Improvement in patient-reported outcomes and work productivity following 3-year ustekinumab or tumour necrosis factor inhibitor treatment in patients with psoriatic arthritis: results from the PsABio real-world study

BACKGROUND

To evaluate the real-world effect of the IL-12/23 inhibitor ustekinumab or of a tumour necrosis factor inhibitor (TNFi) on patient-reported outcomes (PRO) and their association with effectiveness endpoints in psoriatic arthritis (PsA) patients over 3 years.

METHODS

In PsABio (NCT02627768), a prospective, observational study, patients with PsA that were prescribed first- to third-line ustekinumab or a TNFi, and remained on that drug for 3 years, were analysed for change in baseline in PROs (EuroQol-5 dimensions health state VAS [EQ-5D VAS], 12-item Psoriatic Arthritis Impact of Disease questionnaire [PsAID-12; range 0-10], Work Productivity and Activity Impairment for Psoriatic Arthritis questionnaire [WPAI; results expressed as a percentage for each domain]), and the association between PROs and WPAI with effectiveness endpoints, clinical disease activity index for psoriatic arthritis (cDAPSA), low disease activity (LDA)/remission, minimal disease activity (MDA) and very low disease activity (VLDA).

RESULTS

In 437 patients (mean age 49.1 years, 47.8% female), at 3 years, ustekinumab and TNFi treatment led to comparable improvements in EQ-5D VAS; mean change from baseline (95% confidence intervals [CI]) was 11.0 (6.5; 15.4) and 18.9 (14.0; 23.9), respectively. Both groups improved PsAID-12 after 3 years; mean change from baseline (95% CI) was -2.9 (-3.2; -2.5) and -3.5 (-3.9; -3.2), respectively. At baseline, due to their PsA, TNFi-treated patients had lower work productivity compared to ustekinumab-treated patients; mean productivity reduction (95% CI) was 58.8 [52.4; 65.2] and 43.3 [35.6; 51.1]. Over 3 years, TNFi-treated patients had a greater improvement in work productivity compared to ustekinumab-treated patients, ultimately leaving work productivity to be comparable between groups; mean improvement (95% CI) was 44.5% (38.4; 50.6) and 24.9% (15.8; 34.0), respectively. A similar trend was observed in activity impairment. Patients in both treatment groups who achieved effectiveness endpoints, cDAPSA LDA/remission, MDA, and VLDA had greater improvement in PROs and WPAI than patients who did not achieve these endpoints.

CONCLUSIONS

At 3 years, improvements in PROs following ustekinumab or TNFi treatment were generally comparable; however, TNFi-treated patients achieved a greater improvement in work productivity, although this group started from a lower baseline. Achievement of effectiveness endpoints, independent of treatment group, also improved PROs.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT02627768. Registered on 11 December 2015.

AB0907 TREATMENT WITH UPADACINITIB IN REFRACTORY PSORIATIC ARTHRITIS. MULTICENTER STUDY OF FIRST PATIENTS OF CLINICAL PRACTICE

Background

Upadacitinib (UPA) is an inhibitor of JAK kinases recently approved by EMA for the treatment of psoriatic arthritis (PsA) in Europe (January 2021) 1. UPA has shown efficacy in refractory patients to anti-TNF 2.

Objectives

A) to assess efficacy and safety of UPA in the first cases in Spain in clinical practice. B) to compare the profile of clinical practice patients with clinical trial of UPA in PsA refractory to biologics 2.

Methods

Study of 39 patients of clinical practice with PsA treated with UPA in Spain. The diagnosis of PsA was made using CASPAR criteria. Patients who received at least one dose of UPA were included. Results are expressed as percentage, mean±SD or median [IRQ].

Results

39 patients (29♀/10♂), mean age of 51.5 ± 11.4 years (Table 1). Pattern joint involvement was as follows: peripheral (n=19), axial (3) and mixed (17) During the PsA evolution, patients also presented enthesitis (59%) nail involvement (28.2%) and dactylitis (35.9%).

Table 1.CLINICAL PRACTICE N=39CLINICAL TRIAL N=211pBaseline demographic parametersAge, years (mean±SD)51.5±11.453.0 ± 12.00.4706Sex, n (%) female29 (74.4)113 (53.6)0.016Disease CharacteristicsDuration of psoriatic arthritis, year (mean±SD)12.41±8.689.5 ± 8.40.0499HAQ-DI1.10± 0.421.10 ± 0.61.000Swollen joint count, mean±SD6±7.2911.3 ± 8.2< 0.001Painful joint count, mean±SD7.48±7.5824.9 ± 17.3< 0.001Enthesitis, n (%)23 (59.0) MASES172 (81.5) SPARCCDactylitis, n (%)14 (35.9)55(26.1)0.217PASI score, mean±SD2.72±2.3210.1 ± 9.2< 0.001CRP (mg/L)11.1±18.8611.2 ± 18.51.000Oral glucocorticoid use, n (%)17 (43.6)22 (10.4)< 0.001Concomitant synthetic DMARDs, n (%)16(41)98 (46,4)0.532Previous use of biological DMARDs, n (%)39(100)195 (92.4)0.075Number of prior failed biologic DMARDs, n(%)13(7.7)135 (63.7)<0.00124(10.3)35 (16.5)0.383≥332(82)24 (11.3)<0.001UPA in monotherapy, n (%)23(59)113 (53.6)0.531

HAQ-DI Health Assessment Questionnaire-Disability Index, PASI Psoriasis Area Severity Index, CRP C-reactive protein, DMARD disease-modifying antirheumatic drug

Prior to UPA, most patients (59%) had received oral prednisone or equivalent (max 9.03±12.12mg/d), synthetic immunosuppressants (mean1.8±0.9) and biological therapy (TB) (4.5±2.1). TB were as follows: etanercept (25), adalimumab (28), infliximab (12), golimumab (16), certolizumab (15), secukinumab (29), ustekinumab (21) Abatacept (2), brodalumab (1) and ixekizumab (17). Apremilast was used in 13, Tofacitinib in 11 and filgotinib in 1.

After a mean follow-up of 12.41± 8.68.3 years after the PsA diagnosis, UPA was started (15 mg/24 h), 43.6% associated prednisone (7.35±3.36 mg/d). In 16 (41%) UPA was started in combined therapy: methotrexate (9), salazopyrin (3) and leflunomide (4); in the remaining 23 (59%), monotherapy was prescribed. At UPA onset patients presented peripheral arthritis (76.9%), axial involvement (35.8%), skin involvement (25.6%), enthesitis (41%), and dactylitis (10.3%).

Patients of clinical practice compared with clinical trial there were more women, have a longer duration of PsA, and received a higher proportion of previous TB (Table 1).

After a median follow-up of 4.28 ± 2.6 months, patients showed prompt improvement in activity indexes (DAS28, DAPSA) (Figure 1) and laboratory test (CRP mg/L decreased from 4.00 [1.5;10.0] to 0.40 [0.30;4.00] (p 0.024) at the sixth month. Extra-articular manifestations also improved: dactylitis in 25% patients, enthesitis (43.8%), skin involvement (40%) and onychopathy (50%).

Figure 1.

No serious events were reported. Minor side effects were reported in 7 patients (17.9%), and UPA was discontinued in 9 due to inefficiency.

Conclusion

In this preliminary study, first patients of clinical practice in Spain with UPA in PsA had a longer evolution and received a greater number of TB than those of clinical trial. As in the UPA clinical trial, it seems effective, rapid and relatively safe in daily clinical practice for refractory PsA.

References

[1]https://www.ema.europa.eu/en

[2]Mease PJ, et al. Ann Rheum Dis 2021;80:312–320

Disclosure of Interests

None declared

AB0931 Characteristics associated with the perception of high-impact disease (PsAID ≥4) in patients with recent-onset psoriatic arthritis. Model based on machine learning

Background

The Psoriatic Arthritis Impact of Disease (PsAID) questionnaire is the standard tool for evaluating the impact of psoriatic arthritis (PsA) on quality of life [1]. Variables associated with high disease impact were studied in patients with long-standing established disease. The characteristics associated with high-impact PsAID in recent-onset PsA remain unknown.

Objectives

To evaluate which patient and disease characteristics are associated with the perception of high-impact disease (PsAID ≥4) in recent-onset PsA.

All patients gave their informed consent. The study was approved by the Clinical Research Ethics Committee of the Principality of Asturias.

We conducted a cross-sectional analysis. The dataset was generated using data for the independent variables at the 3 visits (baseline, first year, and second year of follow-up) matched with the PsAID values at each of the 3 visits. PsAID was categorized into two groups, namely, <4 and ≥4 [1]. We trained logistic regression models and a random forest–type machine learning algorithm to analyze the association between the outcome measure and the variables selected in the bivariate analysis (statistical significance defined as p value <0.05). We used a confusion matrix to visualize the performance of the final model. This matrix shows the real class of the data items, together with the class predicted by the machine learning algorithm, and records the number of hits and misses.

Results

The sample comprised 158 patients. 20.9% were lost to follow-up. Of the patients who attended the clinic, 45.8% scored PsAID ≥4 at baseline; 27.1%, at the first follow-up visit, and 23.0%, at the second follow-up visit. The variables associated with PsAID ≥4 selected in the logistic regression analysis were HAQ, patient global pain during the previous week, educational level, and level of physical activity in the previous week. The association was positive for the first 2 variables and for level of physical activity and negative for educational level. When physical activity was introduced as a categorical variable, a possible negative association was observed for a moderate level (although this was not statistically significant) and a positive association was observed for a high level (Table 1).

Table 1.

Variables associated with PsAID ≥4: Logistic regression analysis.

VariableRegression coefficient95% CIp value (Wald test)HAQ10.394[7.777, 13.011]<0.001Patient global pain in the previous week5.668[4.016, 7.320]<0.001Educational level-2.064[-3.515, -0.613]0.005Moderate level of physical activity in the previous week-0.341[-1.255, 0.573]0.465High level of physical activity in the previous week1.221[0.158, 2.283]0.024

When the random forest–type machine learning algorithm was trained with these 4 variables, the order of importance (from more to less) attributed by the model was: patient global pain, HAQ, educational level, and physical activity. The percentage of hits in the confusion matrix was 86.14%.

Conclusion

Pain control and control of the disease as a whole, preventing patients from suffering a decrease in their functional capacity, are first-order treatment objectives. PsA patients should take regular physical exercise, but with a moderate or low impact on their joints and entheses.

References

[1]Orbai A, Holland R, Leung YY, Tillett W, Goel N, McHugh N et al. PsAID12 provisionally endorsed at OMERACT 2018 as core outcome measure to assess psoriatic arthritis-specific health- related quality of life in clinical trials. J Rheumatol 2019;46:990–95.

