mean improvement from BL to w52 was 2.1 (28.4%) for normal weight, 1.3 (16.9%) for overweight, and 0.6 (7.4%) for obese AS pts.

The occurrence of AEs/SAEs with or without suspected relationship to secukinumab increased with increasing BMI. For example, the percentage of SAEs in normal weight was 21%, in overweight 26.7% and in obese AS pts 30.9% (data not shown). There were no events with fatal outcome or unexpected safety signals in either subgroup.

Conclusion

In a real-world setting, secukinumab improved disease activity and global functioning and health in all BMI subgroups of AS pts; normal weight AS pts had numerically better ASAS-HI and BASDAI scores than obese AS pts. Altogether, real-world data of this interim analysis show that secukinumab is an effective treatment with a favorable safety profile up to 52 weeks in AS pts in all BMI subgroups.

References

[1]Chen, C.-H., et al. International Journal of Rheumatic Diseases23, 1165-1174 (2020).

Disclosure of Interests

Uta Kiltz Consultant of: AbbVie, Amgen, Biogen, Chugai, Eli Lilly, Gilead, GSK, Grünenthal, Hexal, Janssen, MSD, Novartis, Pfizer, Roche, UCB, Grant/research support from: AbbVie, Amgen, Biogen, Chugai, Eli Lilly, Gilead, GSK, Grünenthal, Hexal, Janssen, MSD, Novartis, Pfizer, Roche, UCB, Jan Brandt-Juergens Consultant of: Abbvie, Affibody, BMS, Gilead, Janssen, Lilly, Medac, MSD, Novartis, Pfizer, Roche, Sanofi-Aventis, UCB, Peter Kästner Consultant of: Chugai, Novartis, Elke Riechers Consultant of: AbbVie, Chugai, Novartis, UCB, Grant/research support from: AbbVie, Chugai, Novartis, UCB, Pfizer, Daniel Peterlik Employee of: Novartis, Christina Budden Employee of: Novartis, Hans-Peter Tony Consultant of: AbbVie, Astra-Zeneca, BMS, Chugai, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, Sanofi

POS0004 WHAT DOES WORSENING IN DAPSA DISEASE ACTIVITY CATEGORIES MEAN FOR PATIENTS WITH PSORIATIC ARTHRITIS? AN ANALYSIS OF 222 PATIENTS

Background

In psoriatic arthritis (PsA), disease activity states have been defined using the DAPSA (Disease Activity index for Psoriatic Arthritis) score (1). The disease activity states have been validated using structural progression as the gold standard (2). However, the worsening in DAPSA states has not been compared to the patient’s perspective.

Objectives

To assess the association between a worsening in disease activity (i.e., change in DAPSA disease activity category) versus the patient’s judgement of disease worsening.

Methods

ReFlap (NCT03119805) was a longitudinal study in 14 countries of consecutive adult patients with definite PsA and more than 2 years of disease duration. Patients were seen twice in the context of usual care, around 4 months apart (3). Worsening in disease activity between the 2 visits was defined as a transition to a more active disease category, based on the DAPSA categories [(remission, low disease activity (LDA), moderate disease activity (MDA) and high disease activity (HDA)] (1).This change was compared to (a) patient perceived-flares collected according to a patient-reported question: “At this time, are you having a flare of your psoriatic arthritis, if this means the symptoms are worse than usual?”; and (b) a worsening according to the MCID (Minimal Clinical Important Difference) question. The agreement between the definitions of worsening were calculated by frequency, Cohen’s kappa and prevalence adjusted bias adjusted kappa (PABAK). There was no imputation of missing data.

Results

Overall, 222 patients were analyzed: 127 (58.8%) were male, aged 53.5±12.3 years and with 10.8±8.3 years of disease duration. Disease activity was moderate: 35.9% had no current psoriasis skin lesions, mean tender joint count (TJC, 0-68) was 3.0±7.5, mean swollen joint count (SJC, 0-66) was 1.6±6.6, and mean DAPSA was 11.5±14.0.

At 4.5±2.2 months follow-up, the proportion of DAPSA worsening was 40.1% [95% confidence interval, 33.9-46.7] (n=89). Most of the changes corresponded to patients going from remission to LDA (N=24, 27.0% of worsened patients) or from LDA to MDA (N=24, 27.0%).

Patient-reported flares were reported in 27.0% [21.6-33.2] (n=60), and MCID worsening was reported in 14.0% [33.9-46.5] (n=31).

Figure 1 shows the distribution of patients with worsening in DAPSA category, versus patient-defined worsening. Of the 89 patients who worsened according to DAPSA categories, 41 (46.1%) had self-perceived flares and 20 (22.5%) had worsening according to MCID. Among patients who worsened in DAPSA category, the mean change in DAPSA was higher in patients with self-perceived flares (increase of 22.2±15.0) than in patients without self-perceived flares (increase of 14.3±12.3). Of 133 patients with no worsening according to DAPSA, 114 (85.7%) had no self-perceived flares and 122 (91.7%) had no MCID worsening. The kappa [95% confidence interval] (PABAK) coefficients between DAPSA and either patient flare or MCID worsening were 0.34 [0.21-0.46] (0.40) and 0.16 [0.05-0.27] (0.28), respectively.

Figure 1.

Venn diagram for disease worsening between 2 visits

Conclusion

After 4 months of follow-up, 40.1% patients with long-standing PsA had a change in DAPSA category corresponding to more active disease. Most of these changes reflected transitions from remission to LDA, or from LDA to MDA. Among patients changing DAPSA category, only 46.1% reported themselves in flare at the second visit and only 22.5% reported themselves as worsened by MCID, leading to only fair (for flares) to low (for MCID worsening) agreement between the assessments of worsening. It is important to assess both disease activity, and the patient’s perspective of flare.

References

[1]Schoels M, et al. Ann Rheum Dis. 2016;75(5):811-8.

[2]Aletaha D, et al. Ann Rheum Dis. 2017;76(2):418-421.

[3]Gorlier C, et al. Ann Rheum Dis 2019;78:201-208.

Disclosure of Interests

None declared

OP0148 THE ASAS CORE MEASUREMENT SET FOR AXIAL SPONDYLOARTHRITIS

Background

Recently, the core domains of the 20-years old core outcome set for ankylosing spondylitis were updated.1 The next step is to define the measurement core set, which includes at least one instrument for each domain.

Objectives

To define the instruments for the ASAS-OMERACT core outcome set for axial spondyloarthritis (axSpA).

Methods

The scientific committee invited an international working group representing all key stakeholders (patients, rheumatologists, health professionals and pharmaceutical industry). The instrument selection process is presented in Figure 1.

Figure 1.

Development process to determine the core measurement set

Results

The updated core measurement set for axSpA is shown in Table 1. This includes seven instruments for six domains that are mandatory for all trials: ASDAS and NRS patient global assessment for disease activity, NRS total back pain for pain, composite index for morning stiffness, NRS fatigue for fatigue, BASFI for physical function, and ASAS Health Index for overall functioning and health. There are 9 additional instruments for disease modifying drugs (DMARDs): two MRI activity scores (SPARCC SIJ and SPARCC spine) for disease activity, the three extra-musculoskeletal manifestations uveitis, IBD and psoriasis assessed as recommended by ASAS2, the three peripheral manifestations (44 swollen joint count, MASES and Dactylitis count2) and mSASSS for structural damage. The imaging outcomes are mandatory to be included at least in one trial for a drug that is considered to be a DMARD. The other instruments specific for DMARDs should be included in every trial. This core set is applicable to patients with radiographic and non-radiographic axSpA. Furthermore, 11 other instruments were also endorsed by ASAS and can additionally be used in axSpA trials: BASDAI, CRP, Berlin MRI-SIJ and MRI-spine activity scores for disease activity, NRS back pain at night for pain, severity (BASDAI Q5) and duration (BASDAI Q6) for morning stiffness, SF-36 for overall functioning and health, 66 swollen joint count and SPARCC enthesitis for peripheral manifestations and MRI-SIJ erosions scores (SPARCC SSS) for structural damage.

Table 1.

Updated core measurement set for axial spondyloarthritis.

Instruments mandatory for all trialsDomainInstrument Disease activityASDASPatient global assessment of disease activity (NRS) PainNRS total back pain (BASDAI Q2) Morning stiffnessSeverity and duration (BASDAI (Q5+Q6)/2)) FatigueNRS fatigue (BASDAI Q1) Physical functionBASFI Overall functioning & healthASAS Health IndexAdditional instruments mandatory for disease modifying drugs trials Disease activitySPARCC MRI-SIJ*SPARCC MRI-spine* Extra-musculoskeletal manifestationsuveitis (ASAS CRF)2psoriasis (ASAS CRF)2inflammatory bowel disease (ASAS CRF)2 Peripheral manifestations44 Swollen joint countMASESDactylitis count (ASAS CRF)2 Structural damagemSASSS*

*Needs to be assessed at least once in a disease modifying drug programme; 2Dougados M, et al. Ann Rheum Dis 2012;71(6):1103-04. ASDAS: Ankylosing Spondylitis Disease Activity Score; NRS: Numerical Rate Scale; BASDAI: Bath Ankylosing Spondylitis Disease Activity Index; Q: question; BASFI: Bath Ankylosing Spondylitis Functional Index; SPARCC: SpondyloArthritis Research Consortium of Canada Scoring System; MRI: Magnetic Resonance Imaging; SIJ: Sacroiliac Joint; CRF: Case Report Form; MASES: Maastricht Ankylosing Spondylitis Enthesitis Score; mSASSS: modified Stoke Ankylosing Spondylitis Spinal Score.

Conclusion

The previous core measurement set has been updated and endorsed by ASAS for the use in all axSpA trials.

References

[1]Navarro-Compán V, et al. Semin Arthritis Rheum 2021;51(6):1342-49.

[2]Dougados M, et al. Annals of the Rheumatic Diseases 2012;71(6):1103-04.

Acknowledgements

The ASAS axSpA core measurement set working group:

Désirée van der Heijde

Victoria Navarro Compán

Annelies Boonen

Philip Mease

Anne Boel

Uta Kiltz

Robert Landewé

Maxime Dougados

Xenofon Baraliakos

Wilson Bautista

Pravina Chiowchanwisawakit

Yu Heng Kwan

Lianne Gensler

Bassel El-Zorkany

Karl Gaffney

Nigel Haroon

Pedro Machado

Walter Maksymowych

Anna Molto

Denis Poddubnyy

Mikhail Protopopov

Sofia Ramiro

Salima van Weely

Marco Garrido Cumbrera

Natasha de Peyrecave

Lara Fallon

In-Ho Song

Hanne Dagfinrud

The Assessment of Spondyloarthritis international Society (ASAS) supported Anne Boel and Victoria Navarro-Compán financially to update the core outcome set.

Disclosure of Interests

Victoria Navarro-Compán Speakers bureau: AbbVie, Eli Lilly, Janssen, MSD, Novartis, Pfizer, UCB Pharma, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB Pharma; Research grants from AbbVie and Novartis, Grant/research support from: AbbVie and Novartis, Anne Boel: None declared, Annelies Boonen Speakers bureau: Abbvie / Galapagos, Consultant of: Galapagos, Grant/research support from: AbbVie, Philip J Mease Speakers bureau: Abbvie, Janssen, Lilly, Novartis, Pfizer, UCB, Consultant of: Abbvie, Aclaris, Amgen, Bristol Myers, Boehringer-Ingelheim, Galapagos, Gilead, GlaxoSmithKline, Inmagene, Janssen, Lilly, Novartis, Pfizer, SUN Pharma, UCB, Grant/research support from: Abbvie, Bristol Myers, Gilead, Inmagene, Janssen, Lilly, Novartis, Pfizer, UCB, Maxime Dougados: None declared, Uta Kiltz Consultant of: AbbVie, Chugai, Eli Lilly, Fresenius, Hexal, Janssen, MSD, Novartis, onkowissen.de, Pfizer, Roche and UCB, Grant/research support from: Abbvie, Amgen, Biogen, Hexal, Novartis und Pfizer, Robert B.M. Landewé Consultant of: AbbVie, BMS, Galapagos, Gilead, GSK, Janssen, Lilly, Novartis, Pfizer, UCB, Désirée van der Heijde Consultant of: AbbVie, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Lilly, Novartis, Pfizer, UCB Pharma, Employee of: Director of Imaging Rheumatology bv.

POS1013 HOW DOES BODY MASS INDEX AFFECT SECUKINUMAB TREATMENT OUTCOMES AND SAFETY IN PATIENTS WITH PSORIATIC ARTHRITIS? – REAL WORLD DATA FROM THE GERMAN AQUILA STUDY

Background

There is a higher prevalence of obesity in patients (pts) with psoriatic disease1. The German non-interventional study AQUILA provides real-world data on the influence of body mass index (BMI) of pts with psoriatic arthritis (PsA) on therapeutic effectiveness and safety under treatment with secukinumab, a fully human monoclonal antibody that selectively inhibits IL-17A.

Objectives

The aims of this interim analysis are to describe selected baseline (BL) demographics and to evaluate secukinumab treatment outcomes on disease activity and impact of disease on health and to report safety profile depending on the BMI of PsA pts.

Methods

AQUILA is an ongoing, multi-center study including up to 3000 pts with active PsA or ankylosing spondylitis. Pts were observed from BL up to week (w) 52. Real-world data were assessed prospectively and analyzed as observed. Data were collected on Psoriatic Arthritis Impact of Disease-12 items (PsAID-12 score) and Patient’s Global Assessment (PGA). For calculation of proportion of pts that experienced (serious) adverse events ((S)AEs), all PsA pts were included that received at least one dose of secukinumab. This interim analysis focuses on BMI subgroups ≤25 kg/m2 (normal weight), >25 to ≤30 kg/m2 (overweight) and >30 kg/m2 (obese) in PsA pts.

Results

At BL, BMI data were available for 1228 PsA pts: 26.5% (n=325) normal weight, 35.0% (n=430) overweight and 38.5% (n=473) obese PsA pts. Proportion of men was lower in normal weight and obese PsA pts. As BMI increased, so did age and comorbidities/extraarticular manifestations (EAMs; Table 1); e.g. percentage of PsA pts with heart-related disease increased from 5.2% in normal weight to 9.3% in obese PsA pts.