Acknowledgements

The authors would like to acknowledge José Luis Fernández Sueiro for his contribution to the conception of the study; José Miguel Carrasco for his contribution to the design of the study; Nuria Montero and Cristina Oliva for her contribution to data monitoring; Ana González Marcos and Cristina Pruenza for her contribution to data analysis; Thomas O´Boyle for the translation of the manuscript; and non-author investigators of Proyecto REAPSER Study Group

Disclosure of Interests

None declared

POS0907 ASSOCIATION BETWEEN DISEASE ACTIVITY AND DAMAGE IN IDIOPATHIC INFLAMMATORY MYOPATHIES. DIFFERENCES BETWEEN INCIDENT AND PREVALENT CASES

Background

There are different measures and tools validated to evaluate disease activity and damage in idiopathic inflammatory myopathies (IIM). Disease activity and damage in patients with early diagnosis is not still well defined.

Objectives

To analyze disease activity outcomes and their association with damage in IIM differentiating between incident and prevalent cases.

Methods

Multicenter cross-sectional study of a cohort of patients included in the Spanish Registry of patients with IIM (Myo-Spain)(1). Patients were classified as incident cohort (time between diagnosis and study initiation ≤ 12 months) or prevalent cohort (> 12 months). Activity and damage data were collected at the initial visit. Differences between both groups were tested by Chi-square, Student’s t and Mann-Whitney tests. Spearman’s correlation coefficients (Rho) were used to analyze correlations between disease activity and damage measures (weak ≥ 0.2 - <0.3; moderate ≥ 0.3 <0.7; strong ≥ 0.7).

Results

We included 139 (67.63% women) and 417 patients (74.34% women) with a mean age at diagnosis of 54 and 48 years in the incident and prevalent cohort, respectively. Patients in the incident cohort had significantly higher disease activity measures: myositis disease activity assessment visual analogue scale (MYOACT) total, extramuscular activity of MYOACT, physician global activity (PhGA), patient global activity (PGA), manual muscle testing (MMT)8, CK, and HAQ (p < 0.001).The organ systems with the bigger differences between the incident and the prevalent cohort were skin and constitutional (p<0.001). No significant differences were found respect to physician global damage (PhGD), patient global damage (PGD) and myositis damage index (MDI), between both cohorts (p > 0.2). Correlations between disease activity and damage measures are showed in the Table 1. The main differences found between both cohorts were the correlations of PhGA, CK, PGD and MDI with other measures of disease activity.

Table 1.

Correlations between disease activity and damage measures

Incident cohortPrevalent cohortMYOACT totalExtramuscular activity of MYOACTPhGAMMT- 8MYOACT totalExtramuscular activity of MYOACTPhGAMMT- 8Extramuscular activity of MYOACTRho0.7610.673-0.1660.77710.764-0.214P-value<0.001<0.001<0.0010.065<0.001<0.001<0.001<0.001PhGARho0.8230.6731-0.50.7790.7641-0.301P-value<0.001<0.001<0.001<0.001<0.001<0.001<0.001<0.001PGARho0.6670.5440.679-0.4340.5850.5280.623-0.345P-value<0.001<0.001<0.001<0.001<0.001<0.001<0.001<0.001MMT-8Rho-0.471-0.166-0.51-0.383-0.214-0.3011P-value<0.0010.065<0.001<0.001<0.001<0.001<0.001<0.001CKRho0.221-0.0860.234-0.4380.07-0.0240.112-0.11P-value0.0140.3510.008<0.0010.1780.6480.0290.034HAQRho0.4860.3380.528-0.490.3860.2480.384-0.505P-value<0.001<0.001<0.001<0.001<0.001<0.001<0.001<0.001PhGDRho0.3670.310.448-0.3050.5730.4920.598-0.334P-value<0.0010.001<0.0010.001<0.001<0.001<0.001<0.001PGDRho0.2930.1630.354-0.2950.4680.4080.476-0.347P-value0.0030.102<0.0010.002<0.001<0.001<0.001<0.001MDIRho0.3980.2790.388-0.2320.5790.4770.545-0.343P-value<0.0010.006<0.0010.026<0.001<0.001<0.001<0.001

Myositis disease activity assessment visual analogue scale (MYOACT), physician global activity (PhGA), patient globalactivity (PGA), manual muscle testing (MMT)8, health assessment questionnaire (HAQ), physician global damage(PhGD), patient global damage (PGD), myositis damage index (MDI).

Conclusion

Incident cases had higher disease activity. In those in whom damage was detected, no differences were found in damage measures with prevalent cases. The correlation between the different measures of activity and damage was slightly better in prevalent patients.

References

[1]Cobo-Ibáñez T, et al. Myo-Spain: Spanish Registry of patients with idiopathic inflammatory myopathy. Methodology. Reumatol Clin (Engl Ed). 2021 Aug 13:S2173-5743(21)00156-8.

Acknowledgements

To Nuria Montero for her contribution to data monitoring, and Francisco Javier Prado-Galbarro for his contribution to data analysis.

Disclosure of Interests

None declared

AB0899 A 24-month Prospective Psoriatic Arthritis Observational Study of Persistence of Treatment (PRO-SPIRIT) - Interim Analysis of Baseline Characteristics

Background

Ixekizumab (ixe), a highly selective interleukin (IL)-17A monoclonal antibody, has been approved for treatment of psoriatic arthritis (PsA). However, there is limited real-world evidence (RWE) available for ixe. PRO-SPIRIT is the first large-sample prospective observational study to provide RWE for ixe in patients (pts) with PsA.

Objectives

PRO-SPIRIT’s primary objective is to describe treatment persistence at 24 months (M) among pts with PsA who initiate or switch to a new biologic Disease Modifying Arthritis Rheumatic Drugs (bDMARDs) or targeted synthetic (tsDMARDs), including ixe. This abstract describes the interim baseline (BL) characteristics.

Methods

PRO-SPIRIT is a prospective observational study, conducted in FR, ES, IT, DE, UK, and CA, enrolling adults with PsA (≥6M) to be initiated or switched to a new b/tsDMARD, locally approved for PsA. Treatment groups include ixe, secukinumab, IL-12/IL-23 inhibitors (i) (ustekinumab) or IL-23i (guselkumab), tumour necrosis factor (TNFi) (adalimumab, etanercept, infliximab or biosimilar), Janus kinase (JAKi) (tofacitinib or upadacitinib). Pt demographic, disease activity and therapy characteristics are collected at BL; clinical and patient-reported outcomes measures are collected at BL and at a routine post-BL visit. BL descriptive statistics are reported.

Results

From December 2019 until this interim data cut (June 2021), a total of 477 pts (305 female; mean age 52) were enrolled. Mean age ranged from 48 (IL-12/23i and IL-23i) to 55 (JAKi), with a majority of female pts in each group (Table 1). Pts in the IL-12/23i and IL-23i and TNFi groups showed the shortest time since PsA diagnosis (5.2±4.5; 6.5±7.9), while pts in the JAKi group showed the longest time (10.6±9.4). The lowest proportion of pts with a prior b/tsDMARDs use was observed in the TNFi group (31%), the highest in the IL-12/23i and IL-23i group (71%). Pts in the ixe and IL-12/23i and IL-23i groups were more likely to be on monotherapy. Tender Joint Count (9.1-11.3) and Swollen Joint Count (3.3-5.8) were comparable across groups, with the highest values in the ixe and JAKi groups, respectively. Pt proportion with enthesitis and dactylitis was higher in the ixe, secukinumab and JAKi groups. Percentage of Body Surface Area affected by psoriasis was higher in the ixe, secukinumab and IL-12/23i and IL-23i groups. Pt proportion with nail psoriasis was higher in the ixe and secukinumab groups. Physician’s Global Assessment Visual Analog Scale (VAS), Patient’s Global Assessment VAS and Patient’s Assessment of Joint Pain VAS reflected a high burden of illness.

Table 1.

Baseline characteristics

bDMARDstsDMARDsIxekizumabSecukinumabIL-12/23 and IL-23 inhibitorsTNF inhibitorsJAK InhibitorsN=137N=46N=24N=211N=40Age52.8±12.252.8±13.147.6±13.450.3±11.755.3±9.9Female, n (%)86 (62.8)31 (67.4)16 (66.7)135 (64.0)25 (62.5)Years since diagnosis8.4±7.57.6±8.05.2±4.56.5±7.910.6±9.4Prior b/tsDMARD, n (%)87 (63.5)27 (58.7)17 (70.8)66 (31.3)26 (65.0)Concomitant csDMARD, n (%)47 (34.3)19 (41.3)5 (20.8)108 (51.2)19 (47.5)Tender Joint Count11.3±10.29.1±10.89.1±9.310.9±10.611.1±8.8Swollen Joint Count5.7±6.63.3±3.83.4±6.44.8±5.65.8±6.6Body Surface Area % affected by psoriasis6.1±10.57.6±14.27.0±9.74.6±11.02.2±3.1Presence of enthesitis, n (%)58 (42.3)16 (34.8)4 (16.7)67 (31.8)16 (40.0)Presence of dactylitis, n (%)33 (24.1)10 (21.7)3 (12.5)26 (12.3)10 (25.0)Presence of nail psoriasis, n (%)57 (41.6)20 (43.5)7 (29.2)71 (33.6)11 (27.5)Physician’s Global assessment VAS62.6±18.159.5±20.555.7±24.661.7±18.063.0±20.5Patient’s Global Assessment VAS60.5±20.456.8±25.156.2±25.757.5±22.955.4±22.5Patient’s Assessment of Joint Pain VAS62.7±21.358.4±27.155.7±28.359.4±22.957.5±24.0

Mean±SD, unless otherwise stated

Conclusion

The reported BL characteristics offer preliminary information about which pts initiate or switch to a b/tsDMARD in a real life-setting. Future disclosures (at 12 and 24M) will provide RWE regarding persistence, effectiveness, and health care resource use of available treatments for PsA, which will help pts and physicians to make better informed treatment decisions.

Disclosure of Interests

Jacques Morel Speakers bureau: Abbvie, Amgen, Biogen, Biogen, Bristol Myer Squib, Fresenius, Galapagos, Eli Lilly and Company, Médac, Novartis, Sandoz, Sanofi, Consultant of: Abbvie, Galapagos, Eli Lilly and Company, Médac, Novartis, Glaxo Smith Kline, Grant/research support from: Bristol Myer Squib, Biogen, Eli Lilly and Company, Novartis, Pfizer, Lorenzo Dagna Speakers bureau: Abbvie, Amgen, BMS, Eli Lilly and Company, Galapagos, GSK, Pfizer, Sobi, Consultant of: Abbvie, Amgen, Astra Zeneca, Biogen, BMS, Celltrion, Eli Lilly and Company, Galapagos, GSK, Janssen, Kiniksa, Pfizer, Roche, Sobi, Sanofi, Beatriz Joven-Ibáñez Speakers bureau: Eli Lilly and Company, Grant/research support from: (institutional grant) Eli Lilly and Company, Thorsten Holzkaemper Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Celine El Baou Consultant of: Eli Lilly and Company, Leonore Unger Speakers bureau: Eli Lilly and Company, Angelo Semeraro: None declared, Nicola Gullick Speakers bureau: AbbVie, Celgene, Janssen, Eli Lilly and Company, Novartis, UCB, Consultant of: AbbVie, Janssen, Eli Lilly and Company, Novartis, UCB, Grant/research support from: (institutional grants) Eli Lilly and Company, AbbVie, Astra Zeneca, Izana, Novartis, Tamas Treuer Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company

POS1074 MINIMAL DISEASE ACTIVITY (MDA) IN PATIENTS WITH RECENT-ONSET PSORIATIC ARTHRITIS. PREDICTIVE MODEL BASED ON MACHINE LEARNING

Background

Very few data are available on predictors of minimal disease activity (MDA) in patients with recent-onset psoriatic arthritis (PsA). Such data are crucial, since the therapeutic measures used to change the adverse course of PsA are more likely to succeed if we intervene early.