Table 1.

Overview of baseline characteristics in PsA pts depending on BMI

DemographicsBMI ≤25 kg/m2(N=325)BMI >25 to ≤30 kg/m2(N=430)BMI >30 kg/m2(N=473)Male*105 (32.3)219 (50.9)188 (39.7)Age, years**49.5 (±12.7)53.2 (±11.0)54.1 (±10.6)PsAID**4.7 (2.4)4.9 (2.2)5.4 (2.0)PGA**4.8 (2.6)5.4 (2.4)5.5 (2.4)Comorbidities/EAMs* Heart-related disease17 (5.2)29 (6.7)44 (9.3) Coronary heart disease10 (3.1)25 (5.8)35 (7.4) Stroke1 (0.3)9 (2.1)11 (2.3) Heart insufficiency9 (2.8)15 (3.5)15 (3.2) Uveitis5 (1.5)6 (1.4)10 (2.1) Depression137 (53.5)190 (55.2)231 (58.5)

*variables are given as n (%); **variables given as mean (SD)

Mean PsAID at BL was similar for all BMI subgroups (≤25: 4.7; >25-≤30: 4.9; >30: 5.4; Figure 1A). Mean improvement from BL to w52 was 1.9 (40.4%) for normal weight, 1.8 (36.7%) for overweight, and 1.7 (31.5%) for obese PsA pts.

Figure 1.

Impact of disease and PGA in PsA pts stratified by BMI.

Note: p-values are of exploratory nature. Wilcoxon tests were used to show significant subroup differences.

Mean PGA developed in a similar way over time with lowest scores for normal weight and highest scores for obese PsA pts (Figure 1B). Mean improvement from BL to w52 was 2.0 (41.6%) for normal weight, 2.2 (40.7%) for overweight, and 1.8 (32.7%) for obese PsA pts.

The occurrence of AEs/SAEs with or without suspected relationship to secukinumab was most frequent in overweight and obese PsA pts. For example, the percentage of SAEs in normal weight PsA pts was 21.6%, in overweight 26.3% and in obese 25.9%. There were no unexpected safety signals in either subgroup. One male obese PsA patient died. Cause of death was not reported, however, treating physician did not suspect a causal relationship to secukinumab.

Conclusion

In a real-world setting, secukinumab improved impact of disease and patient´s global assessment of disease activity in all BMI subgroups of PsA pts. However, normal weight PsA pts had numerically better PsAID and PGA scores than obese PsA pts. Altogether, real-world data of this interim analysis show that secukinumab is an effective treatment with a favorable safety profile up to 52 weeks in PsA pts in all BMI subgroups.

References

[1]Queiro, R., Lorenzo, A., Tejón, P., Coto, P. & Pardo, E. Medicine (Baltimore) 98, e16400 (2019).

Disclosure of Interests

Uta Kiltz Consultant of: AbbVie, Amgen, Biogen, Chugai, Eli Lilly, Gilead, GSK, Grünenthal, Hexal, Janssen, MSD, Novartis, Pfizer, Roche, UCB, Grant/research support from: AbbVie, Amgen, Biogen, Chugai, Eli Lilly, Gilead, GSK, Grünenthal, Hexal, Janssen, MSD, Novartis, Pfizer, Roche, UCB, Jan Brandt-Juergens Consultant of: Abbvie, Affibody, BMS, Gilead, Janssen, Lilly, Medac, MSD, Novartis, Pfizer, Roche, Sanofi-Aventis, UCB, Peter Kästner Consultant of: Chugai, Novartis, Elke Riechers Consultant of: AbbVie, Chugai, Novartis, UCB, Grant/research support from: AbbVie, Chugai, Novartis, UCB, Pfizer, Daniel Peterlik Employee of: Novartis, Christina Budden Employee of: Novartis, Hans-Peter Tony Consultant of: AbbVie, Astra-Zeneca, BMS, Chugai, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, Sanofi

POS0998 DEPRESSION IN SPONDYLOARTHRITIS: THE CHOICE OF MEASUREMENT INSTRUMENT MATTERS

Background

The prevalence of depression is increased in spondyloarthritis (SpA). Research on this topic in SpA is challenging for several reasons, one of them being the wide variety of different instruments used to assess depressive symptoms. It is unknown whether these instruments are comparable in measuring the construct ‘depression’ and can be considered interchangeable. If these instruments actually differ in what they measure, this should be taken into account when designing and interpreting studies, and in clinical practice when monitoring patients with SpA.

Objectives

To compare the constructs of several instruments used to assess depressive symptoms in patients with SpA.

Methods

Data from the international ASAS Health Index Validation Study were used. Included patients had a diagnosis of SpA and fulfilled the ASAS classification criteria for axial/peripheral SpA. Data on demographics and disease characteristics were collected. The following instruments that have been used to assess depressive symptoms in SpA were available: the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D), the Short Form 36 (SF-36) and item 5 of the 5-level EuroQoL 5D (EQ-5Di5). The HADS-D ranges 0-21 (best-worst), with scores ≥8 and ≥11 indicating possible (HADS-possible) and probable depression (HADS-probable), respectively. The SF-36 was summarized using all 36 items in a Mental Component Summary (SF-36MCS, score ≤40 indicating depression), or using only 5 items in the Mental Health subscale (SF-36MH, score ≤56 indicating depression). For the EQ-5Di5, a score of at least “moderately” (level ≥3 on 1-5 scale) or “severely” depressed (level ≥4) indicated depression. Spearman correlations between instrument scores, agreement (kappa) between depressed states, and test characteristics (sensitivity [SE], specificity [SP], positive and negative predictive value [PPV, NPV]) were calculated with HADS-D as external standard, as it was specifically designed to detect depression and considered to have highest content validity.

Results

In total, 1548 patients were included, of which 1281 (83%) had axial SpA, mean age was 41.6 (SD 13.5) years, 1005 were male (65%), mean symptom duration 14.5 (11.4) years, mean ASDAS 2.6 (1.2) and BASDAI 4.1 (2.5). The prevalence of depression varied around 1 in 3 patients for the lower thresholds of depression (32% for HADS-possible, 45% for SF-36MH, 33% for SF-36MCS and 24% for EQ-5Di5-moderately) and was lower for the more stringent thresholds of HADS-probable (15%) and EQ-5Di5-severely (6%); 192 patients (24% of those who scored positive for depression on ≥1 instrument) scored positive on all instruments (Figure 1). Correlations between instruments were moderate (rho = 0.59-0.66), except between SF-36MH and MCS (rho = 0.85). Agreement between instruments was moderate for lower thresholds for depression (pairwise kappa = 0.47-0.58 for HADS-possible, SF-36MCS, SF-36MH, EQ-5Di5-moderately) and substantial for higher thresholds (pairwise kappa = 0.75 for HADS-probable/EQ-5Di5-severely). Using HADS-D as external standard, EQ-5Di5 was very specific but less sensitive, while SF-36MCS/MH were more sensitive but less specific (Table 1).

Table 1.

Test characteristics of instruments

External standard: HADS-D≥8 (possible)Definition of ‘depression’SESPPPVNPVEQ-5Di5 ≥3 (moderate)51896980EQ-5Di5 ≥4 (severe)17998572SF-36MCS ≤4068836685SF-36MH ≤5678715687External standard: HADS-D≥11 (probable)Definition of ‘depression’SESPPPVNPVEQ-5Di5 ≥3 (moderate)67844194EQ-5Di5 ≥4 (severe)30986889SF-36MCS ≤4083753796SF-36MH ≤5688632997

All values are percentages.

Conclusion

Instruments used to assess depression in SpA are not interchangeable. The choice of instrument should be taken into account when interpreting studies on depression in SpA. SF-36MCS and SF-36MH are sensitive and could be considered for screening while EQ-5Di5 is useful when high specificity is required. In situations where assessment of depression is the primary objective, depression-oriented instruments such as the HADS are recommended.

Disclosure of Interests

Casper Webers: None declared, Uta Kiltz: None declared, Juergen Braun: None declared, Désirée van der Heijde Consultant of: AbbVie, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Lilly, Novartis, Pfizer, UCB Pharma, Employee of: Director of Imaging Rheumatology bv., Annelies Boonen Speakers bureau: Abbvie, Galapagos, Consultant of: Galapagos, Grant/research support from: Abbvie

POS0304 THE EFFECT OF ANTI-INFLAMMATORY TREATMENT ON DEPRESSION IN SPONDYLOARTHRITIS: DOES THE TYPE OF DRUG MATTER?

Background

Patients with spondyloarthritis (SpA) are at increased risk of depression compared to the general population. Currently, it is unknown whether this increased risk is only secondary (due to SpA-related symptoms), or also due to a shared inflammatory pathway. From both clinical and pathophysiological perspectives, it is relevant to know whether comorbid depressive symptoms improve with treatment of SpA, and if so, whether such an improvement depends on drug type/mechanism of action.

Objectives

To investigate the effect of pharmacological treatment of SpA on depressive symptoms, and to explore whether this effect differs between drug types.

Methods

Data from the international ASAS Health Index Validation Study were used. Included patients had a diagnosis of SpA and fulfilled the ASAS classification criteria for axial/peripheral SpA. Patients were assessed at baseline, and for those who required a therapeutic change (initiation of NSAID, conventional synthetic (cs)DMARD or TNFi) due to high disease activity, a follow-up assessment was conducted. The current analysis included only those with a therapeutic change. Data on demographics, disease characteristics and disease activity (ASDAS, BASDAI, CRP) were available. Depressive symptoms were assessed with the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D, range 0-21 [best-worst]). HADS-D scores ≥8 and ≥11 indicated possible and probable depression, respectively. Change in depressive symptoms from baseline was compared between treatments (NSAID, csDMARD, TNFi) with ANOVA and linear regression analysis, adjusting for potential confounders.

Results

In total, 1548 patients were assessed at baseline. A therapeutic change was initiated in 304 patients (n=102/45/157 initiated an NSAID/csDMARD/TNFi). Of these, 260 (85%) had axSpA, 190 (63%) were male, mean age was 37.3 (SD 12.6) years and mean ASDAS at baseline 3.3 (1.1). The mean HADS-D was 6.9 (4.2); 126 (42%) were possibly depressed and 66 (22%) probably depressed. At baseline, there were no significant differences in demographics, disease parameters or depressive symptoms between treatment groups. At follow-up, mean HADS-D had improved to 5.1 (change -1.9 (3.8), p<0.01). Improvement in HADS-D was greater for TNFi (-2.4) than NSAIDs (-1.3, p=0.05) or csDMARDs (-1.2, p=0.15). Also, the proportion of patients with possible depression decreased more for TNFi (from 48% at baseline to 29% at follow-up) compared to NSAIDs (from 38% to 32%). In multivariable regression, initiation of TNFi was associated with greater improvement in HADS-D compared to NSAID (B = -1.27, 95%CI -2.23 to -0.32, base model) (Table 1). However, after additional adjustment for change in ASDAS/BASDAI, drug type was no longer associated with HADS-D improvement (Table 1). Adjustment for CRP in addition to BASDAI did not change results, and CRP itself was not associated with depressive symptoms (not shown). Of note, csDMARDs did not differ from NSAIDs in any of the analyses regarding their effect on HADS-D.

Table 1.

Multivariable regression analysis of change in HADS-D from baseline

Base modelASDAS modelBASDAI modelVariableB95%CIB95%CIB95%CIAge, years0.040.00 to 0.070.03-0.01 to 0.070.030.00 to 0.06Male gender0.23-0.67 to 1.140.55-0.39 to 1.490.28-0.54 to 1.10HLA-B27 (vs negative) Positive1.560.46 to 2.671.380.27 to 2.491.170.17 to 2.18 Unknown1.700.19 to 3.222.210.66 to 3.751.410.04 to 2.77Therapy initiated (vs NSAID) csDMARD0.19-1.16 to 1.540.02-1.34 to 1.390.14-1.07 to 1.36 TNFi-1.27-2.23 to -0.32-0.51-1.58 to 0.55-0.23-1.13 to 0.67ASDAS, change1.270.84 to 1.71†BASDAI, change†0.780.60 to 0.96

Associations in bold are statistically significant (p<0.05) †Due to collinearity, ASDAS and BASDAI were tested in separate models

Conclusion

Treatment of active SpA also improves depressive symptoms. TNFi have a larger effect than NSAIDs, which can mainly be explained by a stronger effect on disease activity. This analysis did not find evidence for a direct link between CRP-mediated inflammation and depressive symptoms in SpA.

Disclosure of Interests

Casper Webers: None declared, Uta Kiltz: None declared, Juergen Braun: None declared, Désirée van der Heijde Consultant of: AbbVie, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Lilly, Novartis, Pfizer, UCB Pharma, Employee of: Director of Imaging Rheumatology bv, Annelies Boonen Speakers bureau: Abbvie, Galapagos, Consultant of: Galapagos, Grant/research support from: Abbvie

OP0018 COMPARISON OF THE EFFECT OF TREATMENT WITH NSAIDs ADDED TO ANTI-TNF THERAPY VERSUS ANTI-TNF THERAPY ALONE ON PROGRESSION OF STRUCTURAL DAMAGE IN THE SPINE OVER TWO YEARS IN PATIENTS WITH ANKYLOSING SPONDYLITIS (CONSUL) – AN OPEN-LABEL, RANDOMIZED CONTROLLED, MULTICENTER TRIAL

Background

There is some evidence that NSAIDs, in particular celecoxib (CEL), might possess not only symptomatic efficacy but also disease-modifying properties in radiographic axial spondyloarthritis (r-axSpA) formerly known as ankylosing spondylitis, retarding progression of structural damage in the spine if taken continuously. For biological disease-modifying antirheumatic drugs (bDMARDs), retardation of structural damage progression has also been demonstrated, but at least 4 years of treatment seem to be necessary (at least for tumour necrosis factor inhibitors – TNFi) to see such an effect. Therefore, a combination of an NSAID with a TNFi might bring additional benefits in terms of retardation of structural damage progression especially in high-risk patients.

Objectives

The aim of this RCT was to evaluate the impact of treatment with the COX-II-selective NSAID (CEL) when added to a TNFi (golimumab - GOL) compared with TNFi (GOL) alone on progression of structural damage in the spine over 2 years in patients with r-axSpA.