Objectives

To detect patient and disease variables associated with achieving MDA in patients with recent-onset PsA.

Methods

We performed a multicenter observational prospective study (2-year follow-up, regular annual visits), promoted by the Spanish Society of Rheumatology. Patients aged ≥18 years who fulfilled the CASPAR criteria, with less than 2 years since the onset of symptoms, were included. The intention at the baseline visit was to reflect the patient’s situation before disease progress was modified by the treatments prescribed by the rheumatologist.

All patients gave their informed consent. The study was approved by the Clinical Research Ethics Committee of the Principality of Asturias.

MDA was defined as fulfillment of at least 5 of the following: ≤1 tender joint; ≤1 swollen joint; PASI ≤1 or BSA ≤3%; score on the visual analog scale (VAS) for pain provided by the patient ≤1.5; overall score for disease activity provided by the patient ≤2; HAQ score ≤0.5; ≤1 painful enthesis [1].

The dataset contained data for the independent variables from the baseline visit and from follow-up visit number 1. These were matched with the outcome measures from follow-up visits 1 and 2, respectively. We trained a random forest–type machine learning algorithm to analyze the association between the outcome measure and the variables selected in the bivariate analysis. In order to understand how the model uses the variables to make its predictions, we applied the SHAP technique. This approach assigns a SHAP value to each value of each variable according to the extent to which it affects the prediction of the model (the higher the absolute SHAP value, the greater the influence of this data item on prediction) and to how it affects the prediction (if the SHAP value is positive, the data item positively affects the prediction, that is, it confers a higher value on the prediction). The SHAP summary graphs order the predictors by their importance in the predictions of the model. This importance is calculated with the mean of the SHAP values assigned to each data item of a variable; mean values <0.01 indicate the low importance of the variable in the model. We used a confusion matrix to visualize the performance of the model. This matrix shows the real class of the data items, together with the predicted class, and records the number of hits and misses.

Results

The sample comprised 158 patients. 14.6% were lost to follow-up. 55.5% and 58.3% of the patients had MDA at the first and second follow-up visit, respectively. The importance of the variables in the model according to the mean of the SHAP values is shown in Table 1. The variables with the greatest predictive ability were global pain, impact of the disease (PsAID), patient global assessment of disease and physical function (HAQ-Disability Index). The SHAP values for each value of each variable are shown in Figure 1. The percentage of hits in the confusion matrix was 85.94%.

Table 1.

Variables in the predictions of the random forest for MDA according to the SHAP method.

VariableImportance according to SHAP1Global pain0.069PsAID0.064Patient global assessment of disease0.047HAQ0.044Articular pattern at diagnosis0.029Physician global assessment of disease0.023Tender joint count0.014Sex0.009Weekly alcohol consumption0.009

1Mean of the SHAP values for each value of the variable.

MDA: minimal disease activity.

Figure 1.

SHAP summary graph.

Conclusion

A key objective in the management of PsA should be control of pain, which is not always associated with inflammatory burden, and the establishment of measures to better control the various domains of PsA.

References

[1]Coates LC, Fransen J, Helliwell PS. Defining minimal disease activity in psoriatic arthritis: a proposed objective target for treatment. Ann Rheum Dis. 2010;69:48-53.

Acknowledgements

The authors would like to acknowledge José Luis Fernández Sueiro for the conception of the study; José Miguel Carrasco for his contribution to the design of the study; Nuria Montero and Cristina Oliva for her contribution to data monitoring; Ana González Marcos and Cristina Pruenza for her contribution to data analysis; and Thomas O´Boyle for the translation of the manuscript.

Disclosure of Interests

None declared

Persistence and effectiveness of the IL-12/23 pathway inhibitor ustekinumab or tumour necrosis factor inhibitor treatment in patients with psoriatic arthritis: 1-year results from the real-world PsABio Study

OBJECTIVE

We evaluated real-world treatment persistence and effectiveness at 1 year following initiation of IL-12/23 inhibitor ustekinumab or a tumour necrosis factor inhibitor (TNFi) for psoriatic arthritis (PsA).

METHODS

PsABio (NCT02627768), a prospective, observational study, followed patients with PsA prescribed first-line to third-line ustekinumab or TNFi. Drug persistence, effectiveness (achievement of clinical Disease Activity Index for Psoriatic Arthritis (cDAPSA) low disease activity (LDA)/remission and minimal disease activity/very low disease activity (MDA/VLDA)), and safety were assessed every 6 months. In addition to descriptive statistics, propensity score (PS)-adjusted comparisons across cohorts were performed.

RESULTS

At 1 year, overall persistence was similar in the ustekinumab (n=317/438, 72.4%) and TNFi (n=321/455, 70.5%) groups. PS-adjusted HR (95% CI) for stopping/switching ustekinumab versus TNFi was 0.82 (0.60; 1.13). cDAPSA LDA (including remission)/remission was achieved in 55.9%/22.1% of ustekinumab-treated and 67.1%/31.7% of TNFi-treated patients; PS-adjusted ORs (95% CI) were 0.80 (0.57; 1.10) for cDAPSA LDA and 0.73 (0.49; 1.07) for remission. MDA/VLDA was achieved in 34.2%/11.9% of ustekinumab-treated and 43.1%/12.6% of TNFi-treated patients; PS-adjusted ORs (95% CI) were 0.89 (0.63; 1.26) for MDA and 0.90 (0.54; 1.49) for VLDA. The safety profiles were similar in both groups.

CONCLUSION

In the real-world PsABio Study, after 1 year of treatment, although unadjusted persistence was numerically slightly higher for ustekinumab versus TNFi and unadjusted effectiveness was numerically slightly higher for TNFi versus ustekinumab, the PS-adjusted comparisons demonstrated comparable overall persistence, effectiveness and safety for both modes of action in PsA.

POS0996 SIX-YEAR RESULTS FROM THE ESPERANZA COHORT: EVALUATION OF CLINICAL FEATURES, DISEASE ACTIVITY MEASURES AND TREATMENT ASPECTS IN AXIAL AND PERIPHERAL EARLY SPONDYLOARTHRITIS

Background:

Esperanza was a multicenter national health program developed to facilitate an early diagnosis of patients with Spondyloarthritis (SpA) in Spain.

Objectives:

To compare the clinical evolution of patients with axial SpA (axSpA) and peripheral SpA (pSpA) included in this program.

Methods:

Patients from the Esperanza cohort fulfilling ASAS criteria for axSpA or pSpA and completed the 6-year follow-up were included. Patients were classified according to the predominant symptom. In case of having axSpA and pSpA, they were classified as axSpA. Clinical features, disease activity and treatment aspects at baseline and 6-year visit were evaluated.

Results:

From 775 patients recruited at baseline, 6-year follow-up data from 178 (83.5%) fulfilling ASAS criteria at the final visit were available: 133 (74.7%) for axSpA and 45 for pSpA (25.3%). 118 (66.3%) were males (50.6% with axSpA and 62.2%, pSpA, p=0.4). Patients with axSpA had more frequently positive HLA-B27 (90.5%) vs. (9.5%), p<0.001. Follow-up clinical features are shown in Table 1. At the final visit, both axSpA and pSpA presented an improvement in clinical symptoms, disease activity (CRP, BASDAI, ASDAS and VAS-pt) and quality of life (ASQoL). A worsening of mobility (BASMI) was observed in both groups. The prevalence of uveitis, psoriasis and inflammatory bowel disease (IBD) at baseline was 10.7%, 18% and 5.6%, respectively. At the 6-year visit, the cumulative prevalence (CP) was 14% for uveitis (16.5% in axSpA and 6.7% in pSpA), 22.5% for psoriasis (12.8% in axSpA and 51.1% in pSpA) and 7.9% for IBD (5.3% in axSpA and 15.6% in pSpA). Most of the patients were prescribed NSAIDS at baseline and more patients maintained this treatment at the 6-year visit in axSpA compared with pSpA (96.9% vs 87.5%, p=0.02). At the final visit, a higher percentage with pSpA received csDMARDs in comparison with axSpA (81% vs. 35.7%, p<0.001). Sixty (44.4%) patients received biologic therapy at the final visit and no differences were observed in their prescription: 43% in axSpA and 48.6% in pSpA(p=0.6).

Conclusion:

The early diagnosis of recent-onset SpA achieves a significant improvement in clinical features, disease activity and quality of life in patients with axSpA and pSpA after 6 years of follow-up. Although previous publications revealed a low radiographic progression in this cohort1, the worsening of BASMI must aware clinicians of possible evolutive structural damage.

Reference:

[1]Fernández-Carballido et al. RMD Open. 2020 Sep;6(2):e001345

Acknowledgements:

The Spanish Foundation of Rheumatology received funding from Pfizer (formerly Wyeth) to develop the Esperanza Program. Later, the Program has been supported by restricted grants from the Instituto de Salud Carlos III and Fondos FEDER (FIS PI13/02034 and PI17/01840) and AbbVie.

Disclosure of Interests:

Carolina Tornero: None declared, Victoria Navarro-Compán: None declared, Beatriz Joven-Ibáñez: None declared, RAQUEL ALMODOVAR: None declared, Xavier Juanola-Roura: None declared, Cristina Fernández-Carballido: None declared, Juan Carlos Quevedo-Abeledo: None declared, Jose Rosas: None declared, Azucena Hernández: None declared, Carlos A. Montilla-Morales: None declared, Jose Ramón Maneiro: None declared, A. Juan-Mas: None declared, Jose Antonio Pinto Tasende: None declared, Mireia Moreno: None declared, Jesus Sanz: None declared, Teresa Ruiz Jimeno: None declared, Manuel Moreno: None declared, María Lourdes Ladehesa Pineda: None declared, Eugenio de Miguel Speakers bureau: AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi., Paid instructor for: Janssen, Novartis, Roche, Consultant of: AbbVie, Novartis, Pfizer, Galapagos, Grant/research support from: Abbvie, Novartis, Pfizer.

POS1046 IMPROVEMENTS IN PATIENT-REPORTED IMPACT OF PSORIATIC ARTHRITIS WITH IL-12/23 (USTEKINUMAB) OR TUMOUR NECROSIS FACTOR INHIBITORS: 1-YEAR DATA FROM THE LARGE, REAL-WORLD PsABIO STUDY

Background:

Psoriatic arthritis (PsA) negatively impacts patients’ (pts) quality of life (QoL), with a high burden of pain, fatigue and psychological distress. The 12-item Psoriatic Arthritis Impact of Disease questionnaire (PsAID-12) is a validated measure of pt-reported disease impact.

Objectives:

To analyse PsAID-12 score changes in the overall population and specific subgroups of interest, and assess correlation of these changes using Health Assessment Questionnaire Disability Index (HAQ-DI).

Methods:

PsABio (NCT02627768) is a multinational, prospective, observational study in pts with PsA receiving ustekinumab (UST) or a tumour necrosis factor inhibitor (TNFi) as a 1st/2nd/3rd-line biologic. Descriptive statistics, including 95% CI, are presented at baseline (BL) and 1 year. Linear regression, including propensity score (PS) adjustment for BL covariates, was used to compare change in PsAID-12 total from BL to 1 year between treatments. The relationship between changes in PsAID-12 and HAQ-DI was investigated using Spearman’s correlation.

Results:

Data were available for 438 UST and 455 TNFi pts. From BL to 1 year, significant improvements were seen in total PsAID-12 scores and in all domains with both treatments (Figure 1). PS-adjusted treatment comparison showed no difference in total PsAID-12 improvement (regression coefficient [95% CI]: 0.14 [-0.22; 0.51], p=0.4433), or in any domain, except skin problems, which improved significantly more with UST than TNFi (-0.55 [-1.04, -0.06], p=0.0277). Improvements in PsAID-12 and HAQ-DI showed strong positive correlation with both treatments (UST: r=0.63, p<0.0001; TNFi: r=0.70, p<0.0001). Effectiveness was demonstrated with UST and TNFi in subgroups of interest, including biologic treatment line, sex and psoriasis extent (Table 1. next page).

Conclusion:

Treatment with IL-12/23 (UST) or TNF inhibitors significantly improved pt-reported disease impact at 1 year. PS-adjusted PsAID-12 improvements did not differ significantly between treatments, except skin problems (better with UST). Improvements in disease impact and physical functioning (HAQ-DI) were strongly correlated, emphasising the effect of these biologics on QoL in PsA pts.

Figure 1.Table 1.

PsAID-12 scores by BL characteristic subgroup

Mean (95% CI)USTTNFiBLUnadjusted change from BL at 1 year (LOCF)BLUnadjusted change from BL at 1 year (LOCF)Biologic line1st5.51(5.19; 5.82)-2.14(-2.49; -1.79)5.44(5.15; 5.72)-2.41(-2.72; -2.09)2nd6.05(5.69; 6.41)-2.14(-2.55; -1.72)5.57(5.19; 5.95)-2.37(-2.79; -1.94)3rd5.84(5.33; 6.35)-1.81(-2.45; -1.17)5.34(4.52; 6.15)-1.89(-2.62; -1.16)Sex*Male5.27(4.95; 5.59)-2.35(-2.70; -1.99)4.89(4.56; 5.23)-2.49(-2.83; -2.15)Female6.14(5.86; 6.43)-1.86(-2.20; -1.52)5.95(5.67; 6.23)-2.20(-2.53; -1.87)EnthesitisYes5.95(5.66; 6.24)-2.19(-2.51; -1.86)5.89(5.61; 6.17)-2.65(-2.98; -2.31)No5.51(5.19; 5.83)-1.98(-2.36; -1.59)4.99(4.65; 5.32)-2.02(-2.35; -1.68)Psoriasis BSA, %<35.66(5.32; 6.00)-1.60(-2.03; -1.18)4.97(4.63; 5.31)-1.89(-2.25; -1.52)3–105.44(5.05; 5.83)-2.16(-2.59; -1.74)5.78(5.43; 6.14)-2.99(-3.38; -2.59)>106.15(5.70; 6.60)-2.93(-3.43; -2.43)6.13(5.55; 6.71)-2.86(-3.49; -2.23)Joint involvement†Mono/oligoarticular5.07(4.56; 5.58)-1.96(-2.47; -1.45)4.82(4.38; 5.25)-2.18(-2.66; -1.70)Polyarticular5.98(5.75; 6.22)-2.21(-2.51; -1.92)5.78(5.52; 6.04)-2.47(-2.75; -2.18)FiRST score*<55.15(4.87; 5.44)-2.18(-2.50; -1.87)5.10(4.83; 5.36)-2.44(-2.71; -2.16)≥56.72(6.43; 7.00)-1.95(-2.38; -1.53)6.49(6.15; 6.83)-2.09(-2.57; -1.61)

*At BL, female pts and pts with FiRST score ≥5 (chronic widespread pain) were significantly more impacted than male pts and pts with FiRST score <5, and remained significantly more impacted at 1 year. †Polyarticular pts were significantly more impacted at BL, but not 1 year.

BSA, body surface area; CI, confidence interval; FiRST, Fibromyalgia Rapid Screening Tool; LOCF, last observation carried forward

Acknowledgements:

This study was funded by Janssen.

Disclosure of Interests:

Laure Gossec Consultant of: AbbVie, Amgen, Bioepis, Biogen, Bristol-Myers Squibb, Celgene, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, Samsung, Sanofi-Aventis, UCB, Grant/research support from: Amgen, Galapagos, Janssen, Lilly, Pfizer, Sandoz, Sanofi, Stefan Siebert Speakers bureau: AbbVie, Amgen (previously Celgene), Biogen, Janssen, Novartis, UCB, Consultant of: AbbVie, Janssen, UCB, Grant/research support from: Amgen (previously Celgene), Boehringer Ingelheim, Bristol-Myers Squibb, GSK, Janssen, Novartis, Pfizer, UCB, Paul Bergmans Shareholder of: Johnson & Johnson, Employee of: Janssen, Kurt de Vlam Speakers bureau: AbbVie, Amgen, Eli Lilly, Novartis, UCB, Paid instructor for: Amgen, Galapagos, UCB, Consultant of: Eli Lilly, Galapagos, Johnson & Johnson, Novartis, UCB, Grant/research support from: Celgene, Elisa Gremese: None declared, Beatriz Joven-Ibáñez Speakers bureau: AbbVie, Celgene, Janssen, MSD, Novartis, Pfizer, Tatiana Korotaeva Speakers bureau: AbbVie, Amgen, Biocad, Lilly, Janssen, MSD, Novartis, Novartis-Pfizer, Sandoz, UCB, Consultant of: AbbVie, Amgen, Biocad, Lilly, Janssen, MSD, Novartis, Novartis-Sandoz, Pfizer, UCB, Grant/research support from: Pfizer, Wim Noel Employee of: Janssen, Michael Nurmohamed Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Menarini, MSD, Mundipharma, Pfizer, Roche, Sanofi, UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Galapagos, Janssen, Menarini, MSD, Mundipharma, Pfizer, Roche, Sanofi, UCB, Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Galapagos, Gilead, Janssen, Menarini, MSD, Mundipharma, Pfizer, Roche, Sanofi, UCB, Petros Sfikakis Consultant of: AbbVie, Actelion, Boehringer Ingelheim, Enorasis, Farmaserv-Lilly, Genesis, Gilead, Pfizer, MSD, Novartis, UCB, Grant/research support from: AbbVie, Amgen, Boehringer Ingelheim, Faran, Janssen, Pfizer, Roche, Elke Theander Employee of: Janssen, Josef S. Smolen Speakers bureau: AbbVie, Amgen, AstraZeneca, Astro, Bristol-Myers Squibb, Celgene, Celltrion, Chugai, Gilead, ILTOO, Janssen, Lilly, MSD, Novartis- Sandoz, Pfizer, Roche, Samsung, Sanofi, UCB, Grant/research support from: AbbVie, AstraZeneca, Lilly, Novartis, Roche.

OP0232 FEMALE VERSUS MALE BURDEN OF PSORIATIC ARTHRITIS IS HIGHER AND TREATMENT PERSISTENCE SHORTER AFTER USTEKINUMAB OR TUMOUR NECROSIS FACTOR INHIBITOR TREATMENT: 1-YEAR DATA FROM THE PSABIO STUDY

Background:

Sex-related differences in biologic treatment of psoriatic arthritis (PsA) have been insufficiently studied in a real-world setting.

Objectives:

To evaluate impact of sex on PsA, treatment effectiveness and persistence after 1 year of biologic treatment.

Methods:

PsABio (NCT02627768) is a multinational, prospective real-world study in PsA with ustekinumab (UST) or TNF inhibitor (TNFi) as 1st/2nd/3rd-line biologic. Males and females were compared for disease activity and patient-reported outcomes. Descriptive statistics including 95% CI at baseline (BL) and 12 (±3) months (LOCF) follow-up are presented. Intra-sex comparisons between UST and TNFi cohorts were done by logistic regression analysis, with propensity score adjustment for imbalanced BL covariates and non-response imputation for stopping/switching biologic drugs.

Results:

Among 494 females and 399 males, age and disease duration were similar. However, differences in disease characteristics at BL were considerable: females had worse scores than males for cDAPSA, HAQ-DI, EQ5D VAS, PsAID-12, pain and comorbidities. At 1 year, similar improvements from BL were observed between sexes, but females remained in a worse health state than males (Table). Achievement of composite endpoints MDA (including VLDA) and cDAPSA LDA (including remission) was high overall (38.6% and 61.5%, respectively), but reached by >2-fold and 3-fold more males than females, respectively. HAQ-DI scores remained worse for females at 1 year (0.95) than for males at BL (0.93). Enthesitis resolution was achieved in 46% of females and 75% of males. No significant differences in effectiveness of UST vs TNFi were detected between sexes (Figure). Kaplan–Meier estimated drug persistence was significantly better in males than females (log-rank p=0.0007). There was no intra-sex difference between UST or TNFi in risk of stopping/switching in males or females.

Table 1.

Patient and disease characteristics at BL and 1-year by sex

BL femaleBL male1-year LOCF female1-year LOCF maleBiologic line, %1st4655N/AN/A2nd34333rd2013Co-treatment, %MTX37.434.3N/AN/ACorticosteroids34.632.1NSAIDs59.964.4Antidepressant7.92.5Comorbidities, %N/AN/ACardiovascular69.059.4metabolic syndrome40.131.7Obesity35.223.7Anxiety/depression12.67.5Smoking status, %N/AN/ANever54.941.9Past16.826.6Current22.724.3Unknown5.77.3Joint counts, nSwollen 666.1 (5.4; 6.9)5.6 (4.7; 6.4)2.2 (1.7; 2.6)1.3 (1.0; 1.6)Tender 6813.2 (12.0; 14.4)10.0 (8.9; 11.1)6.0 (5.2; 6.7)3.6 (2.9; 4.3)cDAPSA score, mean (95% CI)cDAPSA, %32.5 (30.5; 34.4)26.9 (24.9; 29.0)15.9 (14.5; 17.2)10.3 (9.0; 11.6)Remission1.0 (0.3; 2.6)4.0 (2.1; 6.7)17.8 (14.1; 22.0)37.7 (32.4; 43.2)Low6.7 (4.4; 9.7)15.0 (11.3; 19.4)33.0 (28.3; 37.9)36.5 (31.3; 42.0)Moderate38.9 (34.0; 44.0)42.6 (37.2; 48.2)34.3 (29.6; 39.2)16.9 (13.0; 21.4)High53.4 (48.2; 58.4)38.3 (33.0; 43.9)14.9 (11.6; 18.9)8.9 (6.0; 12.5)MDA2.3 (1.0; 4.3)7.7 (5.1; 11.2)27.5 (23.1; 32.1)52.2 (46.6; 57.7)VLDA0.00.9 (0.2; 2.6)6.2 (4.1; 9.0)19.7 (15.6; 24.3)HAQ-DI score1.31 (1.25; 1.37)0.93 (0.86; 1.00)0.95 (0.89; 1.02)0.53 (0.47; 0.59)PsAID-12 score6.1 (5.9; 6.3)5.1 (4.9; 5.3)4.0 (3.8; 4.3)2.7 (2.4; 2.9)EQ5D VAS score48.6 (46.6; 50.5)53.8 (51.6; 55.9)59.2 (56.9; 61.4)68.0 (65.5; 70.4)Enthesitis50.7 (45.9; 55.5)48.1 (42.8; 53.3)32.6 (28.3; 37.3)18.0 (14.1; 22.3)Dactylitis15.6 (12.4; 19.3)24.7 (20.4; 29.3)5.7 (3.8; 8.3)4.8 (2.9; 7.4)

Data are % (95% CI) unless indicated otherwise. Bold data are significantly different (non-overlapping 95% CI).