Methods

Eligible patients had r-axSpA and high disease activity (BASDAI ≥4), NSAID failure and risk factors for radiographic spinal progression: C-reactive protein >5 mg/l and/or ≥1 syndesmophyte(s). The trial consisted of two phases: a 12-week run-in phase, in which all included patients received treatment with GOL 50 mg every 4 weeks sc, followed by a 96-week controlled treatment period, in which patients who achieved a BASDAI improvement of ≥2 points were randomly assigned to GOL + CEL 200 mg bid or GOL alone arms. The primary endpoint was radiographic spinal progression as assessed by the change in the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) after 108 weeks in the intent-to-treat population, read by 3 independent readers blinded for the treatment arm and the time-point.

Results

Of the 157 screened patients, 81.5% (n=128) were enrolled into the run-in phase. 109 patients fulfilled the BASDAI response criterion at w12 and were randomized 1:1 (54 vs. 55) to GOL+CEL or GOL alone; 97 (45 vs. 52) patients completed the study at w108. Clinical characteristics of the randomized patients are shown in Tab. 1. The mSASSS change after w108 was 1.1 (95%CI 0.2; 2.0) vs. 1.7 (95%CI 0.8; 2.6) in the GOL+CEL vs. GOL alone groups, respectively, p=0.79. Figure 1 shows the cumulative probability of the mSASSS change in both treatment arms. New syndesmophytes in the opinion of three readers occurred in 11% vs. 25% of the patients in the GOL+CEL vs. GOL alone groups, respectively, p=0.12. During the study, a total of 14 serious adverse events (SAE) were reported (7 in the GOL+CEL group, 5 in the GOL alone group and 2 during the run-in phase).

Figure 1.

Cumulative probability plot of mSASSS progression over 108 weeks of treatment.

Conclusion

In this study, a combined therapy with GOL+CEL did not show significant superiority over GOL monotherapy in retarding radiographic spinal progression over two years in r-axSpA patients.

However, the observed numerical reduction in radiographic spinal progression associated with the combined treatment might be, however, clinically relevant for patients at high risk for progression.

Table 1.

Baseline characteristics of randomized patients

ParametersGOL+CEL N=54GOL alone N=55All patients N=109validnvaluevalidnvaluevalidnvalueSex, malen (%)5440 (74.1)5541 (74.5)10981 (74.3)Age, yearsMean (SD)5439.9 (9.9)5537.5 (10.8)10938.7 (10.4)Smokern (%)5319 (35.8)5522 (40)10841 (38)HLA-B27 positivityn (%)5445 (83.3)5147 (92.2)10592 (87.6)BASDAIMean (SD)546.2 (1)556.1 (1.1)1096.1 (1.1)BASMIMean (SD)542.6 (1.9)542.9 (1.4)1082.8 (1.6)CRP > 5 mg/Ln (%)5438 (70.4)5538 (69.1)10976 (69.7)ASDAS-CRPMean (SD)543.6 (0.6)553.7 (0.9)1093.7 (0.8)Prior bDMARDsn (%)5417 (31.5)559 (16.4)10926 (23.9)Presence of ≥ 1 syndesmophyte(s)n (%)5427 (50)5528 (50.9)10955 (50.5)mSASSSMean (SD)5413.5 (16.9)5510.3 (13.2)10911.9 (15.2)

Acknowledgements

The CONSUL study has been supported by a grant from the German Ministry of Education and Research (BMBF), grant number FKZ 01KG1603 and study medication (golimumab) was provided free of charge by MSD Sharp & Dohme GmbH, Munich, Germany.

Furthermore we would like to thank Anne Weber, Bianca Mandt, Claudia Lorenz, Hildrun Haibel, Judith Rademacher, Laura Spiller, Petra Tietz as well as all participating rheumatologist and included patients.

Disclosure of Interests

Fabian Proft Speakers bureau: AMGEN, AbbVie, BMS, Celgene, Janssen, MSD, Novartis, Pfizer, Roche, UCB, Consultant of: Novartis, Grant/research support from: Novartis, UCB, Lilly, Burkhard Muche Speakers bureau: UCB Pharma, AMGEN, Consultant of: UCB Pharma, AMGEN, Valeria Rios Rodriguez Speakers bureau: AbbVie, Falk e.V., Murat Torgutalp: None declared, Mikhail Protopopov Consultant of: Novartis, Joachim Listing: None declared, Maryna Verba: None declared, Uta Kiltz: None declared, Jan Brandt-Juergens: None declared, Maren Sieburg: None declared, Swen Holger Jacki: None declared, Joachim Sieper Speakers bureau: AbbVie, Janssen, Merck, Novartis, Consultant of: Abbvie, Janssen, Lilly, Merck, Novartis, UCB, Denis Poddubnyy Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Biocad, Eli Lilly, Gilead, GlaxoSmithKline, Janssen, MSD, Novartis, Pfizer, Samsung Bioepis, and UCB, Grant/research support from: AbbVie, Eli Lilly, MSD, Novartis, and Pfizer.

[Axial spondyloarthritis : Update on management based on the interdisciplinary S3 guidelines on axial spondyloarthritis including early forms and ankylosing spondylitis]

This review article presents the innovations in the update of the S3 guidelines on axial spondylarthritis. The total of eight new recommendations address the areas of the consideration of differential diagnoses, coordination of comorbidity management, including a vaccination strategy, treatment targets, safety of nonsteroidal anti-inflammatory drugs (NSAID), treatment response to biological disease-modifying antirheumatic drugs (bDMARD) and discontinuation strategies when remission has been achieved. In this article the authors deal particularly with the areas of early diagnosis and referral as well as exercise therapy and drug treatment.

Real-world effectiveness and rheumatologist satisfaction with secukinumab in the treatment of patients with axial spondyloarthritis

OBJECTIVES

To assess the effectiveness of secukinumab in patients with axSpA treated in routine clinical settings in 5 European countries.

METHODS

Retrospective analysis of a cross-sectional survey to assess real-world effectiveness of secukinumab in the management of axSpA and rheumatologist satisfaction with treatment in France, Germany, Italy, Spain and the UK from March to December 2018. Outcomes collected included patient demographics, clinical characteristics and rheumatologist- and patient-reported satisfaction with secukinumab treatment.

RESULTS

Five hundred thirty-five patients receiving secukinumab for more than 4 months were assessed, 359 of whom were diagnosed with AS and 178 with nr-axSpA. Rheumatologist assessment of disease status at treatment initiation indicated that 39 (7.3%) had stable/improving disease. Secukinumab treatment for 4 months or longer resulted in 515 (95.9%) patients judged as stable/improving. Treatment was associated with benefits from initiation to assessment in terms of BASDAI (6.2 vs 2.8), 44-joint count score (9.7 vs 6.6), rheumatologist global VAS score (56.9 vs 23.0) and patient global VAS scores (64.4 vs 25.5). These benefits for key clinical outcomes were sustained for periods of 12 months or longer. Patient-reported outcomes on health status using EQ-5D, global functioning using the ASAS health index and overall work impairment via WPAI were sustained over the treatment period, while patient and rheumatologist satisfaction with secukinumab treatment remained very high at 80.2 and 91.2%, respectively.

CONCLUSION

Consistent benefits across multiple clinical and patient-reported outcomes were seen with secukinumab treatment in patients with AS and nr-axSpA treated in routine clinical settings across five European countries. Key Points • In routine clinical settings across five European countries, secukinumab treatment resulted in improvements in a wide range of clinical outcomes including physician-reported disease severity, disease status, pain, BASDAI, 44-joint count score and global VAS scores. • Key clinical and patient reported outcomes were sustained for a 12-month period or longer with secukinumab treatment. • Rheumatologist- and patient-reported treatment satisfaction was high with secukinumab.

The ASAS-OMERACT core domain set for axial spondyloarthritis

BACKGROUND

The current core outcome set for ankylosing spondylitis (AS) has had only minor adaptations since its development 20 years ago. Considering the significant advances in this field during the preceding decades, an update of this core set is necessary.

OBJECTIVE

To update the ASAS-OMERACT core outcome set for AS into the ASAS-OMERACT core outcome set for axial spondyloarthritis (axSpA).

METHODS

Following OMERACT and COMET guidelines, an international working group representing key stakeholders (patients, rheumatologists, health professionals, pharmaceutical industry and drug regulatory agency representatives) defined the core domain set for axSpA. The development process consisted of: i) Identifying candidate domains using a systematic literature review and qualitative studies; ii) Selection of the most relevant domains for different stakeholders through a 3-round Delphi survey involving axSpA patients and axSpA experts; iii) Consensus and voting by ASAS; iv) Endorsement by OMERACT. Two scenarios are considered based on the type of therapy investigated in the trial: symptom modifying therapies and disease modifying therapies.

RESULTS

The updated core outcome set for axSpA includes 7 mandatory domains for all trials (disease activity, pain, morning stiffness, fatigue, physical function, overall functioning and health, and adverse events including death). There are 3 additional domains (extra-musculoskeletal manifestations, peripheral manifestations and structural damage) that are mandatory for disease modifying therapies and important but optional for symptom modifying therapies. Finally, 3 other domains (spinal mobility, sleep, and work and employment) are defined as important but optional domains for all trials.

CONCLUSION

The ASAS-OMERACT core domain set for AS has been updated into the ASAS-OMERACT core domain set for axSpA. The next step is the selection of instruments for each domain.

POS0912 LONG-TERM TREATMENT WITH IXEKIZUMAB IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS: TWO-YEAR RESULTS FROM COAST-Y

Background:

The efficacy and safety of the interleukin-17 inhibitor ixekizumab (IXE) for the treatment of radiographic (r-) and non-radiographic (nr-) axial spondyloarthritis (axSpA) has been shown for up to 52 weeks.1-2

Objectives:

To study the efficacy and safety of ixekizumab in the treatment of patients with r- and nr-axSpA for up to 116 weeks.

Methods:

COAST-Y (NCT03129100) is the 2-year extension of the COAST-V, -W, and -X trials. Patients continued with the dose received at the end of the originating trial at Week 52, either with 80 mg IXE every 4 weeks (Q4W) or every 2 weeks (Q2W). Patients who had been assigned to adalimumab or placebo were re-randomized to IXE Q4W or Q2W at Week 16 in COAST-V and -W. Patients who had received placebo for 52 weeks in COAST-X were switched to IXE Q4W in COAST-Y. Patients who switched from placebo or adalimumab treatment to IXE (COAST-V, -W, or -X) or from IXE Q4W to open-label IXE Q2W (COAST-X) during the originating studies were analyzed separately from patients continuously treated with IXE. Standardized efficacy measures were used (Table 1). Missing data were handled by non-responder imputation for categorical data and modified baseline observation carried forward for continuous data. Safety data were analyzed for all patients who received ≥1 dose of IXE.

Table 1.

Demographic and efficacy results for patients continuously treated with IXE for 116 weeks

IXE Q4W N=157IXE Q2W N=195Demographics Age42.7 (13.0)41.8 (11.2) Male (n, [%])124 (79.0)132 (67.7) Baseline ASDAS3.92 (0.80)3.95 (0.76) Baseline BASDAI7.07 (1.26)7.18 (1.35) Baseline BASFI6.57 (1.76)6.74 (1.86) Baseline BASMI4.08 (1.46)3.97 (1.52) Baseline SF-36 PCS33.90 (7.27)33.26 (6.88)Outcome measureResponse (n, [%])Week 52Week 116Week 52Week 116 ASDAS <2.175 (47.8)69 (43.9)88 (45.1)96 (49.2) ASAS partial remission34 (21.7)31 (19.7)35 (17.9)39 (20.0) ASAS4082 (52.2)89 (56.7)99 (50.8)108 (55.4) BASDAI5078 (49.7)75 (47.8)83 (42.6)99 (50.8)Change from baseline ASDAS-1.64 (1.05)-1.60 (1.15)-1.63 (1.03)-1.78 (1.04) BASFI-2.88 (2.31)-2.76 (2.39)-2.83 (2.38)-3.15 (2.34) BASMI-0.57 (0.95)-0.57 (0.93)-0.53 (0.92)-0.60 (1.00) SF-36 PCS9.03 (8.62)8.43 (8.70)8.87 (7.57)9.86 (8.45)

Data are mean (SD) unless otherwise noted. Non-responder imputation was used for categorical variables, and modified baseline observation carried forward for continuous variables.

Results:

Of the 773 patients enrolled in COAST-Y, 86.0% completed Week 116 of treatment (52 weeks of one of the originating trials and 64 weeks of COAST-Y). Among the patients continuously treated with IXE for 116 weeks (IXE Q4W: N=157; IXE Q2W: N=195), 46.9% achieved low disease activity (ASDAS <2.1), and 19.9% achieved ASAS partial remission at 116 weeks (Table 1; Figure 1). In comparison to baseline, 56.0% achieved ASAS40 (Table 1). The mean change from baseline at Week 116 was –1.70 for ASDAS, –2.98 for BASFI, and 9.22 for SF-36 Physical Component Summary (Table 1). Similar observed responses were achieved between the patients continuously treated with IXE and patients initially treated with placebo or adalimumab. For the 932 patients in the safety population, no new safety signals were identified.

Conclusion:

Ixekizumab treatment led to consistent and sustained long-term improvements in disease activity and quality of life in patients with r- and nr-axSpA, with no new safety signals after up to 2 years of treatment.

References:

[1]Dougados, et al. Ann Rheum Dis 2020;79:176-185.

[2]Deodhar, et al. Lancet 2020; 395:53-64.

Disclosure of Interests:

Juergen Braun Speakers bureau: Abbvie, Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, Eli Lilly and Company, Medac, MSD, Mundipharma, Novartis, Pfizer, Roche, Sanofi-Aventis, and UCB, Consultant of: Abbvie, Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, Eli Lilly and Company, Medac, MSD, Mundipharma, Novartis, Pfizer, Roche, Sanofi-Aventis, and UCB, Grant/research support from: Abbvie, Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, Eli Lilly and Company, Medac, MSD, Mundipharma, Novartis, Pfizer, Roche, Sanofi-Aventis, and UCB, Uta Kiltz Speakers bureau: AbbVie, Hexal, MSD, Novartis, Pfizer, Roche, and UCB, Consultant of: AbbVie, Biocad, Eli Lilly and Company, Grünenthal, Hexal, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Amgen, Biogen, Hexal, Novartis, and Pfizer, Atul Deodhar Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly and Company, Giliad, GlaxoSmith & Kline, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Boehringer Ingelheim, Eli Lilly and Company, GlaxoSmith & Kline, Novartis, Pfizer, and UCB, Tetsuya Tomita Speakers bureau: AbbVie, Astellas, Bristol-Myers Squibb, Eisai, Eli Lilly and Company, Janssen, Mitsubishi Tanabe, Novartis, Takeda, Pfizer, Consultant of: AbbVie, Astellas, Bristol-Myers Squibb, Eisai, Eli Lilly and Company, Janssen, Mitsubishi Tanabe, Novartis, Takeda, Pfizer, Maxime Dougados Consultant of: AbbVie, BMS, Eli Lilly and Company, Merck, Novartis, Pfizer, Roche, and UCB, Grant/research support from: AbbVie, BMS, Eli Lilly and Company, Merck, Novartis, Pfizer, Roche, and UCB, Rebecca Bolce 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, David Adams Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Chen-Yen Lin Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Jessica A. Walsh Consultant of: AbbVie, Amgen, Eli Lilly and Company, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Merck, and Pfizer

AB0823 TREATMENT WITH ADALIMUMAB IN PATIENTS WITH CHRONIC INFLAMMATORY RHEUMATIC DISEASES: A STUDY OF TREATMENT TRAJECTORIES ON A PATIENT LEVEL IN CLINICAL PRACTICE

Background:

There is evidence that drug retention rates to adalimumab (ADA) in patients (pts.) with chronic inflammatory rheumatic diseases (CIRD) are impaired by loss of efficacy and adverse events, and that about 50% of users had discontinued ADA within 5 years (1). With the introduction of ADA biosimilars in October 2018, non-medical switching from originator to ADA biosimilars is now increasingly part of daily practice in rheumatologic care.

Objectives:

The aim was to study treatment trajectories over two years in pts. with CIRD receiving originator ADA.

Methods:

Pts. with CIRD on originator ADA who switched to ADA biosimilar from October 2018 onwards were identified and followed until 2020. Disease activity (ASDAS), physical function (HAQ, BASFI), and changes in treatment were documented every 3 months. The four predefined treatment trajectories “continued ADA biosimilar therapy”, “back-switch to originator ADA therapy”, “switch to other biological (b) disease modifying anti-rheumatic drug (DMARD) therapy”, and “stopped bDMARD therapy /death /drop out” were used to compare characteristics of pts. with different trajectories.

Results:

A total of 111 CIRD pts. on treatment with originator ADA were switched to ADA biosimilar (Table 1). The majority of pts. 75 continued therapy with ADA biosimilar (Figure 1 next page) while 16% switched back to originator ADA, 7% switched to a different bDMARD, and 9% either stopped treatment (n=9) or died (n=1). Pts. who continued ADA biosimilar were more frequently male, older or with a longer disease duration than those who switched therapy back to originator ADA and those who switched to a different bDMARD (Table 1). The previous duration on originator ADA treatment was increased in patients who continued ADA biosimilar compared to those who switched therapy back to originator ADA and those who switched to a different bDMARD. There was more functional impairment (HAQ, BASFI) and higher disease activity (ASDAS) in pts. who switched compared to those who continued ADA biosimilar therapy (Table 1). Treatment with csDMARDs and glucocorticoids was increased in pts. who continued ADA biosimilar therapy, while pts. who switched therapy had more previous bDMARD therapies (Table 1).

Table 1.

Characteristics of patients at baseline for the entire group and stratified by treatment trajectory

Total groupN=111 (100%)Treatment trajectorycontinued ADA biosimilar therapyN=75 (67.6%)back-switch to originator ADA therapyN=18 (16.2%)switch to different bDMARD therapyN=8 (7.2%)no bDMARD therapy /death /drop outN=10 (9.0%)Age, y51.2 (14.5)51.5 (13.6)50.6 (16.8)43.5 (9.5)56.4 (19.0)Women, No. (%)46 (41.4)27 (36.0)9 (50.0)6 (75.0)4 (40.0)RA23 (20.7)17 (22.7)2 (11.1)1 (12.5)3 (30.0)axSpA68 (61.3)47 (62.7)11 (61.1)6 (75.0)4 (40.0)PsA15 (13.5)7 (9.3)4 (22.2)1 (12.5)3 (30.0)Other diagnoses5 (4.5)4 (5.3)1 (5.6)0 (0.0)0 (0.0)Disease duration, median (IQR), y5.0 (2.0-8.0)5.0 (2.0-9.0)3.5 (2.0-6.0)2.0 (1.0-5.5)4.5 (2.0-8.0)Duration previous originator ADA therapy40.7 (27.7)45.3 (27.8)35.0 (25.2)20.3 (24.7)32.3 (25.1)DAS283.0 (1.0)2.9 (1.0)3.4 (1.0)-3.3 (1.2)CRP, median (IQR), mg/L0.2 (0.1-0.3)0.1 (0.1-0.2)0.2 (0.0-0.5)0.2 (0.2-1.3)0.3 (0.2-0.4)HAQ score1.3 (0.8)1.1 (0.7)1.7 (0.8)-1.8 (1.0)ASDAS2.2 (1.1)2.0 (1.0)3.0 (1.2)2.7 (0.9)2.3 (0.2)BASFI3.5 (2.6)3.0 (2.5)5.4 (2.4)3.4 (1.6)5.4 (1.6)

+values are given as mean (SD)

Conclusion:

Two thirds of pts. who switched to ADA biosimilar remained on this therapy for 2 years. As many as 16% of pts. switched back to ADA originator. Whether or to what degree this was influenced by nocebo effects needs further study. The same is true for the effect of functional impairment – it would be interesting to know whether this was due to inflammation or structural damage.

References:

[1]Neovius M et al. Ann Rheum Dis 2015; 74:354-360

[2]The study was funded by Hexal Germany.

Figure 1.

Treatment trajectories of ADA therapy in patients with CIRD during two years ADA: adalimumab; bDMARD: biological disease modifying anti-rheumatic drug.

Disclosure of Interests:

None declared

POS0910 EVALUATION OF THE NONSTEROIDAL ANTI-INFLAMMATORY DRUG-SPARING EFFECT OF SECUKINUMAB IN PATIENTS WITH ANKYLOSING SPONDYLITIS: RESULTS OF THE MULTICENTER, RANDOMISED, DOUBLE-BLIND, PHASE IV ASTRUM-TRIAL

Background:

Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to treat inflammatory back pain in patients (pts) with ankylosing spondylitis (AS). However, an increased risk of side effects associated with NSAIDs and their dosage has been reported1. Therefore, lower doses and a dose reduction is desirable.

Objectives:

To evaluate the short-term NSAID sparing effect of secukinumab (SEC) in AS pts with NSAID intake.

Methods:

In a prospective controlled trial, 211 adult pts with active AS (BASDAI ≥4) and an inadequate response (IR) to at least 2 NSAIDs at the highest recommended/tolerated dose and pts with an IR, or those who were naïve/intolerant to a maximum of 2 tumour necrosis factor inhibitors (TNFi) were enrolled. NSAID intake was evaluated using the ASAS-NSAID score. To be eligible, pts had to take at least 50% of the highest recommended/tolerated NSAID dose regularly. Pts were randomised (1:1:1) to receive SEC 150 mg s.c. from Week (Wk) 0 (group [gp] 1), Wk 4 (gp 2) and Wk 16 (gp 3). All groups received SEC 150 mg from Wk 16. NSAID tapering was allowed in all groups from Wk 4 onwards. The primary endpoint (PE) was an ASAS20 response of pooled gp 1 and gp 2 vs. gp 3 at Wk 12.

Results:

There were 71 pts in gp 1, 70 in gp 2 and 70 in gp 3. Baseline (BL) characteristics were comparable across groups; mean age (SD) was 45.2 (12.3) years (yrs), time since diagnosis was 7.4 (9.8) yrs, 57.8% male, 79.0% HLA-B27 positive, 48.6% pts had an elevated CRP 40.8% were current/ever smoker and 72.0% were TNFi-naïve. The ASAS-NSAID (SD) scores at BL were: gp 1 vs. gp 2 vs. gp 3: 82.9 (37.7) vs. 79.9 (45.3) vs.82.3 (39.1). BASDAI and ASDAS-CRP scores were similar between groups: 6.0 (1.4) vs. 6.2 (1.5) vs. 6.2 (1.3), and 3.4 (0.7) vs. 3.3 (0.8) vs. 3.4 (0.7), respectively. The ASAS20 response at Wk 12 of pooled gp 1 and 2 vs. gp 3 was 51.1% vs. 44.3% but PE was not met (p=0.35). A higher proportion of pts in gp 1 and 2 achieved ASAS40 and BASDAI50 and other secondary outcomes at Wk 16 (Table 1). More pts in gp 1 and 2 reduced their NSAID intake from BL through Wk 16 vs. gp 3 (Table 1 and Figure 1).

Conclusion:

In this population of pts with AS, SEC provided clinical improvements in conventional clinical outcomes and a short-term NSAID sparing effect.

References:

[1]Burmester G, et al. Ann Rheum Dis 2011;70:818-822.

Table 1.

Effect of SEC 150 mg s.c. in AS pts (Intention-to-Treat population) at Wk 16

(%), unless otherwise specifiedGroup 1 (N=71)(SEC 150 mg from BL until Wk 20)Group 2 (N=70)(PBO from BL until Wk 4; SEC 150 mg from Wk 4)Group 3 (N=70)(PBO from BL until Wk 16; SEC 150 mg from Wk 16)ASAS20*56.350.041.4ASAS40*43.7§32.921.4ASAS5/6*39.4‡32.921.4ASAS-PR*8.520.0‡5.7ASAS20 TNF-IR^*60.0‡‡26.345.0 TNF-naïve^^*54.958.8‡40.0ASAS40 TNF-IR^*45.015.825.0 TNF-naïve^^*43.1‡39.2‡20.0ASDAS-CRP change (mean±SD)**-1.2±0.9§-1.0±0.9‡-0.7±0.8BASDAI change (mean±SD)***-2.3±1.9‡-2.0±2.0-1.7±2.0BASDAI50+32.428.622.9ASAS-NSAID score change (mean±SD)++-51.5±46.2‡-42.5±68.6-33.7±38.8ASAS-NSAID score decrease ≥50%*64.8‡58.642.9 <10*52.1§45.7‡28.6 =0*32.4‡38.6§17.1

AS, ankylosing spondylitis; ASAS, Assessment of SpondyloArthritis International Society; ASDAS, AS Disease Activity score; BASDAI, Bath AS Disease Activity Index; BL, baseline; CRP, C-reactive protein; IR, inadequate responder; NSAID, nonsteroidal anti-inflammatory drug; N, total number of subjects in each treatment gp; PBO, placebo; PR, partial remission; pts, patients; SEC, secukinumab; TNFi, tumour necrosis factor inhibitor; Wk, week.

†p<0.001; §p<0.01 and ‡p<0.05 vs. gp 3; ‡‡p<0.05 vs. gp 2

*p-values are from a logistic regression model with treatment, TNFi status (IR / naïve) and CRP status (>/ ≤ central lab ULN) as factors.

+p-values are from MMRM with treatment, TNFi status (IR / naïve), CRP status (>/ ≤ central lab ULN) and visit as factors, BL value as continuous covariate.

*+Missing values were imputed as non-response.

Observed data (pts) for gp 1, 2, 3, respectively:

**67, 66, 62

***67, 66, 63

++67, 67, 65

^20, 19, 20

^^51, 51, 50

Disclosure of Interests:

Uta Kiltz Speakers bureau: AbbVie, Biocad, Chugai, Eli Lilly, Grünenthal, Janssen, MSD, Novartis, Pfizer, Roche and UCB, Consultant of: AbbVie, Biocad, Chugai, Eli Lilly, Grünenthal, Janssen, MSD, Novartis, Pfizer, Roche and UCB, Grant/research support from: Abbvie, Amgen, Biogen, Fresenius, GSK, Novartis and Pfizer, Xenofon Baraliakos Consultant of: AbbVie, Biocad, Chugai, Eli Lilly, Janssen, MSD, Novartis, Pfizer, Roche and UCB, Grant/research support from: AbbVie, Biocad, Chugai, Eli Lilly, Janssen, MSD, Novartis, Pfizer, Roche and UCB, Jan Brandt-Juergens Speakers bureau: Abbvie, Pfizer, Roche, Sanofi-Aventis, Novartis, Lilly, MSD, UCB, BMS, Janssen, Medac, Consultant of: Abbvie, Pfizer, Roche, Sanofi-Aventis, Novartis, Lilly, MSD, UCB, BMS, Janssen, Medac, Ulf Wagner Speakers bureau: Pfizer, Novartis and Roche, Consultant of: Pfizer, Novartis and Roche, Grant/research support from: Roche, Novartis, BMS, Pfizer, Sebastian Lieb Employee of: Novartis, Christian Sieder Employee of: Novartis, Christian Mann Employee of: Novartis, Juergen Braun Speakers bureau: Abbvie, Amgen, Celltrion, Chugai, Medac, MSD, Novartis, Pfizer, Roche, and UCB, Consultant of: Abbvie, Amgen, Celltrion, Chugai, Medac, MSD, Novartis, Pfizer, Roche, and UCB, Grant/research support from: Abbvie, Amgen, Celltrion, Chugai, Medac, MSD, Novartis, Pfizer, Roche, and UCB

OP0074 A FRAMEWORK OF POTENTIAL INTERVENTIONS TO ACCELERATE GENDER-EQUITABLE CAREER ADVANCEMENT IN ACADEMIC RHEUMATOLOGY

Background:

A growing number of professional societies in clinical and medically related disciplines investigate evidence, make recommendations, and take action to advance gender equity. Evidence on women’s advancement and leadership in the context of the European Alliance of Associations for Rheumatology, EULAR, is limited [1].

Objectives:

The objective of the EULAR Task Force on Gender Equity in Academic Rheumatology was to establish the extent of the unmet need for support of female rheumatologists, health professionals and non-clinical scientists in academic rheumatology and develop a framework to address this through EULAR and Emerging EULAR Network (EMEUNET).