Conclusion:

These real-world data from PsABio on sex differences with biologic treatment suggest that females generally start biologics in a worse PsA state than males. Although treatment improvements were similar between sexes, females remained in worse health at 1 year, and stopped/switched biologic earlier. More comprehensive treatment before severe disease manifestations evolve may improve management in females.

Acknowledgements:

This study was funded by Janssen

Disclosure of Interests:

Irene van der Horst-Bruinsma Consultant of: AbbVie, Lilly, MSD, Novartis, UCB, Grant/research support from: AbbVie, MSD, Pfizer, UCB, Michael Nurmohamed Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Menarini, MSD, Mundipharma, Pfizer, Roche, Sanofi, UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Galapagos, Janssen, Menarini, MSD, Mundipharma, Pfizer, Roche, Sanofi, UCB, Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Galapagos, Gilead, Janssen, Menarini, MSD, Mundipharma, Pfizer, Roche, Sanofi, UCB, Arno Van Kuijk Consultant of: AbbVie, Janssen, LEO Pharma, Novartis, Grant/research support from: Janssen, Stefan Siebert Speakers bureau: AbbVie, Amgen (previously Celgene), Biogen, Janssen, Novartis, UCB, Consultant of: AbbVie, Janssen, UCB, Grant/research support from: Amgen (previously Celgene), Boehringer Ingelheim, Bristol-Myers Squibb, GSK, Janssen, Novartis, Pfizer, UCB, Paul Bergmans Shareholder of: Johnson & Johnson, Employee of: Janssen, Kurt de Vlam Speakers bureau: AbbVie, Amgen, Eli Lilly, Novartis, UCB, Paid instructor for: Amgen, Galapagos, UCB, Consultant of: Eli Lilly, Johnson &Johnson, Novartis Galapagos, UCB, Grant/research support from: Celgene, Elisa Gremese: None declared, Beatriz Joven-Ibáñez Speakers bureau: AbbVie, Celgene, Janssen, MSD, Novartis, Pfizer, Tatiana Korotaeva Speakers bureau: AbbVie, Amgen, Biocad, Janssen, Lilly, MSD, Novartis, Novartis-Sandoz, Pfizer, UCB, Consultant of: AbbVie, Amgen, Biocad, Janssen, Lilly, MSD, Novartis, Novartis-Sandoz, Pfizer, UCB, Grant/research support from: Pfizer, Wim Noel Employee of: Janssen, Petros Sfikakis Consultant of: AbbVie, Actelion, Boehringer Ingelheim, Enorasis, Farmaserv-Lilly, Genesis, Gilead, MSD, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Amgen, Boehringer Ingelheim, Faran, Janssen, Pfizer, Roche, Elke Theander Employee of: Janssen, Josef S. Smolen Speakers bureau: AbbVie, Amgen, AstraZeneca, Astro, Bristol-Myers Squibb, Celgene, Celltrion, Chugai, Gilead, ILTOO, Janssen, Lilly, MSD, Novartis-Sandoz, Pfizer, Roche, Samsung, Sanofi, UCB, Consultant of: AbbVie, AstraZeneca, Lilly, Novartis, Roche, Laure Gossec Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Biogen, Celgene, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, Samsung Bioepis, Sanofi-Aventis, UCB, Grant/research support from: Amgen, Galapagos, Janssen, Lilly, Pfizer, Sandoz, Sanofi

AB0530 EFFECT OF SKIN SYMPTOMS ON DISEASE IMPACT IN PATIENTS WITH PSORIATIC ARTHRITIS RECEIVING THE IL-12/23 INHIBITOR USTEKINUMAB OR TNF INHIBITORS IN THE REAL-WORLD PSABIO STUDY

Background:

Psoriatic arthritis (PsA) is characterised by musculoskeletal symptoms, and patients (pts) with PsA usually experience psoriasis concurrently. Real-world data reflecting impact of skin symptoms on PsA disease burden are limited.

Objectives:

Analyse effectiveness of ustekinumab (UST) and tumour necrosis factor inhibitor (TNFi) therapy on extent of skin involvement, and the impact this has on PsA disease burden and drug persistence.

Methods:

PsABio (NCT02627768) is a prospective, observational study of 1st/2nd/3rd-line UST or TNFi treatment in PsA in 8 European countries. Extent of skin involvement was categorised as body surface area (BSA): clear/almost clear; <3% but not clear/almost clear; 3–10%; or >10%. Pt-reported disease impact was evaluated by PsAID-12, including assessment of two skin-related domains (D): D3 (skin problems, including itching) and D10 (embarrassment and/or shame because of appearance). Estimated persistence at 1 year was assessed across baseline (BL) BSA categories.

Results:

At BL, significantly more pts receiving UST than TNFi had BSA >10% (Figure 1). BL disease impact (PsAID-12) was worse in pts with BSA >10% than <3% in D3, D10 and total (non-overlapping 95% CIs suggest significance) (Table 1). BSA improved from BL to 1 year with both treatments. At 1 year, 64% of pts in both groups had clear/almost clear skin and only 3% had BSA >10% (Figure 1). At 1 year, both treatments significantly reduced disease impact (PsAID-12 total), and D3 and D10 scores, irrespective of BL BSA category, but most markedly in pts with higher BL BSA (Table 1). Worse BL psoriasis was generally associated with longer persistence for both treatments; however, at 1 year, pts with BSA >10% had significantly shorter persistence with TNFi (mean [95% CI]: 361 [336; 387] days) than with UST (410 [394; 426] days).

Conclusion:

In PsA, interleukin-12/23 inhibition (UST) and TNFi therapy in routine care rapidly and substantially reduced extent of skin involvement and related disease impact. Pts with highest BL skin involvement had significantly longer drug persistence with UST than with TNFi. Together, PsABio data suggest that successful treatment of skin involvement in PsA with biologics reduces disease burden and may improve persistence, especially in pts with worse BL psoriasis.

Figure 1Table 1.

PsAID-12 scores at BL and change from BL scores at 6 months and 1 year, by BL BSA category

Mean (95% CI)Domain 3(skin problems, including itching)Domain 10(embarrassment and/orshame because of appearance)Total PsAID-12USTTNFiUSTTNFiUSTTNFiPsAID-12 score at BL by BL BSA <3%4.2 (3.7; 4.8)3.1 (2.7; 3.6)3.9 (3.3; 4.4)3.1(2.6; 3.6)5.7(5.3; 6.0)5.0 (4.6; 5.3) 3–10%6.4 (5.9; 6.8)5.8 (5.3; 6.3)4.1 (3.5; 4.7)4.5 (3.9; 5.1)5.4 (5.1; 5.8)5.8 (5.4; 6.1) >10%7.9 (7.5; 8.3)6.7 (6.0; 7.5)6.1 (5.4; 6.8)5.8 (4.8; 6.8)6.2 (5.7; 6.6)6.1 (5.6; 6.7)Change from BL in PsAID-12 score at 6 months by BL BSA <3%-1.5 (-2.1; -0.9)-0.8 (-1.3; -0.3)-1.5 (-2.0; -0.9)-1.2 (-1.6; -0.7)-1.6 (-2.0; -1.2)-1.9 (-2.2; -1.5) 3–10%-3.2 (-3.8; -2.7)-2.4 (-3.0; -1.9)-1.9 (-2.5; -1.3)-2.0 (-2.5; -1.5)-2.0 (-2.4; -1.6)-2.4 (-2.8; -2.0) >10%-4.2 (-4.9; -3.6)-2.5 (-3.2; -1.9)-2.9 (-3.5; -2.2)-1.6 (-2.4; -0.8)-2.4 (-2.8; -2.0)-2.2 (-2.7; -1.7)Change from BL in PsAID-12 score at 1 year (LOCF) by BL BSA <3%-1.5 (-2.1; -0.9)-0.8 (-1.3; -0.3)-1.6 (-2.2; -1.1)-1.2 (-1.7; -0.7)-1.6 (-2.0; -1.2)-1.9 (-2.3; -1.5) 3–10%-3.5 (-4.0; -2.9)-3.2(-3.7; -2.7)-2.0 (-2.6; -1.4)-2.5 (-3.0; -2.0)-2.2 (-2.6; -1.7)-3.0 (-3.4; -2.6) >10%-4.9 (-5.5; -4.3)-3.1 (-4.0; -2.3)-3.5 (-4.2; -2.8)-2.7 (-3.7; -1.8)-2.9 (-3.4; -2.4)-2.9 (-3.5; -2.2)

PsAID-12 total score ≤4 is considered a patient-acceptable symptom state.

BL, baseline; BSA, body surface area; CI, confidence interval; LOCF, last observation carried forward; PsAID-12, 12-item Psoriatic Arthritis Impact of Disease questionnaire; TNFi, tumour necrosis factor inhibitor; UST, ustekinumab

Acknowledgements:

This study was funded by Janssen.