Methods:

Potential interventions to accelerate gender-equitable career advancement in academic rheumatology were gathered from a narrative review of the relevant literature, expert opinion of a multi-disciplinary Task Force (comprised of 23 members from 11 countries), data from the surveys of EULAR scientific member society leaders, EULAR and EMEUNET members, and EULAR Executive Committee members. These interventions were rated by Task Force members, who ranked each according to perceived priority on a five-point numeric scale from 1 = very low to 5 = very high.

Results:

A framework of 29 potential interventions was formulated, which covers six thematic areas, namely, EULAR policies, advocacy and communication, EULAR Congress and associated symposia, training courses, mentoring/peer support, and EULAR funding (Figure 1).

Figure 1.

A framework of potential interventions with the levels of priority, mean and standard deviation (SD)

Conclusion:

The framework provides structured interventions for accelerating gender-equitable career advancement in academic rheumatology.

References:

[1]Andreoli L, Ovseiko PV, Hassan N, et al. Gender equity in clinical practice, research and training: Where do we stand in rheumatology? Joint Bone Spine 2019;86(6):669-72.

Acknowledgements:

The task force is grateful to EULAR for funding this activity under project number EPI 024.

Disclosure of Interests:

None declared

POS0245 PERFORMANCE OF STANDARDIZED SCORES FOR DISEASE ASSESSMENT AND PAIN IN PATIENTS WITH SPONDYLOARTHRITIS AND FIBROMYALGIA

Background:

The pathogenesis of spondyloarthritis (SpA) including axial SpA (axSpA) and psoriatic arthritis (PsA) differs from fibromyalgia (FM). However, symptoms partially overlap and both patient groups suffer from pain and stiffness. In addition, SpA patients may also develop a secondary form of FM. Classification criteria for SpA and diagnostic criteria for FM are used to differentiate between these subsets. Patient reported outcomes (PRO) often generated by questionnaires are used to assess severity and other disease features.

Objectives:

To study whether PROs developed for axSpA, PsA, and related physician-based information behave in a similar way in patients diagnosed with FM without an additional chronic inflammatory rheumatic disease (CIRD) as in patients with a primary diagnosis of SpA without or with secondary FM.

Methods:

Patients were consecutively recruited. The main inclusion criterion was a clinical diagnosis of FM (without CIRD), axSpA or PsA (without or with secondary FM) and the indication for a treatment adaptation (escalation or change within the same class) for any reason, based on the judgement of experienced rheumatologists. Standardized assessment tools and lab parameters (BASDAI, ASDAS-CRP, DAPSA, patient´s and global assessment (NRS), CRP, BASFI, Fibromyalgia Impact questionnaire (FIQ), Leeds Enthesitis Index (LEI), Maastricht Ankylosing Spondylitis (MASES) and SpA Research Consortium of Canada (SPARCC) Enthesitis Score were assessed and compared between subgroups.

Results:

The baseline demographics of 300 recruited patients (100 FM. 100 axSpA and 100 PsA) are shown in Table 1. All patients with FM (primary or secondary to SpA) showed the highest scores in almost all assessments, and this was independent of the main diagnosis (Table 2). In comparison, patients with axSpA or PsA without secondary FM showed significantly lower scores in all PROs as compared to those with primary and secondary FM, with exception of (i) scores of ASDAS-CRP and (ii) duration of morning stiffness (Question 6 of BASDAI), which were not affected by the presence of secondary FM (Table 2).

Conclusion:

Secondary FM is leading to significantly higher levels of SpA-specific scores. ASDAS-CRP was the only score that was not influenced by the presence of secondary FM in patients with axSpA even though it was also increased in patients with primary FM, while similar results were found for the duration but not the level of morning stiffness. On the other hand, FM-specific questionnaires also showed high scores in patients with axSpA and PsA with concomitant FM but not in those without.

Table 1.

Baseline characteristics of all diagnosis subtypes and comparison (p-values) to primary FM diagnosis. ‘+’: diagnosis with concomitant FM, ‘-‘: diagnosis without concomitant FM

Table 2.

Mean values (±standard deviation) of the assessed diseasespecific indices and comparison (p-values) to primary FM diagnosis.

Disclosure of Interests:

None declared

POS0301 NO MAJOR DIFFERENCES BETWEEN PATIENTS WITH CHRONIC INFLAMMATORY RHEUMATIC DISEASE WHO UNDERWENT MONO- OR MULTISWITCHING OF BIOSIMILARS IN ROUTINE CARE (PERCEPTION STUDY)

Background:

The increasing availability of biosimilars (bsDMARDs) has created a financial incentive to encourage switching to cheaper products (“non-medical switch”) leading to different switching scenarios. While the clinical efficacy and safety of multiswitching seems to be established (1), limited data on patients’ knowledge about bsDMARDs and satisfaction with care are available.

Objectives:

The aim of our study was to learn more about the outcome of mono- and multiswitching scenarios in routine care with respect to patients’ attitudes towards bsDMARDs in chronic inflammatory rheumatic diseases (CIRD) such as rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA).

Methods:

Consecutive patients with CIRD who were planned to switch treatment of one adalimumab biosimilar (ADA-bsDMARD) to another ADA-bsDMARD were recruited. The number of previous ADA-bsDMARD categorized the patients into: monoswitch = 1 and multiswitch = >1. Demographics and standard assessments using validated outcome parameters for disease activity, physical function, and patient satisfaction with care (Leeds Satisfaction Questionnaire (LSQ) were documented. LSQ contains items on five subscales (provision of information; empathy with the patient; attitude to the patient; access to and continuity with the care giver; and technical competence) and a general satisfaction scale. Knowledge about bsDMARDs was recorded using a structured questionnaire.

Results:

Out of 90 patients in total, there were 42 with a monoswitch and 48 with a multiswitch scenario (Table 1). Patients were satisfied with care irrespective of the switching scenario. However, the knowledge about bsDMARDs was generally rather low (Figure 1). Less than one third of patients was able to identify correct answers about manufacturing, efficacy/safety issues, approval status and costs of bsDMARDs. However, when comparing the two switch scenarios, no differences in disease characteristics nor in satisfaction with care were found. Also the number of switches had not increased the knowledge about bsDMARDs.

Table 1.

Patients and disease characteristics stratified by switch scenario

Variables*Monoswitch (n=42)Multiswitch (n=48)P-WertSex, male, n (%)23 (54.7)26 (54.2)Age, years44 (14)51 (11)Rheumatoid Arthritis, n (%)14 (33.3)7 (14.6)Axial Spondyloarthritis, n (%)23 (54.8)31 (64.6)Psoriatic arthritis, n (%)5 (11.9)10 (20.8)Disease duration, years9.2 (2.5)10.6 (6.7)0.48DAS282.2 (1.2)2.9 (0.7)0.13HAQ1.2 (0.6)1.2 (0.5)0.91ASDAS2.1 (1.2)1.6 (1)0.70BASFI4.6 (2.9)3.7 (2.9)0.87Patient satisfactionLSQ-General (1-5) #3.7 (0.7)3.9 (0.6)0.58LSQ-Information (1-5)3.7 (0.6)3.6 (0.4)0.20LSQ-Empathy (1-5)3.6 (0.6)3.5 (0.5)0.57LSQ-Technical (1-5)4.1 (0.5)4.1 (0.5)0.51LSQ-Attitude (1-5)3.8 (0.7)3.9 (0.5)0.62LSQ-Access (1-5)3.7 (0.6)3.8 (0.6)0.70

*values in mean (SD)

# values of 1 indicate dissatisfaction

Conclusion:

This study shows that multiswitching did not lead to reduced satisfaction with care in patients on treatment with bsDMARDs. Especially, the number of switches did have no negative impact on patients satisfaction. The observation that patients who underwent multiple switches had no more knowledge about bsDMARDs than patients who just had one switch may just be explained by the positive experience most patients had with switching.

References:

[1]Kiltz U et al. Ann Rheum Dis 2020;79 (supplement 1):1872

Figure 1.

Knowledge about biosimilars bsDMARDs: biosimilar disease-modifying anti-rheumatic drugs

Disclosure of Interests:

None declared

POS0983 WORK PARTICIPATION IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS IN GERMANY: RESULTS FROM A MULTICENTER, OBSERVATIONAL SURVEY (ATTENTUS-axSpA)

Background:

Axial spondyloarthritis (axSpA) is a chronic inflammatory condition often associated with impaired working participation1 not only translating to devastating outcomes for patients (pts) but also increased economic and social burden due to a significant amount of indirect costs. Data on the different work participation domains in axSpA pts with access to biologic therapies are limited.

Objectives:

To characterise the different domains of work participation [presenteeism, absenteeism, sick leave, unemployment, disability pensions] in axSpA pts and their associations with demographic and clinical confounders.

Methods:

Pts with confirmed clinical diagnosis of axSpA were enrolled in a multicenter, observational ATTENTUS survey conducted across Germany (Nov-2019 to Jul-2020). To ensure high data quality, inclusion criteria was verified by external monitoring, followed by evaluation of the domains of impaired work participation, including absenteeism and presenteeism (WPAI). Demographics, clinical parameters and patient related outcomes (PROs) were collected via tablet. This analysis included working age (18–65 years) pts; and excluded students and retired pts. Pts without absenteeism (value=0) and presenteeism ≤20% were defined as no impairment at work.

Results:

A total of 787 axSpA pts were enrolled in the survey. Seven students, 68 retired pts and 17 pts not fulfilling the inclusion criteria were excluded from this analysis, leaving 695 pts with complete data sets. Baseline data are outlined in Table 1. 50 pts received disability pensions, 29 pts received unemployment benefits, 590 (84.9%) pts reported paid work [part-time: n=132 (22.4%); full-time: n=458 (65.9%)], with 242 (41.0%) pts having no impairments at work. 379 (64.2%) employed pts took sick leave within the previous 12 months (mo) (<3 mo: n=351; 3–6 mo: n=17; >6 mo: n=11). Absenteeism and presenteeism occurred in 140 (23.7%) and 496 (84.1%) pts, respectively. Pts without impairments were mostly of young age, male sex, well-educated, with low disease activity, less fatigue and shorter duration of morning stiffness, and preserved global and physical functioning. No apparent differences between pts with and without impairment of work participation were observed in terms of biologic treatment, disease duration and BMI.

Table 1.

Descriptive characteristics of the study population

Mean (SD), unless specifiedImpaired WP (n=453)Full WP(n=242)p-valueTotal(n=695)Age (yrs)46.7 (11.1)42.8 (10.1)<0.00145.3 (10.9)BMI28.5 (14.0)27.0 (6.8)0.14628.0 (12.0)Male, n(%)246 (54)177 (73)<0.001423 (61)Disease duration (yrs)12.7 (11.3)12.4 (10.2)0.81312.6 (11.0)University-Education, n(%)104 (23.0)82 (33.9)0.001186 (26.8)In a committed relation, n(%)310 (68.4)159 (65.7)0.464469 (6.6)ASAS-HI8.0 (3.3)3.7 (3.0)<0.0016.5 (3.8)BASDAI4.8 (1.9)2.1 (1.6)<0.0013.9 (2.2)BASDAI > 4, n(%)286 (63.1)28 (11.6)<0.001314 (45.2)Fatigue [BASDAI #1]5.8 (2.1)2.8 (2.1)<0.0014.7 (2.5)Duration morning stiffness [BASDAI #6]3.5 (2.4)1.6 (1.8)<0.0012.8 (2.4)BASFI4.2 (2.3)1.5 (1.5)<0.0013.3 (2.4)Biologic treatment, n(%)230 (50.8)134 (55.4)0.390364 (52.4)Full time employment, n(%)256 (56.5)202 (83.5)<0.001458 (65.9)Absenteeism17.9 (32.1)0-10.6 (26.2)Presenteeism48.6 (21.00)9.6 (8.3)-32.6 (25.6)

ASAS-HI, Assessment of SpondyloArthritis International Society-Health Index; BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; BASFI, Bath Ankylosing Spondylitis Functional Index; BMI, basal metabolic index; n, number of pts; SD, standard deviation; WP, work productivity; years, yrs

Conclusion:

There was a substantial impact on work participation for axSpA pts, despite numerous available therapeutic options. Pts with impaired work participation compared to pts with no impairment, reported increased fatigue, longer duration of morning stiffness, decreased functional capacity, female sex and a lower level of education.

References:

[1]Ramoda R et al. Arthritis Res Ther. 2016;78

Disclosure of Interests:

Uta Kiltz Speakers bureau: AbbVie, Biocad, Chugai, Eli Lilly, Grünenthal, Janssen, MSD, Novartis, Pfizer, Roche and UCB, Consultant of: AbbVie, Biocad, Chugai, Eli Lilly, Grünenthal, Janssen, MSD, Novartis, Pfizer, Roche and UCB, Grant/research support from: Abbvie, Amgen, Biogen, Fresenius, GSK, Novartis and Pfizer, Kirsten Hoeper Speakers bureau: Abbvie, Chugai, Gilead, Lilly, Novartis, Sandoz Hexal and Sanofi. Consultant of: Abbvie, Chugai, Gilead, Lilly, Novartis, Sandoz Hexal and Sanofi. Ludwig Hammel: None declared, Sebastian Lieb Employee of: Employee of Novartis, Andreas Haehle Employee of: Employee of Novartis, Dirk Meyer-Olson Speakers bureau: Abbvie, Amgen, Berlin Chemie, Bristol Myers Squibb, Cellgene, Chugai, Fresenius Kabi, GSK, Jansen Cilag, Lilly, Medac, Merck Sharp & Dome, Mylan, Novartis, Pfizer, Sandoz Hexal, Sanofi and UCB, Consultant of: Abbvie, Amgen, Berlin Chemie, Bristol Myers Squibb, Cellgene, Chugai, Fresenius Kabi, GSK, Jansen Cilag, Lilly, Medac, Merck Sharp & Dome, Mylan, Novartis, Pfizer, Sandoz Hexal, Sanofi and UCB.