Disclosure of Interests:

Josef S. Smolen Speakers bureau: AbbVie, Amgen, AstraZeneca, Astro, Bristol-Myers Squibb, Celgene, Celltrion, Chugai, Gilead, ILTOO, Janssen, Lilly, MSD, Novartis- Sandoz, Pfizer, Roche, Samsung, Sanofi, UCB, Grant/research support from: AbbVie, AstraZeneca, Lilly, Novartis, Roche, Tatiana Korotaeva Speakers bureau: AbbVie, Amgen, Biocad, Janssen, Lilly, MSD, Novartis, Novartis-Sandoz, Pfizer, UCB, Consultant of: AbbVie, Amgen, Biocad, Janssen, Lilly, MSD, Novartis, Novartis-Sandoz, Pfizer, UCB, Grant/research support from: Pfizer, Michael Nurmohamed Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Menarini, MSD, Mundipharma, Pfizer, Roche, Sanofi, UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Galapagos, Janssen, Menarini, MSD, Mundipharma, Pfizer, Roche, Sanofi, UCB, Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Galapagos, Gilead, Janssen, Menarini, MSD, Mundipharma, Pfizer, Roche, Sanofi, UCB, Stefan Siebert Speakers bureau: AbbVie, Amgen (previously Celgene), Biogen, Janssen, Novartis, UCB, Consultant of: AbbVie, Janssen, UCB, Grant/research support from: Amgen (previously Celgene), Boehringer Ingelheim, Bristol-Myers Squibb, GSK, Janssen, Novartis, Pfizer, UCB, Paul Bergmans Shareholder of: Johnson & Johnson, Employee of: Janssen, Kurt de Vlam Speakers bureau: AbbVie, Amgen, Eli Lilly, Novartis, UCB, Paid instructor for: Amgen, Galapagos, UCB, Consultant of: Eli Lilly, Galapagos, Johnson & Johnson, Novartis, UCB, Grant/research support from: Celgene, Elisa Gremese: None declared., Beatriz Joven-Ibáñez Speakers bureau: AbbVie, Celgene, Janssen, Novartis, MSD, Pfizer, Wim Noel Employee of: Janssen, Petros Sfikakis Consultant of: AbbVie, Actelion, Boehringer Ingelheim, Enorasis, Farmaserv-Lilly, Genesis, Gilead, MSD, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Amgen, Boehringer Ingelheim, Faran, Janssen, Pfizer, Roche, Elke Theander Employee of: Janssen, Laure Gossec Consultant of: AbbVie, Amgen, Bioepis, Biogen, Bristol-Myers Squibb, Celgene, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, Samsung Sanofi-Aventis, UCB, Grant/research support from: Amgen, Galapagos, Janssen, Lilly, Pfizer, Sandoz, Sanofi.

FRI0362 COMPARATIVE EFFECTIVENESS OF USTEKINUMAB (UST) AND TNF INHIBITORS (TNFI) IN PATIENTS WITH PSORIATIC ARTHRITIS (PSA) IN THE REAL-WORLD, MULTINATIONAL PSABIO STUDY: 12-MONTH FOLLOW-UP

Background:

Among treatment options for PsA, IL-12/23 inhibition with UST was the first new biologic mode of action after TNFi. Few real-world data comparing UST with TNFi are available.

Objectives:

Comparison of UST and TNFi treatment effectiveness within the prospectively followed PsABio cohort at 12-month (mo) follow-up.

Methods:

The PsABio study (NCT02627768) evaluates effectiveness, tolerability and persistence of 1st, 2nd or 3rd-line UST or TNFi in PsA. Proportions of patients (pts) reaching MDA/very low disease activity (VLDA) and clinical Disease Activity index for PSoriatic Arthritis (cDAPSA) LDA/remission are described. Comparison across UST and TNFi cohorts was done on last observation carried forward up to 12 (±3) mo, with non-response imputation for pts who had stopped/switched initial treatment. Logistic regression analysis was used, including propensity score (PS) analysis to adjust for imbalanced prognostic baseline (BL) covariates: country, age, sex, BMI, smoking (yes/no), comorbidities (cardiovascular/metabolic syndrome), PsA type (axial, polyarticular, oligoarticular), psoriasis body surface area (BSA), disease duration, cDAPSA, 12-item PsA Impact of Disease (PsAID-12), dactylitis, enthesitis, Fibromyalgia Rapid Screening Tool (FiRST) score, line of biologic (b)DMARD, synthetic DMARD use, and steroid or NSAID use.

Results:

Of 929 eligible pts, 893 had evaluable data at BL and at follow-up; 438 (95.6%) were treated with UST and 455 (96.6%) with TNFi (including stoppers/switchers). UST and TNFi groups had BL differences in mean age (51.0 vs 48.5 years, respectively), concurrent comorbidities (68.7% vs 60.9%), time since diagnosis (7.5 vs 6.2 years), line of treatment (1st-line 45.0% vs 55.2%; 3rd-line 20.5% vs 12.1%), NSAID use (54.8% vs 68.8%), concomitant MTX use (29.9% vs 42.0%) and psoriasis skin involvement (BSA >10% in 26.6% vs 14.8%).

In 714 pts with available data, mean (standard deviation) BL cDAPSA was 30.6 (20.2; n=358) for UST and 29.3 (18.6; n=356) for TNFi. Observed data showed differences in proportion of pts achieving MDA/VLDA and cDAPSA LDA/remission in favour of TNFi, but after PS adjustment for BL differences (such as line of therapy, skin psoriasis, concomitant conventional DMARD, etc.), odds ratios for reaching targets at 12 mo did not significantly differ between UST and TNFi groups (Fig. 1).

Comparison of 6- and 12-mo unadjusted data showed sustained MDA/VLDA responses with both UST (21.8%) and TNFi (29.5%), with comparable proportions of additional pts achieving these targets between 6 and 12 mo (17.0% and 20.3%, respectively). Sustained efficacy became lower with successive lines of treatment (data not shown).

Conclusion:

Various factors, including patient characteristics such as comorbidities, influence the physician’s selection of treatment modality for patients needing a bDMARD. Our real-world results demonstrate differences in observed clinical effectiveness between UST and TNFi. However, after PS adjustment for a number of BL differences, clinical results at 12 mo were comparable between UST and TNFi groups. Data at 12 mo also show sustained response with both UST and TNFi treatment, as well as a similar rate of pts achieving targets after 6 to 12 mo of treatment.

Acknowledgments:

This study was funded by Janssen.

Disclosure of Interests:

Josef S. Smolen Grant/research support from: AbbVie, AstraZeneca, Celgene, Celltrion, Chugai, Eli Lilly, Gilead, ILTOO, Janssen, Novartis-Sandoz, Pfizer Inc, Samsung, Sanofi, Consultant of: AbbVie, AstraZeneca, Celgene, Celltrion, Chugai, Eli Lilly, Gilead, ILTOO, Janssen, Novartis-Sandoz, Pfizer Inc, Samsung, Sanofi, Stefan Siebert Grant/research support from: BMS, Boehringer Ingelheim, Celgene, GlaxoSmithKline, Janssen, Novartis, Pfizer, UCB, Consultant of: AbbVie, Boehringer Ingelheim, Janssen, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, Celgene, Janssen, Novartis, Tatiana Korotaeva Grant/research support from: Pfizer, Consultant of: Abbvie, BIOCAD, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Novartis-Sandoz, Pfizer, UCB, Speakers bureau: Abbvie, BIOCAD, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Novartis-Sandoz, Pfizer, UCB, Paul Bergmans Shareholder of: Johnson & Johnson, Employee of: Janssen, Kurt de Vlam Consultant of: Celgene Corporation, Eli Lilly, Novartis, Pfizer, UCB – consultant, Speakers bureau: Celgene Corporation, Eli Lilly, Novartis, Pfizer, UCB – speakers bureau and honoraria, Elisa Gremese Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Sanofi, UCB, Roche, Pfizer, Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Sanofi, UCB, Roche, Pfizer, Beatriz Joven-Ibáñez Speakers bureau: Abbvie, Celgene, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, Wim Noel Employee of: Janssen Pharmaceuticals NV, Michael T Nurmohamed Grant/research support from: Abbvie, Bristol-Myers Squibb, Celltrion, GlaxoSmithKline, Jansen, Eli Lilly, Menarini, Merck Sharp & Dohme, Mundipharma, Pfizer, Roche, Sanofi, USB, Consultant of: Abbvie, Bristol-Myers Squibb, Celltrion, GlaxoSmithKline, Jansen, Eli Lilly, Menarini, Merck Sharp & Dohme, Mundipharma, Pfizer, Roche, Sanofi, USB, Speakers bureau: Abbvie, Bristol-Myers Squibb, Celltrion, GlaxoSmithKline, Jansen, Eli Lilly, Menarini, Merck Sharp & Dohme, Mundipharma, Pfizer, Roche, Sanofi, USB, Petros Sfikakis Grant/research support from: Grant/research support from Abvie, Novartis, MSD, Actelion, Amgen, Pfizer, Janssen Pharmaceutical, UCB, Elke Theander Employee of: Janssen-Cilag Sweden AB, Laure Gossec Grant/research support from: Lilly, Mylan, Pfizer, Sandoz, Consultant of: AbbVie, Amgen, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Sandoz, Sanofi-Aventis, UCB

AB0700 RADIOGRAPHIC PROGRESSION IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS UNDER TREATMENT WITH TNF INHIBITORS. DATA FROM REGISPONSERBIO (SPANISH REGISTER OF BIOLOGICAL THERAPY IN SPONDYLOARTHRITIDES)

Background:

Clinical efficacy of TNF inhibitors (TNFi) in axial spondyloarthritis (axSpA) has been widely probed in randomized control trials. In clinical practice, some studies suggested that long-term (more than 4 years) treatment with TNFi could slow down radiographic progression in axSpA; however, whether this treatment inhibits structural damage remains unclear.

Objectives:

To evaluate radiographic progression in axSpA patients receiving long-term TNFi (over 4 years) in comparison with patients starting TNFi.

Methods:

A total of 204 patients with axSpA were included in the Spanish Register of Biological Therapy in Spondyloarthritides (REGISPONSERBIO). Out of these, 80 patients (31 starting TNFi and 49 under long-term TNFi) were included in this study based on the availability of spinal radiographs (cervical and lumbar lateral views), at two time points. Radiographs in patients starting TNFi were available: i) at baseline (before TNFi) and ii) after 3 to 5 years of TNFi therapy (mean follow-up 3.7±0.8), while in long-term TNFi patients, these were available: i) at one follow-up visit at least 4 years later since TNFi was started and ii) after 3 to 5 years of this visit (mean follow-up 3.5±1.1). Two trained readers, not blinded for chronological order, independently scored lateral cervical and lumbar spine images according to the mSASSS system (0-72). Following definitions for progression were used: change of the absolute scores, change of ≥2 units, development of new syndesmophytes, and development of new syndesmophytes or growth of the existing syndesmophytes.

Results:

Reliability of both readers was excellent with intraclass correlation coefficients (ICCs) of 0.98 (0.98-0.99) at inclusion and 0.98 (0.97-0.99) at follow-up. Most patients (82.5%) were classified as radiographic axSpA. Mean BASDAI at first visit (i) was of 5.0±2.4 for starting TNFi patients and of 3.2±1.9 for long-term TNFi patients. The table depicted the results for radiographic scores and progression. Mean mSASSS score at first visit (i) was 15.8±21.5 and 15.1±18.4 units for starting TNFi and long-term TNFi patients, respectively. The change score between both visits was 2.3±4.2 and 2.3±4.1, respectively. Similarly, no differences were found for change of ≥2 points (32.3% in starting TNFi and 35% in long-term TNFi patients). However, development of new syndesmophytes or growth of the existing syndesmophytes were found to be more frequently (but not significant) in starting TNFi patients compare to long-term TNFi patients.

Conclusion:

In patients with axSpA treated with TNFi in clinical practice radiographic progression is observed, independently of the time under this therapy. Nevertheless, the development and growth of syndesmophytes seem to be lower in long-term treated patients.