AB0255 BASELINE CHARACTERISTICS OF PATIENTS WITH RHEUMATOID ARTHRITIS TREATED WITH UPADACITINIB IN GERMAN REAL-WORLD PRACTICE: RESULTS FROM THE POST-MARKETING OBSERVATIONAL UPwArds STUDY

Background:

The efficacy and safety of upadacitinib (UPA), a selective Janus kinase inhibitor, has been evaluated in the SELECT rheumatoid arthritis (RA) clinical program,1–6 but its real-world effectiveness remains to be investigated. The UPwArds study will assess the association of C-reactive protein (CRP) level with remission and other efficacy outcomes in patients with RA treated with UPA in German real-world practice.

Objectives:

To describe the baseline characteristics of patients enrolled in the UPwArds study.

Methods:

The prospective, open-label, multicenter, non-interventional, post-marketing UPwArds study included adult patients with moderate-to-severe RA (swollen joint count [SJC28] ≥3 and inadequate response or intolerance to ≥1 disease-modifying antirheumatic drug [DMARD]). Patients were treated with UPA 15 mg once daily, as monotherapy or in combination with methotrexate (MTX; 50:50 mono:combo enrollment planned), according to the German label. Variables assessed included medical history (disease duration, previous RA therapy, and vaccination status), CRP level, and disease activity (disease activity score [DAS28(CRP)], tender joint count [TJC28], and SJC28). There was no recruitment restriction regarding CRP level. This descriptive interim analysis reports patient baseline characteristics after enrollment was complete. All data were analyzed as observed, with no imputation of missing data.

Results:

533 patients (UPA monotherapy: 257 [48%]; UPA plus MTX: 276 [52%]) were included. Mean patient age was 58 years; mean disease duration was 9 years (Table 1). Despite having active RA, almost half the population (44%; n=237) did not have elevated CRP at the start of UPA treatment. Mean DAS28(CRP) was 4.6; mean TJC28 and SJC28 were 7.7 and 5.6, respectively. Overall, 39% of patients had not been treated with any biologic (b) DMARD or targeted synthetic (ts) DMARD before enrollment; 25% and 36% had previously been treated with 1 or ≥2 bDMARDs or tsDMARDs, respectively (Figure 1). 8.7% of patients had previously received a herpes zoster vaccination (8.1% Shingrix; 0.6% Zostavax).

Conclusion:

In German clinical practice, the population of patients with RA in the UPwArds study was predominantly treatment-refractory. Half of these patients had no elevated CRP despite active disease; future analyses will assess the impact of CRP on efficacy outcomes.

References:

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

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

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

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

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

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

Table 1.

Baseline characteristics

Age, yearsUPAUPA + MTXTotal57.7 (13.2)n=25758.1 (11.4)n=27657.9 (12.3)n=533Disease duration, years9.4 (8.3)8.5 (7.7)9.0 (8.0)n=253n=272n=525CRP, mg/dL1.3 (1.9)1.1 (1.7)1.2 (1.8)n=257n=276n=533CRP >ULN, n (%)137 (53.3)159 (57.6)296 (55.5)n=257n=276n=533TJC287.4 (6.0)7.9 (6.4)7.7 (6.2)n=257n=276n=533SJC285.5 (3.7)5.6 (4.1)5.6 (3.9)n=257n=276n=533Patient’s Global Assessment6.2 (1.9)6.3 (1.8)6.3 (1.8)n=257n=276n=533Physician’s Global Assessment5.8 (1.5)5.9 (1.6)5.9 (1.6)n=257n=276n=533DAS28(CRP)4.6 (1.0)4.6 (1.0)4.6 (1.0)n=257n=276n=533DAS28(ESR)4.8 (1.1)4.9 (1.2)4.9 (1.1)n=224n=239n=463CDAI24.9 (10.2)25.7 (10.8)25.4 (10.5)n=257n=276n=533SDAI26.2 (10.5)26.9 (11.3)26.6 (10.9)n=257n=276n=533RAID5.7 (2.0)5.7 (2.0)5.7 (2.0)n=255n=275n=530Pain (RAID-1)6.2 (2.2)6.1 (2.3)6.2 (2.2)n=255n=275n=530SF-12 Physical Component Summary32.6 (8.5)33.9 (8.6)33.3 (8.6)n=245n=262n=507SF-12 Mental Component Summary42.4 (11.6)42.6 (11.3)42.5 (11.5)n=245n=262n=507HAQ-DI1.3 (0.7)1.3 (0.6)1.3 (0.6)n=250n=270n=520PHQ-98.9 (5.3)8.6 (5.3)8.7 (5.3)n=252n=272n=524Erosions, n (%)87 (33.9)95 (34.4)182 (34.1)n=257n=276n=533

Data are mean (SD), n unless otherwise stated

Acknowledgements:

AbbVie funded this study; contributed to its design; participated in data collection, analysis, and interpretation of the data; and 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 Grant Thomas Kirkpatrick, MSc, of 2 the Nth (Cheshire, UK), and was funded by AbbVie.

Disclosure of Interests:

Torsten Witte Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Chugai, Gilead, Janssen, Lilly, MSD, Mylan, Novartis, Pfizer, Roche, and UCB., Uta Kiltz Consultant of: AbbVie, Biocad, Eli Lilly and Company, Grünenthal, Hexal, Janssen, MSD, Novartis, Pfizer, Roche, and UCB, Grant/research support from: AbbVie, Amgen, Biogen, Fresenius, GSK, Hexal, Novartis, and Pfizer, Florian Haas Consultant of: AbbVie, Celgene, Novartis, and Pfizer, Grant/research support from: AbbVie, BMS, Celgene, Chugai, MSD, Novartis, Pfizer, Roche, and Sanofi Genzyme, Elke Riechers Consultant of: AbbVie, Chugai, Novartis, and UCB, Grant/research support from: AbbVie, Chugai, Lilly, Janssen, Novartis, Pfizer, Roche, and UCB, Ulrich Prothmann Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Chugai, Glaxo Smith Kline, Novartis, Pfizer, Roche, Sanofi, SOBI, and UCB, Daniela Adolf Employee of: Employee of StatConsult and may own stock or options, Carsten Holland Employee of: Employee of AbbVie and may own stock or options, Rouven Hecht Employee of: Employee of AbbVie and may own stock or options, Alexander Roessler Employee of: Employee of AbbVie and may own stock or options, Kirsten Famulla Employee of: Employee of AbbVie and may own stock or options, Klaus Krueger Grant/research support from: AbbVie, Biogen, BMS, Celltrion, Gilead, Hexal, Janssen, Lilly, Medac, MSD, Novartis, Pfizer, Roche, and UCB.

POS0899 HOW DOES GENDER AFFECT SECUKINUMAB TREATMENT OUTCOMES AND RETENTION RATES IN PATIENTS WITH ANKYLOSING SPONDYLITIS? - REAL WORLD DATA FROM THE GERMAN AQUILA STUDY

Background:

Current studies suggest that the phenotype of spondyloarthritis differs between genders and that this may influence the subsequent diagnostic approach and therapeutic decisions1. The German non-interventional study AQUILA provides real-world data on the influence of gender on therapeutic effectiveness and retention rate under treatment with secukinumab, a fully human monoclonal antibody that selectively inhibits interleukin-17A.

Objectives:

The aim of this interim analysis is to describe selected baseline (BL) demographics, to evaluate secukinumab treatment outcomes on disease activity, global functioning and health and retention rate depending on the gender of AS patients.

Methods:

AQUILA is an ongoing, multi-center, non-interventional study including more than 3000 patients with active AS or psoriatic arthritis. Patients were observed from BL up to week (w) 52 according to clinical routine. Real-world data was assessed prospectively and analyzed as observed. Validated questionnaires were used to collect data on disease activity (Bath Ankylosing Spondylitis Disease Activity Index, BASDAI), global functioning and health (Assessment of SpondyloArthritis-Health Index, ASAS-HI) and severity of depressive mood (Beck´s Depression Inventory version II, BDI-II). Patient reported outcomes were reported using patient´s global assessment (PGA). In addition, retention rates (time from study inclusion until premature secukinumab treatment discontinuation) were assessed through Kaplan-Meier plots. This interim analysis focuses on the subgroups of male and female AS patients.

Results:

At BL, 683 AS patients were included: 59.7% (n=408) male and 40.3% (n=275) female. Demographic data (Table 1) of male and female AS patients differed numerically in the following parameters: proportion of obese patients, smokers, pretreatment with disease-modifying antirheumatic drugs (csDMARDs), and biologicals/biosimilars (b-bsDMARDs).

Mean BASDAI and PGA were comparable between male and female AS patients over time (♂: 5.2 at BL to 3.8 at w52, ♀: 5.3 at BL to 4.1 at w52 and ♂: 5.9 at BL to 4.1 at w52, ♀: 5.6 at BL to 4.3 at w52, respectively). Mean ASAS-HI over time was higher in women; nevertheless, improvements in global functioning were comparable for both genders from BL to week 52 (Fig. 1A). Severity of depressive mood was numerically lower in male patients; nevertheless, BDI-II reductions were comparable across the genders (♂: 11.2 at BL to 10.0 at w52, ♀: 13.1 at BL to 11.0 at w52). Secukinumab treatment retention rate for men was (not significantly) higher than for women (Fig. 1B).

Conclusion:

In a real-world setting, secukinumab improved disease activity, global functioning and severity of depressive mood in AS patients in both men and women. Women showed overall higher disease burden. Altogether, real-world data of this interim analysis are in line with those of Phase 3 studies and show that secukinumab is an effective treatment up to 52 weeks with high treatment retention rates, irrespective of gender.

References:

[1]Landi, M., et al. Medicine (Baltimore) 95, e5652 (2016).

Table 1.

Overview of baseline characteristics in AS patients depending on gender

Demographics*Male (N=408)Female (N=275)Age, years45.6 (12.1)47.8 (12.2)BMI, kg/m227.4 (4.5)27.6 (5.7)BMI >25 to ≤30 kg/m2, n (%)178 (45.1)88 (32.4)BMI >30 kg/m2, n (%)94 (23.8)83 (30.5)Smoker, n (%)150 (36.8)67 (24.4)BASDAI5.2 (1.9)5.3 (1.9)PGA5.8 (4.9)5.6 (5.6)ASAS-HI7.4 (3.5)8.2 (3.5)BDI-II11.2 (10.2)13.1 (13.0)Medication prior to secukinumab initiation, n (%):NSAID330 (80.9)222 (80.7)csDMARD145 (35.5)137 (49.8)b-bsDMARD249 (61.0)190 (69.1)

*variables given as mean (SD)

Figure 1.

Global functioning and secukinumab treatment retention in AS patients stratified by gender Note: P-values are of exploratory nature

Disclosure of Interests:

Uta Kiltz Consultant of: AbbVie, Biocad, Chugai, Eli Lilly, Gruenenthal, Janssen, MSD, Novartis, Pfizer, Roche, UCB, Grant/research support from: AbbVie, Biogen, Novartis, Pfizer, Jan Brandt-Juergens Consultant of: Abbvie, Affibody, BMS, Gilead, Janssen, Lilly, Medac, MSD, Novartis, Pfizer, Roche, Sanofi-Aventis, UCB, Peter Kästner Consultant of: Chugai, Novartis, Elke Riechers Consultant of: AbbVie, Chugai, Novartis, UCB, Grant/research support from: AbbVie, Chugai, Lilly, Janssen, Novartis, Pfizer, Roche, UCB, Daniel Peterlik Employee of: Novartis Pharma GmbH, Hans-Peter Tony Consultant of: AbbVie, Astra-Zeneca, BMS, Chugai, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, Sanofi

OP0298 ARE PATIENTS WITH PSORIATIC ARTHRITIS BEING TREATED OPTIMALLY ACROSS THE WORLD? DISPARITIES IN HEALTH CARE FOR PATIENTS WITH PSORIATIC ARTHRITIS ACROSS COUNTRIES WITH DIFFERENT GDP’S, AN ANALYSIS OF 429 PATIENTS FROM 13 COUNTRIES

Background:

In psoriatic arthritis (PsA), EULAR recommendations are to aim for remission or low disease activity(1). Many treatments are now available, though some are costly and not widely available in all countries. Country of patient care, and in particular Gross Domestic Product (GDP) may be linked to PsA outcomes(2). Although patients with high disease activity are eligible for targeted therapies such as biologic disease-modifying anti-rheumatic drugs (bDMARDs), they may not be able to get the benefits from these efficacious treatments in all countries equally.

Objectives:

The objective was to explore the rate of PsA patients with high to moderate disease activity, not receiving bDMARDs across countries, and to assess the consequences on functional incapacity.

Methods:

This was a cross-sectional analysis of an observational study (ReFlap, NCT03119805)(3), which included adult patients with PsA with ≥ 2 years disease duration from 14 countries. One country was excluded from this analysis since only 7 patients were included. We explored the rate of patients with significant disease activity (i.e based on DAPSA > 14) and no ongoing bDMARD prescription. Countries of inclusion were analysed separately, and classified into tertiles by GDP/capita (lowest tertile: Brazil, Turkey, Russia, Romania, Estonia; middle tertile: Spain, Italy, UK, France; highest tertile: Canada, Germany, USA and Singapore). The rate of no bDMARDs - DAPSA > 14 patients was analysed by country and compared between the 3 tertiles of GDP/capita by parametric tests. Functional capacity (HAQ) was compared between no bDMARDs - DAPSA > 14 patients and the other patients (pooling patients with moderate or high disease activity with bDMARD, low disease activity and remission with or without bDMARD). There was no imputation of missing data.

Results:

Of the 459 patients, 429 had complete data available and were analysed: mean age 52.3 (SD 12.6) years, mean disease duration 10.2 (SD 8.2) years, 215 (50.1%) males. The rate of no bDMARDs - DAPSA > 14 patients was 18.4% (76/414). The rate ranged from 7.4% (UK and Spain) to 40% (Russia): Figure 1. A link was seen with the country and the tertiles of countries according to GDP/capita, with higher rate of no bDMARDs - DAPSA > 14 patients in the lowest GDP/capita countries (28.8%, 15.3% and 14.3% in the 3 GDP/capita tertiles, respectively, p=0.005; Figure 1). Of note, 40/76 no bDMARDs - DAPSA > 14 patients received a treatment intensification during the visit. Among no bDMARDs - DAPSA > 14 patients, functional incapacity was higher than in the other patients, as expected (mean HAQ 0.96 (SD 0.64) vs 0.57 (SD 0.63), p<0.001).

Figure 1.

The size of the bubbles represent the number of patients per country (range, 13 to 89). The horizontal lines represent the mean proportion of patients with no bDMARDs – DAPSA > 14 for each tertiles of countries by GDP/capita.

Conclusion:

In this exploratory comparison of disease patterns and treatments choices in 13 countries, we observed that more PsA patients with high or moderate disease activity and living in low GDP/capita countries were less likely to be treated with bDMARDs. As a consequence, no bDMARDs – DAPSA > 14 patients had worse functional incapacity. Equitable access to bDMARDs should be aimed for all patients regardless of their country of origin.

References:

[1]Gossec L et al. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update. Ann Rheum Dis. 2020 Jun;79(6):700-712.

[2]Gossec L et al. Are There Country Differences in Disease Activity and Life Impact of Psoriatic Arthritis? An Analysis of 436 Patients from 14 Countries [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10).

[3]Gorlier C et al. Comparing patient-perceived and physician-perceived remission and low disease activity in psoriatic arthritis: an analysis of 410 patients from 14 countries. Ann Rheum Dis. 2019 Feb;78(2):201-208.

Disclosure of Interests:

None declared.

POS0973 CONTEXTUAL FACTORS SHOULD COMPLETE THE ASSESSMENT OF FUNCTIONING IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS (axSpA)

Background:

Functioning of patients (pts.) with axial spondyloarthritis (axSpA) is influenced by a variety of factors. In contrast to clinical factors, the influence of contextual factors on functioning has not been well studied. According to the According to the International Classification of Functioning, Disability and Health (ICF), functioning is a complex interaction between health status and contextual factors such as social support, relationships and attitudes.

Objectives:

The aim of this study is to understand limitations in participation and to investigate barriers and facilitators of contextual factors in pts. with axSpA.

Methods:

Consecutive axSpA pts. underwent a standardized assessment with collection of patient and disease characteristics, patient-reported outcomes (ASDAS, BASFI, BASMI, PHQ-9, ICF Measure of Participation and ACTivities questionnaire (IMPACT-S (0-100%)), ASAS Health Index (ASAS HI and environment factor item set (EFIS) (1). The EFIS contains 9 dichotomous questions addressing ICF categories of products and technologies (e1), support and relationship (e3), attitudes (e4) and health services (e5). Validated cut-offs of ASAS HI were used to categorize global functioning.

Results:

A total of 200 axSpA pts. were included: 69% males, 44.3±12.5 years, symptom duration 17.9±12.6 years, ASDAS 2.5±1.1, BASFI 4.0±2.7, BASMI 3.5±1.8, ASAS HI 7.0±4.1. Pts. reported limitations in the IMPACT-S activity and participation domain (82.3% (15.2) and 83.5% (16.8), respectively. The majority of pts. reported as barrier that treatment of axSpA requires time (e4, 58.5%). A minority of pts. but quite a few reported as barrier the need for support by family members (e3, 43.5%), the need to modify home and work environment (e1, 39.5%) and that they cannot rely on family members for help (e3, 22%). Some pts. (< 20%) reported that they have problems to be understood by health care professionals when experiencing a flare (e5, 18.5%), that pts. at home are not adequately taken care of (e4, 18.5%), disliking friends’ behavior toward them (e4, 13.5%), and that friends are too demanding (e4, 13%). The majority of pts. (e4, 75.9%) identified attitudes of friends as the only and major facilitator. All pts. reporting at least one barrier had significantly worse global functioning (ASAS HI, IMPACT-S), and depression (PHQ-9) compared to patients who reported no barriers in the respective ICF categories (p< 0.01). Similarly, pts. with poor functioning are more likely to report barriers in contextual factors compared to pts. with good functioning (Table 1). Pts. having to ask for more support from their families expressed the feeling that they cannot rely on that.

Conclusion:

Barriers more than facilitators of contextual factors are present in pts. with axSpA. This study shows that barriers in contextual factors are more common in pts. with impairments in self-reported and performed functioning as in those without impairments. This underlines the importance of contextual factors in the management of axSpA pts.

References:

[1]Kiltz et al. Ann Rheum Dis 2013;72(s3):572

Table 1.

Presence of contextual factors, stratified for global functioning categories

ICF categoryEFIS ItemGlobal Functioning (ASAS HI 0-17)Good ≤ 5(n= 69)Moderate <5 to <12(n= 106Poor ≥ 12(n= 25)e3EFIS 1: As a result of my rheumatic disease, the children take more responsibility for household tasks.11 (15.9)55 (51.9)21 (84)e3EFIS 2: I don’t like the way my friends acts around me.0 (0)15 (14,2)12 (48,0)e3EFIS 3: I can’t count on my relatives to help me with my problems11 (15,9)24 (22,6)9 (36)e1EFIS 4: I modify my home and work environments.16 (23,2)47 (44,3)9 (36)e5EFIS 5: I have difficulties getting worsening of my disease acknowledged by a health care professional3 (4,3)21 (19,8)16 (64)e5EFIS 6: Treatment of my rheumatic disease is taking up time22 (31,9)73 (68,9)22 (88)e4,EFIS 7: My friends expect too much of1 (1,4)18 (17,0)7 (28)e4EFIS 8: No one pays much attention to me at home10 (14,5)20 (18,9)7 (28)e4EFIS 9: My friends understand me56 (17,4)83 (78,3)12 (48)

values given as number (%)

Disclosure of Interests:

None declared.

AB0684 LESS THAN 20% OF PATIENTS WITH A CHRONIC INFLAMMATORY RHEUMATIC DISEASE CHANGED THEIR IMMUNOSUPPRESSIVE MEDICATION BECAUSE OF THE COVID 19 PANDEMIC

Background:

The best treatment options of patients with chronic inflammatory rheumatic diseases (CIRD) in the pandemic have not been completely clear, especially in the beginning of the lockdown. Whether and to which degree pandemic-related therapy changes have occurred, has not been studied in detail.

Objectives:

To study the behaviour of patients with CIRD initially facing the COVID 19 pandemic related to their disease status and medication.

Methods:

Patients with CIRD were contacted by telephone to assess their health status and ask for changes in medication. Standardized assessment tools were used to assess disease activity, depression and anxiety. High disease activity was assumed if RADAI-5 ≥ 3.2 and BASDAI ≥ 4. Anxiety (HADS-A) and depression (HADS-D) of patients were assessed using HADS. A score < 8 was taken as indication of no major problem in this regard.

Results:

A total of 886 patients was interviewed between April 15 and June 15 of 2020. Here we report on 550 patients with complete information on standard assessments (62%). About 60% were female, mean age 54.4±13.7, mean disease duration 12.2±10.5 years. Most had spondyloarthritis (SpA, n=287) including axial SpA (axSpA, n=172) and psoriatic arthritis (PsA, n=116), in total 52.2%, while 40.2% had rheumatoid arthritis (RA, n=221), and 7.6% connective tissue diseases (CTD, n=42). Most RA patients were on methotrexate (48.8%), while 43.8% took glucocorticoids. In addition, 61.0% of patients were on bDMARDs, mostly on TNF inhibitors (59.6%). More SpA than RA patients were on bDMARDs: 71.0% vs 49.7% respectively. A recent change in medication was reported by 182 patients (33.1%): 89 with RA (40.2%), 88 with SpA (30.6%) and 5 with CTD (11.9%). Half of those who changed (n=92; 50.5%) admitted that the change was mainly made due to fear of the pandemic (16.7% of all patients). Altogether, significantly more patients changed bDMARDs (68.5%) than csDMARDs (57.3%). The data of patients who changed vs patients who didn’t change is shown in the Table 1, including subgroup analyses. The median HADS scores were < 8.

Table 1.

RA and SpA patients who changed and who did not change their medication

Group (N) / ReasonNActive disease (%)HADS-D≥ 8 (%)HADS-A≥ 8 (%)bDMARD therapy (%)Rheumatoid arthritis221134 (60.6)76 (35.0) [4]94 (43.3) [4]110 (50.9) [5]Spondyloarthritis287130 (45.4)83 (29.5) [6]109 (38.8) [6]204 (72.6) [6]  Pa (RA vs SpA)<0.0010.2280.354<0.001Patients did not change their medication Rheumatoid arthritis (%)132 (59.7)84 (63.6)46 (35.9) [4]58 (45.3) [4]62 (48.4) [4] Spondyloarthritis (%)199 (69.3)88 (44.2)58 (30.1) [6]69 (35.8) [6]137 (71.0) [6]  P (RA vs SpA)0.031<0.0010.3580.101<0.001Patients changed their medication Rheumatoid arthritis89 (40.3)50 (56.2)30 (33.7)36 (40.4)48 (54.5) [1]  P (vs no change)0.3310.8460.5670.457  Reason[9] Pandemic41 (51.3)15 (36.6)11 (26.8)14 (34.1)24 (60.0) [1] Inactive disease23 (28.8)12 (52.2)6 (26.1)10 (43.5)12 (52.2) Active disease b16 (20.0)14 (87.5)6 (37.5)7 (43.8)7 (43.8)  P (reasons)0.0030.6870.6870.526 Spondyloarthritis88 (30.7)42 (47.7)25 (28.4)40 (45.5)67 (76.1)  P (vs no change)0.6730.8890.1570.451  Reason[6] Pandemic50 (61.0)22 (44.0)13 (26.0)22 (44.0)42 (84.0) Inactive disease15 (18.3) 7 (46.7)4 (26.7)7 (46.7)10 (66.7) Active disease b17 (20.7)11 (64.7)6 (35.3)6 (35.3)11 (64.7)  P (reasons)0.3310.7560.7740.156  P (RA vs SpA)0.0310.2940.9500.6030.004

Data are presented as numbers (percentage proportions; across rows except for column N) or medians (interquartile ranges). Missing values are in square brackets.

a P values calculated using χ2 test or Mann-Whitney rank sum test.

b Self-reported claim of disease activity.

Conclusion:

Two thirds of patients did not change medication but one third changed. A relatively high number of patients did so due to fear of the pandemic, mostly those on biologics. There were no major differences between RA and SpA. Anxiety and depression do not seem to play an important role for the decision to change medication (Table 1 below).

Disclosure of Interests:

None declared

POS0234 SECUKINUMAB RETENTION AND SAFETY IN PATIENTS WITH ACTIVE PSORIATIC ARTHRITIS OR ANKYLOSING SPONDYLITIS: 2 YEAR INTERIM RESULTS OF THE OBSERVATIONAL SERENA STUDY

Background:

SERENA is an ongoing, prospective, non-interventional study evaluating retention, effectiveness, safety/tolerability and quality of life in more than 2900 patients (pts) with moderate to severe plaque psoriasis, active psoriatic arthritis (PsA) or active ankylosing spondylitis (AS) treated with secukinumab (SEC) at 438 sites across Europe for a period of up to 5 years1.

Objectives:

We present interim results reporting SEC treatment retention and safety data through 2 years in the PsA and AS pts enrolled in the study.

Methods:

This interim analysis presents data from 534 PsA and 470 AS pts who were enrolled (target population fulfilling all eligibility criteria) in the study and were followed up for at least 2 years. Pts (aged ≥18 years) with active PsA or AS should have received at least 16 weeks SEC treatment before enrolment in the study1. Retention rate was defined as the percentage of pts who have not discontinued SEC treatment. A treatment break was defined as interruption of therapy for at least 3 months after last injection.

Results:

The mean treatment duration prior to enrolment in the study was 1.0 year and 0.91 year for PsA and AS, respectively. The retention rates for SEC after 1 year since enrolment and since initiation of treatment were: PsA, 85.2% [n=519, CI: 82.01–88.32] and 96.8% [n=528, CI: 95.18–98.38]; AS, 85.8% [n=452, CI: 82.52–89.17] and 94.2% [n=464, CI: 91.94–96.42], respectively. After 2 years since enrolment and since initiation of treatment, the retention rates were: PsA, 74.9% [n=498, CI: 70.99–78.81] and 87.0% [n=515, CI: 83.99–89.99]; AS, 78.9% [n=437, CI: 75.01–82.88] and 84.8% [n=454, CI: 81.39–88.21], respectively. Survival probabilities for individual indications are presented in Figure 1. At baseline, the majority of PsA (79.5%; n/N=423/532) pts were receiving SEC 300 mg, while 97.0% (n/N=456/470) of AS pts were receiving SEC 150 mg. The majority of pts continued their initial SEC dose; “no dose change” in SEC treatment was reported after 1 and 2 years in the study (Year 1: PsA, 93.4% [n=499] and AS, 92.6% [n=435]; Year 2: PsA, 89.7% [n=479] and AS, 87.9% [n=413]). SEC treatment break was recorded for 31 PsA pts [median (min, max) treatment break duration in days: 125.0 (61, 461)] and for 42 AS [118.0 (61, 813)] pts mainly due to adverse events reported in 58.1% (n=18) and 45.2% (n=19) of pts, respectively. The retreatment started with monthly dosing in most of the cases: PsA, 80.6% (n/N=25/31) and AS, 76.2% (n/N=32/42). No new or unexpected safety signals were reported (Table 1).

Table 1.

Safety profile of treatment-emergent adverse events within the study period

AE summary, n (%)PsA N=575AS N=499Year 1Year 2Year 1Year 2Subject with any AE239 (41.6)289 (50.3)203 (40.7)247 (49.5)Subject with any serious AE29 (5.0)45 (7.8)29 (5.8)44 (8.8)Subject with AE leading to discontinuation55 (9.6)84 (14.6)47 (9.4)62 (12.4)Death0 (0.0)0 (0.0)0 (0.0)1 (0.2)AEs of special interest, n (IR per 100 subject-years)Serious infections and infestations5 (0.96)9 (0.95)8 (1.78)11 (1.33)Candida infections1 (0.19)2 (0.21)2 (0.44)2 (0.24)Malignancy5 (0.96)7 (0.74)N/R3 (0.36)Major adverse cardiovascular eventsN/R1 (0.11)2 (0.44)3 (0.36)Inflammatory bowel diseaseN/RN/R1 (0.22)1 (0.12)

N, total number of patients in the safety set; n, number of patients with event; AE, adverse events; IR, incidence rate; N/R, not reported.