Table.Starting TNFi patientsLong-term TNFi patients*p-valuePresence of syndesmophytes at first visit, % (n)45.2% (14)53.1% (26)NSPresence of syndesmophytes at follow up, %51.6% (16)55.1% (27)NSMean change score, mean ± SD2.32 ± 4.192.26 ± 4.09NSChange of ≥ 2 units in the score % (n)32.3% (10)34.7% (17)NSDevelopment of new syndesmophytes, % (n)29% (9)18.4% (9)0.3Progression or development of new syndesmopyhtes % (n)29% (9)22.4% (11)0.5

* Patients with more than 4 years under TNFi treatment

Disclosure of Interests:

María LLop Vilaltella Speakers bureau: Janssen and Pfizer, Mireia Moreno: None declared, Jordi Gratacos-Masmitja Grant/research support from: a grant from Pfizzer to study implementation of multidisciplinary units to manage PSA in SPAIN, Consultant of: Pfizzer, MSD, ABBVIE, Janssen, Amgen, BMS, Novartis, Lilly, Speakers bureau: Pfizzer, MSD, ABBVIE, Janssen, Amgen, BMS, Novartis, Lilly, Victoria Navarro-Compán Consultant of: Abbvie, Lilly, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Lilly, Novartis, Pfizer, UCB, Eugenio de Miguel Grant/research support from: Yes (Abbvie, Novartis, Pfizer), Consultant of: Yes (Abbvie, Novartis, Pfizer), Paid instructor for: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi), Speakers bureau: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi), Font Ugalde Pilar: None declared, Teresa Clavaguera Speakers bureau: novartis, BMS, Faes, Luis F. Linares Ferrando: None declared, Beatriz Joven-Ibáñez Speakers bureau: Abbvie, Celgene, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, Xavier Juanola-Roura: None declared

SAT0432 EFFECT OF SEX ON DISEASE CHARACTERISTICS AND DISEASE IMPACT IN PATIENTS WITH PSORIATIC ARTHRITIS (PsA): INSIGHTS FROM THE REAL-WORLD, OBSERVATIONAL MULTINATIONAL PsABio COHORT

Background:

Female sex has been associated with more severe disease and poorer treatment outcomes in PsA. These observations are often based on small populations or national cohorts/registries.

Objectives:

To investigate the effects of sex on disease characteristics and disease impact in PsA, using data of 929 consecutive patients (pts) from PsABio.

Methods:

PsABio is a real-world, non-interventional European study in PsA pts treated with UST or TNFi based on their rheumatologist’s choice. Observed male and female baseline (BL) data were described and compared using 95% CI.

Results:

Women in PsABio (n=512 [55%]) were numerically older than men (mean [SD]: 50.5 [12.7] / 48.7 [12.3] years, respectively). Women were more obese (BMI >30), % (95% CI): F: 35 (30, 39), M: 24 (20, 29), men more overweight (BMI >25–30): F: 31 (27, 36), M:51 (46, 57). Age at diagnosis, delay from first symptom to diagnosis, and disease duration were similar for both sexes.

Women entered PsABio more often on 3rd line treatment, whereas men started on 1st-line biologic treatment more often (F/M 1st line 47%/55%; 2nd line 34%/33%; 3rd line 20%/12%). Numerically, concomitant MTX was given more often to women vs men (32% vs 27%). At BL, 60% of women and 64% of men were on NSAIDs; 7.9% and 2.5% on antidepressant drugs. Women had significantly more comorbidities, with numerically more cardiovascular disease and anxiety/depression, and 3 times more IBD.

Women had significantly higher 68 tender joint counts (TJC): 13.0 vs 10.4, while 66 swollen joint counts were not significantly different: 5.8 vs 5.5. Axial or combined axial-peripheral disease was similarly frequent, in 29% of women and 26% of men (Figs. 1, 2).

Clinical Disease Activity index for PSoriatic Arthritis (cDAPSA) was higher in women (31.8 vs 27.3); pt-reported levels of pain, global disease activity (VAS scales) and higher TJC contributed to this. While enthesitis prevalence (based on Leeds Enthesitis Index) was comparable, men had significantly more frequent dactylitis, nail disease and worse skin psoriasis. At BL, 3.4% of women vs 7.1% of men, were in MDA.

Regarding physical functioning (HAQ-DI), impact of disease (PSAID-12) and quality of life (EQ5D-3L health state), women with PsA starting a biologic (b)DMARD, expressed significantly greater negative impact and more limitations due to their disease (Fig. 2).

Conclusion:

In routine care, women with PsA starting a bDMARD presented with worse outcomes over a range of assessments compared with men (higher pt-reported pain and disease activity, TJC, and worse physical functioning and QoL), while men had worse dactylitis and psoriasis. Follow-up analysis will report whether the effects of biologic therapy are different in both sexes. The increased prevalence of associated features related to pain and impact on functioning and QoL may indicate the need for a more comprehensive treatment approach for women to avoid unnecessary and premature bDMARD stop or switch.

Acknowledgments:

This study was funded by Janssen.

Disclosure of Interests:

Michael T Nurmohamed Grant/research support from: Abbvie, Bristol-Myers Squibb, Celltrion, GlaxoSmithKline, Jansen, Eli Lilly, Menarini, Merck Sharp & Dohme, Mundipharma, Pfizer, Roche, Sanofi, USB, Consultant of: Abbvie, Bristol-Myers Squibb, Celltrion, GlaxoSmithKline, Jansen, Eli Lilly, Menarini, Merck Sharp & Dohme, Mundipharma, Pfizer, Roche, Sanofi, USB, Speakers bureau: Abbvie, Bristol-Myers Squibb, Celltrion, GlaxoSmithKline, Jansen, Eli Lilly, Menarini, Merck Sharp & Dohme, Mundipharma, Pfizer, Roche, Sanofi, USB, Irene van der Horst-Bruinsma Grant/research support from: AbbVie, Novartis, Eli Lilly, Bristol-Myers Squibb, MSD, Pfizer, UCB Pharma, Consultant of: AbbVie, Novartis, Eli Lilly, Bristol-Myers Squibb, MSD, Pfizer, UCB Pharma, Arno WR van Kuijk Grant/research support from: Janssen, Stefan Siebert Grant/research support from: BMS, Boehringer Ingelheim, Celgene, GlaxoSmithKline, Janssen, Novartis, Pfizer, UCB, Consultant of: AbbVie, Boehringer Ingelheim, Janssen, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, Celgene, Janssen, Novartis, Paul Bergmans Shareholder of: Johnson & Johnson, Employee of: Janssen, Kurt de Vlam Consultant of: Celgene Corporation, Eli Lilly, Novartis, Pfizer, UCB – consultant, Speakers bureau: Celgene Corporation, Eli Lilly, Novartis, Pfizer, UCB – speakers bureau and honoraria, Elisa Gremese Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Sanofi, UCB, Roche, Pfizer, Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Sanofi, UCB, Roche, Pfizer, Beatriz Joven-Ibáñez Speakers bureau: Abbvie, Celgene, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, Tatiana Korotaeva Grant/research support from: Pfizer, Consultant of: Abbvie, BIOCAD, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Novartis-Sandoz, Pfizer, UCB, Speakers bureau: Abbvie, BIOCAD, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Novartis-Sandoz, Pfizer, UCB, Wim Noel Employee of: Janssen Pharmaceuticals NV, Petros Sfikakis Grant/research support from: Grant/research support from Abvie, Novartis, MSD, Actelion, Amgen, Pfizer, Janssen Pharmaceutical, UCB, Elke Theander Employee of: Janssen-Cilag Sweden AB, Josef S. Smolen Grant/research support from: AbbVie, AstraZeneca, Celgene, Celltrion, Chugai, Eli Lilly, Gilead, ILTOO, Janssen, Novartis-Sandoz, Pfizer Inc, Samsung, Sanofi, Consultant of: AbbVie, AstraZeneca, Celgene, Celltrion, Chugai, Eli Lilly, Gilead, ILTOO, Janssen, Novartis-Sandoz, Pfizer Inc, Samsung, Sanofi, Laure Gossec Grant/research support from: Lilly, Mylan, Pfizer, Sandoz, Consultant of: AbbVie, Amgen, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Sandoz, Sanofi-Aventis, UCB

AB0655 IMPACT OF BIOLOGIC THERAPY ON WORK IMPAIRMENT IN REAL LIFE IN AXIAL SPONDYLOARTHRITIS PATIENTS: DATA FROM REGISPONSERBIO

Background:

Biologic therapy (BT) has demonstrated its effect in improving work impairment in axial Spondyloarthritis (axSpA) patients in clinical trials, however there is few data of these effects in clinical practice.

Objectives:

-To assess the influence of BT in work status using the WPAI questionnaire in patients with axSpA in real life.

-To compare work status between incident and prevalent cases with BT.

-To evaluate factors related to changes in work status in these patients.

Methods:

REGISPONSERBIO is an observational, prospective and multicentric Spanish registry of SpA patients under biologic treatment recruited between September 2013 and December 2014. The study includes demographic, radiologic and disease data from both incident (starting biological therapy at the inclusion) and prevalent (already under biologic therapy at the inclusion) patients. WPAI (Work Productivity and Activity Impairment) questionnaire was used to assess work status (employment, lost hours, absenteeism and presenteeism) in both groups of patients at six months after study inclusion. Patients more than 65 years old who were not working were excluded from the analysis, as no changes in work impairment are expected in these individuals.

A descriptive study of work status and related factors was performed using mean and standard deviation as appropriate. Work status was compared between both time-points in incidents and between incidents and prevalents. Uni and multivariate analysis for factors related to baseline work status were assessed, and correlation for change at six months.

Results:

The study included 75 incident and 134 prevalent axSpA patients. After start of BT, incident patients presented an increase in the number of patients who affirmed to be actively working and an improvement in absenteeism, lost hours and presenteeism, however statistical significance was only reached in the number of hours lost. Comparing incident and prevalent cases, incident patients showed worse data on work status compared to prevalent ones, but only presenteeism reached statistical significance. Factors related to absenteeism and presenteeism at study inclusion were disease activity variables (PGA, BASDAI, ASDAS-CRP), ASQoL and BASFI. Best correlation with improvement in absenteeism at six months was with change in BASDAI (0.84 p 0.07) and age (-0.56 p 0.11), and with improvement in presenteeism were BASFI (0.59 p 0.002), ASQoL (0.57 p 0.002), BASDAI (0.54 p 0.04), PGA (0.51 p 0.01) and ASDAS-CRP(0.51 p 0.01).

Conclusion:

Biologic therapy is associated to an improvement in work status in axSpA patients. The results suggest that the fast and high improvement in disease activity and disability observed after start of BT is not directly translated to an improvement in work status at short time. Disease activity, disability and quality of life were the main factors influencing both, work status at inclusion and improvement in absenteeism and presenteeism after BT was started.