Conclusion:

Secukinumab retention rates in a real world setting after more than 2 years since initiation of treatment and after 2 years since enrolment in the study indicate high persistence rates. Safety data collected prospectively for up to 2 years confirm the favorable safety profile of secukinumab.

References:

[1]Kiltz, U et al. Adv Ther 2020; 37:2865–83.

Disclosure of Interests:

Uta Kiltz Consultant of: AbbVie, Biocad, Biogen, Chugai, Eli Lilly, Grünenthal, Hexal, Janssen, MSD, Novartis, Pfizer, Roche and UCB, Grant/research support from: AbbVie, Biocad, Biogen, Chugai, Eli Lilly, Grünenthal, Hexal, Janssen, MSD, Novartis, Pfizer, Roche and UCB, Petros Sfikakis Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Celgene, Eli-Lilly, Janssen, Novartis and Pfizer, Grant/research support from: AbbVie, Amgen, Boehringer Ingelheim, Celgene, Eli-Lilly, Janssen, Novartis and Pfizer, Nicola Gullick Speakers bureau: AbbVie, Celgene, Eli Lilly, Izana, Janssen, Novartis, UCB., Consultant of: AbbVie, Celgene, Eli Lilly, Izana, Janssen, Novartis, UCB., Grant/research support from: AbbVie, Celgene, Eli Lilly, Izana, Janssen, Novartis, UCB., Athina Theodoridou Consultant of: UCB, Amgen, Novartis, Jan Brandt-Juergens Speakers bureau: AbbVie, Pfizer, Roche, Sanofi-Aventis, Novartis, Lilly, MSD, UCB, BMS, Janssen, and Medac, Consultant of: AbbVie, Pfizer, Roche, Sanofi-Aventis, Novartis, Lilly, MSD, UCB, BMS, Janssen, and Medac, Eric Lespessailles Speakers bureau: Amgen, Expanscience, Lilly and MSD, Consultant of: Amgen, Expanscience, Lilly and MSD, Grant/research support from: Abbvie, Amgen, Lilly, MSD and UCB, Rasho Rashkov Speakers bureau: AbbVie, Amgen, Pfizer, Novartis, MSD, UCB, Roche and Janssen, Consultant of: AbbVie, Amgen, Pfizer, Novartis, MSD, UCB, Roche and Janssen, Jenny Fang Employee of: Novartis, Effie Pournara Shareholder of: Novartis, Employee of: Novartis, Barbara Schulz Employee of: Novartis, Piotr Jagiello Employee of: Novartis, Karl Gaffney Speakers bureau: AbbVie, Celgene, Lilly, Pfizer, Gilead, MSD, Novartis and UCB, Consultant of: AbbVie, Celgene, Lilly, Pfizer, Gilead, MSD, Novartis and UCB, Grant/research support from: AbbVie, Celgene, Lilly, Pfizer, Gilead, MSD, Novartis and UCB.

OP0047 IDENTIFICATION OF CLINICAL PHENOTYPES IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS, PERIPHERAL SPONDYLOARTHRITIS AND PSORIATIC ARTHRITIS ACCORDING TO PERIPHERAL MUSCULOSKELETAL MANIFESTATIONS: A CLUSTER ANALYSIS IN THE INTERNATIONAL ASAS-PERSPA STUDY

Background:

Patients with a diagnosis of Spondyloarthritis (SpA) and Psoriatic Arthritis (PsA) may have predominant axial or peripheral symptoms, and the frequency and distribution of these symptoms may determine the clinical diagnosis by the rheumatologist (“clinical clusters”). Clustering analysis represents an unsupervised exploratory analysis which tries to identify homogeneous groups of cases (“statistical clusters”) without prior information about the membership for any of the cases.

Objectives:

To identify “statistical clusters” of peripheral involvement according to the specific location of these symptoms in the whole spectrum of SpA and PsA (without prior information about the diagnosis of the patients), and to evaluate whether these “statistical clusters” are in agreement with the “clinical clusters”.

Methods:

Cross-sectional and multicentre study with 24 participating countries. Consecutive patients considered by their treating rheumatologist as suffering from either PsA, axial SpA (axSpA) or peripheral SpA (pSpA) were enrolled. Four different cluster analyses were conducted: the first one using information about the specific location from all the peripheral musculoskeletal manifestations (i.e., peripheral arthritis, enthesitis and dactylitis), and thereafter a cluster analysis for each peripheral manifestation individually. Multiple correspondence analyses and k-means clustering methods were used. Distribution of peripheral manifestations and clinical characteristics were compared across the different clusters.

Results:

4465 patients were included in the analysis. Two clusters were found with regard to the location of all the peripheral manifestations (Fig. 1). Cluster 1 showed a low prevalence of peripheral manifestations in comparison with cluster 2; however, when peripheral involvement appeared in cluster 1, this was mostly represented by arthritis of hip, knee and ankle, as well as enthesitis of the heel. Patients from cluster 1 showed a higher prevalence of males (63% vs 44%), HLA-B27 positivity (69% vs 38%) and axial involvement (80% vs 52%), as well as more frequent diagnosis of axSpA (66% vs 21%) and more frequently fulfilling the ASAS axSpA criteria (69% vs. 41%). Patients from cluster 2 showed a higher prevalence of psoriasis (63% vs 25%), a more frequent diagnosis of PsA (61% vs 19%), and they fulfilled more frequently the peripheral ASAS (26% vs 11%) and the CASPAR criteria (57% vs 19%).

Figure 1.

Distribution of the peripheral involvement across clusters

Three clusters were found with regard to the location of the peripheral arthritis. Clusters 2 and 3 showed a high prevalence of peripheral joint disease, although this was located more predominantly in the lower limbs in cluster 2, and in the upper limbs in cluster 3. Cluster 1 showed a higher prevalence of males, HLA-B27 positivity, axial involvement, a lower presence of psoriasis, a more frequent diagnosis of axSpA and fulfilling the ASAS axSpA criteria in comparison with clusters 2 and 3, respectively. Clusters 2 and 3 showed a higher prevalence of enthesitis and dactylitis in comparison with cluster 1, a more frequent diagnosis of PsA and fulfillment of the CASPAR criteria.

Information about the location of enthesitis exhibited three groups: cluster 1 showed a very low prevalence of enthesitis, while cluster 2 and 3 showed a high prevalence of enthesitis, with a predominant involvement of axial enthesis in cluster 2 and peripheral enthesitis in cluster 3.

Finally, the analysis of dactylitis also exhibited three clusters that showed a very low prevalence of dactylitis, predominantly toes and predominantly fingers involvement, respectively.

Conclusion:

These results suggest the presence of heterogeneous patterns of peripheral involvement in SpA and PsA patients without clearly defined groups, confirming the clear overlap of these peripheral manifestations across the different underlying diagnoses.

Acknowledgements:

This study was conducted under the umbrella of ASAS with unrestricted grant of Abbvie, Pfizer, Lilly, Novartis, UCB, Janssen and Merck.

Disclosure of Interests:

None declared

POS1023 HOW DOES GENDER AFFECT SECUKINUMAB TREATMENT OUTCOMES AND RETENTION RATES IN PATIENTS WITH PSORIATIC ARTHRITIS? – REAL WORLD DATA FROM THE GERMAN AQUILA STUDY

Background:

Gender disparities in PsA can affect natural course of disease, clinical presentation and response to medication1. The German non-interventional study AQUILA provides real-world data on the influence of gender of patients with psoriatic arthritis (PsA) on therapeutic effectiveness and retention rate under treatment with secukinumab, a fully human monoclonal antibody that selectively inhibits interleukin-17A.

Objectives:

The aim of this interim analysis is to describe selected baseline (BL) demographics, to evaluate secukinumab treatment outcomes on disease activity, depressive mood and retention rate depending on the gender of PsA patients.

Methods:

AQUILA is an ongoing, multi-center study including more than 3000 patients with active PsA or ankylosing spondylitis. Patients were observed from BL up to week (w) 52. Real-world data was assessed prospectively and analyzed as observed. Data was collected on impact of disease (Psoriatic Arthritis Impact of Disease - 12 items, PsAID-12 score), skin disease activity (Psoriasis Area and Severity Index, PASI), joint counts and severity of depressive mood (Beck´s Depression Inventory version II, BDI-II), in addition to patient´s global assessment (PGA). Moreover, retention rates (time from study inclusion until premature secukinumab treatment discontinuation) were assessed through Kaplan-Meier plots. This interim analysis focuses on the subgroups of male and female PsA patients.

Results:

At BL, 1278 PsA patients were included: 41.5% (n=531) male and 58.5% (n=747) female. Demographic data (Table 1) of male and female PsA patients differed most obviously regarding proportion of overweight patients, smokers, pretreatment with nonsteroidal anti-inflammatory drugs (NSAIDs) and biologicals/biosimilars (b-bsDMARDs).

Mean PsAID-12 values over time were higher in women; nevertheless, PsAID-12 improved comparably for both genders from BL to week 52 (♂: 4.8 at BL to 2.9 at w52, ♀: 5.3 at BL to 3.5 at w52, Figure 1A). This was similar to the course of improvements for mean PGA across genders (♂: 4.9 at BL to 3.0 at w52, ♀: 5.6 at BL to 3.5 at w52). In terms of PASI scores, both BL mean values and improvements over time were similar across genders (♂: 6.8 at BL to 1.9 at w52, ♀: 7.0 at BL to 1.0 at w52). Mean joint counts (tender/swollen) also improved similarly (♂: 6.8/3.7 at BL to 3.1/0.9 at w52, ♀: 7.3/3.7 at BL to 2.8/0.9 at w52). Over time, male patients showed overall reduced BDI-II values; nevertheless, BDI-II reductions were comparable across the genders (♂: 10.2 at BL to 8.1 at w52, ♀: 13.0 at BL to 10.6 at w52). Secukinumab treatment retention rate for men was (not significantly) higher than for women (Figure 1B).

Conclusion:

In a real-world setting, secukinumab improved disease activity and depressive mood of PsA patients in both men and women. Women showed overall higher burden of disease. Altogether, this interim analysis shows that secukinumab is an effective treatment up to 52 weeks with high treatment retention rates in real-world setting, irrespective of gender.

References:

[1]Eder, L., Chandran, V. & Gladman, D.D. Int J Clin Rheumtol7, 641-649 (2012).

Table 1.

Overview of baseline characteristics in PsA patients depending on gender

Demographics*Male (N=531)Female (N=747)Age, years51.9 (11.6)53.1 (11.2)BMI, kg/m229.1 (4.9)29.0 (6.4)BMI >25 to ≤30 kg/m2, n (%)219 (42.8)211 (29.5)BMI >30 kg/m2, n (%)188 (36.7)285 (39.8)Smoker, n (%)103 (19.4)196 (26.2)PsAID-124.8 (2.2)5.3 (2.2)PGA4.9 (2.6)5.6 (2.4)PASI6.8 (9.8)7.0 (11.1)Tender joint counts6.8 (7.9)7.3 (7.4)Swollen joint counts3.7 (5.3)3.7 (5.0)BDI-II10.2 (8.8)13.0 (9.4)Medication prior to secukinumab initiation, n (%):NSAID290 (54.6)467 (62.5)csDMARD460 (86.6)678 (90.8)b-bsDMARD299 (56.3)477 (63.9)

*variables given as mean (SD)

Figure 1.

Impact of disease and treatment retention in PsA patients stratified by gender A) PsAID-12 (mean) B) Retention rate Note: P-values are of exploratory nature

Disclosure of Interests:

Uta Kiltz Consultant of: AbbVie, Biocad, Chugai, Eli Lilly, Gruenenthal, Janssen, MSD, Novartis, Pfizer, Roche, UCB, Grant/research support from: AbbVie, Biogen, Novartis, Pfizer, Jan Brandt-Juergens Consultant of: Abbvie, Affibody, BMS, Gilead, Janssen, Lilly, Medac, MSD, Novartis, Pfizer, Roche, Sanofi-Aventis, UCB, Peter Kästner Consultant of: Chugai, Novartis, Elke Riechers Consultant of: AbbVie, Chugai, Novartis, UCB, Grant/research support from: AbbVie, Chugai, Lilly, Janssen, Novartis, Pfizer, Roche, UCB, Daniel Peterlik Employee of: Novartis Pharma GmbH, Hans-Peter Tony Consultant of: AbbVie, Astra-Zeneca, BMS, Chugai, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, Sanofi.

[Standardized documentation of health-related quality of life in patients with psoriatic arthritis : Validation of the German version of the psoriatic arthritis quality of life (PsAQoL) questionnaire]

BACKGROUND

The standardized assessment of health-related quality of life is becoming increasingly more important. The English questionnaire on psoriatic arthritis quality of life (PsAQoL) is a disease-specific instrument for measuring the quality of life of patients with psoriatic arthritis (PsA). The aim of the present study was to translate the PsAQoL into German and to validate the German version in a cohort of PsA patients recruited from routine care.

METHOD

The translation and validation of the PsAQoL questionnaire was carried out in a stepwise procedure involving affected patients with PsA. After translation of the original English questionnaire the German version was evaluated in a field test. The psychometric features of the questionnaire were then examined in a PsA cohort from routine care. In addition to the construct and group validity, the reliability of the questionnaire was tested using test-retest reliability and internal consistency. The physical functioning was measured with the health assessment questionnaire (HAQ) and domains of the quality of life with the Nottingham health profile (NHP).

RESULTS

In a field test with 10 patients the German version of the PsAQoL questionnaire proved to be relevant, easily understandable and feasible (processing time 4.7 ± 2.1 min). A total of 126 patients (37.3% male, age 55.6 ± 11.3 years) were included in the validation cohort. The PsAQoL showed moderate correlation with the HAQ (r = 0.65) and moderate to good correlation with the NHP (subdomains r = 0.58-0.75). The internal consistency was high (Cronbach's α 0.92) and reliability in patients with stable disease course was very good (Spearman correlation coefficient 0.94). The PsAQoL can differentiate between different patient groups.

CONCLUSION

The German translation of the PsAQoL provides a valid disease-specific instrument for the standardized assessment of health-related quality of life in patients with PsA. The psychometric characteristics of this questionnaire are comparable with the original English version. The German PsAQoL can therefore be recommended for clinical and scientific application.