Disclosure of Interests:

Marta Arévalo: None declared, Mireia Moreno: None declared, Victoria Navarro-Compán Consultant of: Abbvie, Lilly, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Lilly, Novartis, Pfizer, UCB, Font Ugalde Pilar: None declared, Eugenio de Miguel Grant/research support from: Yes (Abbvie, Novartis, Pfizer), Consultant of: Yes (Abbvie, Novartis, Pfizer), Paid instructor for: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi), Speakers bureau: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi), Teresa Clavaguera Speakers bureau: novartis, BMS, Faes, Luis F. Linares Ferrando: None declared, Beatriz Joven-Ibáñez Speakers bureau: Abbvie, Celgene, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, Jordi Gratacos-Masmitja Grant/research support from: a grant from Pfizzer to study implementation of multidisciplinary units to manage PSA in SPAIN, Consultant of: Pfizzer, MSD, ABBVIE, Janssen, Amgen, BMS, Novartis, Lilly, Speakers bureau: Pfizzer, MSD, ABBVIE, Janssen, Amgen, BMS, Novartis, Lilly, Xavier Juanola-Roura: None declared

FRI0324 NO RADIOGRAPHIC SACROILIITIS PROGRESSION OVER 6 YEARS IN PATIENTS WITH EARLY SPONDYLOARTHRITIS FROM THE ESPERANZA COHORT

Background:

Longitudinal studies about the change from non-radiographic axial Spondyloarthritis (nr-axSpA) to r-axSpA (radiographic axial Spondyloarthritis) are scarce but show a 9-10% progression rate over 2 years (1-2) and a 24% progression rate over 10 years in another study (3). However, in early cohorts such as DESIR, this only represents a 5% over 5 years (4).

Objectives:

The aim of this study was to know the rate of progression from nr-axSpA to r-axSpA over 6 years in the early Esperanza cohort.

Methods:

This study included 94 patients of the Spanish early spondyloarthritis (SpA) Esperanza cohort, 60 fulfilled the ASAS classification criteria for SpA. Every patient had a baseline and a six years sacroiliac X-ray. Nine readers, blinded for the diagnosis, participated in the reliability exercise, all of them experienced rheumatologists and members of the Spanish spondyloarthritis working group (GRESSER). Patients with SpA were classified as having r-axSpA, at baseline or after 6 years of follow-up, if they fulfilled the radiographic item of the modified New York criteria (mNY) (presence of radiographic changes in the sacroiliac joints -SIJ- of at least grade II bilaterally or grade III or IV unilaterally). The gold standard of SIJ X-Ray was the categorical opinion of at least five of the expert readers. For the statistical analysis, the Chi-square and Kappa tests were performed.

Results:

Demographic data of the SpA patients were: mean age 33.4±7.5 years; 37 (61.7%) male; mean CRP 6.4±6.5 mg/dl and ESR 10.3±10.6. Present smokers 30.6%; and past smokers 16.3%. HLA-B27 (+) 56.7%. Regarding the presence of X-Ray sacroilitis: 20 patients had baseline sacroilitis and 18 at the final visit; 11 had sacroiliitis at both baseline and final visits; 9 patients changed from baseline sacroiliitis to no-sacroiliitis and 7 changed from baseline no-sacroiliitis to sacroiliitis at the 6 year visit. The reliability of the readers was fair with a mean inter-reader kappa test of 0.375 (range 0.146 - 0.652) and a mean agreement of 73.7% (range 58.7% - 90%).

Conclusion:

In this group of patients with early SpA no progression from nr-axSpA to r-axSpA over 6 years was observed. It appears that early diagnosis and standard treatment seem to reduce SIJ radiographic progression.

References:

[1]Poddubnyy D, Rudwaleit M, Haibel H, et al. Rates and predictors of radiographic sacroiliitis progression over 2 years in patients with axial spondyloarthritis. Ann Rheum Dis 2011;70:1369–74.

[2]Sampaio-Barros PD, Conde RA, Donadi EA, et al. Undifferentiated spondyloarthropathies in Brazilians: importance of HLA-B27 and the B7-CREG alleles in characterization and disease progression. J Rheumatol 2003;30:2632–7.

[3]Sampaio-Barros PD, Bortoluzzo AB, Conde RA, et al. Undifferentiated spondyloarthritis: a longterm followup. J Rheumatol 2010;37:1195–9.

[4]Dougados M, et al. Ann Rheum Dis 2017;76:1823–1828.

Disclosure of Interests:

Carolina Tornero: None declared, María del Carmen Castro Villegas: None declared, Xavier Juanola-Roura: None declared, Maria Luz García-Vivar: None declared, Cristina Fernández-Carballido Consultant of: Yes, I have received fees for scientific advice (Abbvie, Celgene, Janssen, Lilly and Novartis), Speakers bureau: Yes, I have received fees as a speaker (Abbvie, Celgene, Janssen, Lilly, MSD, Novartis), Jose Francisco Garcia LLorente: None declared, Beatriz Joven-Ibáñez Speakers bureau: Abbvie, Celgene, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, E. Galindez: None declared, Claudia Urrego-Laurín: None declared, Eugenio de Miguel Grant/research support from: Yes (Abbvie, Novartis, Pfizer), Consultant of: Yes (Abbvie, Novartis, Pfizer), Paid instructor for: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi), Speakers bureau: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi)

AB0602 SYSTEMIC SCLEROSIS: SUBCLINICAL ATHEROSCLEROSIS AND MORBIMORTALITY

Background:

Rheumatic diseases are associated with accelerated atherosclerosis, and an increase in cardiovascular morbidity and mortality. This process is mediated by classic cardiovascular risk factors (CVRF), chronic inflammation and atherogenic treatments such as corticosteroids. In Systemic Sclerosis (SSc) cardiovascular complications have increased in recent decades, although the studies on subclinical atherosclerosis (sATS) in SSc show discordant results.

Objectives:

To evaluate prospectively the relationship between subclinical atherosclerosis, cardiovascular morbidity and mortality in patients with SSc.

Methods:

120 consecutive patients with SSc who attended their medical regular review during November and December 2011 were included. We evaluated the presence of plaques and measured the right CCA IMT by B doppler US for the detection of sATS (IMT> 0.9mm and/or presence of plaque), review of classic CVRF and estimation of Medsger severity and EUSTAR activity index. Patients have been followed for 8 years, with at least annual consultation. In retrospect, the SCTC damage index, published in 2019, was obtained at the time of inclusion in the study. The clinical characteristics of the patients are collected since 1990 in a Prospective Longitudinal Observational Study (PLOS). Descriptive analysis was performed, using contigence tables for qualitative variables, and comparison of means for quantitative variables. The relationship between clinical characteristics, mortality, cardiovascular events (CVE), activity, severity and damage index, and sATS, was analyzed using binary logistic regression, adjusting for age and sex.

Results:

120 patients with SSc were included (93% female, age 60 ± 12 years). 42 of these patients (35%) had subclinical atherosclerosis. Age was statistically significant higher in patients with sATS compared to those without it (67.9±11.5 vs. 56.1±10.4 years, p <0.001). We found no differences between groups in activity, damage and severity index (Table 1). Patients with sATS had higher levels of ESR and CRP, but the difference was not confirmed after adjusting for age (*). During the 8 years of follow-up, 9 CVE in 7 patients (5.8%): three myocardial infarction, one transient ischemic accident, one angor, one intermittent claudication and three refractory heart failure. The incidence of severe CVE was more than double in patients with SAtS (10.25% vs. 3.7%), but the difference was not significant. We found no relationship between the mortality of any cause, or the secondary to CVE, with sATS, in the 32 patients who died during the follow-up, 3 due to CVE (9.4%). The results are similar when we analyze only the presence of plaques.

Table 1.

Relationship between clinical characteristics and activity, severity and damage index with the presence of accelerated atheromatosis.

Absent n=78Present n=42Diffuse cutaneous SSc37.18%26.12%NSmRSS7.71 ± 6.326.38 ± 4.92NSHigh mRSS9.69 ± 8.337.57 ± 4.74NSArthritis32.05%28.57%NSLung involvement33.33%30.95%NSPAH10.26%7.14%NSCardiac involvement15.38%9.52%NSDigital ulcers35.90%35.83%NSAntiScl7025.64%21.43%NSESR20.12 ± 13.7726.88 ±17.25p =0.037*CPR0.65 ± 0.610.89 ± 0.7p =0.041*High activity index11.54%19.05%NSDamage index6.67 ± 5.565.62 ± 4.9NSΣ Medsger index5.37 ± 3.55.05 ± 3.45NS

Conclusion:

In our study subclinical atherosclerosis is not related to higher mortality in patients with SSc, but it does seem to influence the occurrence of cardiovascular events. In addition, our results suggest that SSc does not influence the onset of accelerated atheromatosis.

Acknowledgments:

M Retuerto was recipient of a training grant from Sociedad Española de Reumatologia (SER).

Disclosure of Interests:

M. Retuerto-Guerrero: None declared, MARIA MARTIN LOPEZ: None declared, Beatriz Joven-Ibáñez Speakers bureau: Abbvie, Celgene, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, José Luis Rosales Grant/research support from: I have received financial support from Novartis, UCB, Pfizer, Abvie to meeting and symposia, Patricia Carreira Grant/research support from: Actelion, Roche, MSD, Consultant of: GlaxoSmithKline, VivaCell Biotechnology, Emerald Health Pharmaceuticals, Boehringer Ingelheim, Roche, Speakers bureau: Actelion, GlaxoSmithKline, Roche

AB0768 TREATMENT WITH TOFACITINIB IN REFRACTORY PSORIATIC ARTHRITIS. MULTICENTER STUDY OF 87 PATIENTS IN CLINICAL PRACTICE

Background:

Tofacitinib (TOFA) is the first JAKi approved for psoriatic arthritis (PsA) in Europe (July 2018). TOFA has shown efficacy in refractory patients to anti-TNF in Randomized Clinical Trials (RCT) (Gladman D. NEJM 2017; 377: 1525-36).

Objectives:

To assess efficacy and safety of TOFA in clinical practice (CP). To compare the profile of CP with RCT

Methods:

Study of 87 patients of CP with PsA treated with TOFA; Results are expressed as percentage, mean±SD or median [IRQ].

Results:

87 patients (28♀/59♂), mean age of 52.8±11.4 years (Table 1). Pattern of joint involvement was: peripheral (n=60), axial (1) and mixed (26). Presented also enthesitis (49.4%), nail involvement (30.2%) and dactylitis (31%).

Prior TOFA, most patients (80%) received oral prednisone, synthetic immunosuppressants (mean 2.3±0.9) and biological therapy (BT) (3.6±1.9): etanercept (n=58), adalimumab (54), infliximab (31), golimumab (37), certolizumab (30), secukinumab (54), ustekinumab (39) and ixekizumab (2). Apremilast was used in 17.

After a mean follow-up of 12.3±9.3 years from PsA diagnosis, TOFA was started (5 mg/12 h). In 48 (55.2%) TOFA was used in combined therapy: methotrexate (30) and leflunomide (15). In the remaining 39, monotherapy was prescribed.

Patients of CP compared with RCT have a longer duration of PsA, worst functional disability (HAQ) and received a higher proportion of corticosteroids and BT (anti-TNF and non-anti-TNF) (Table 1).

Patients improved in activity indexes (PASI, DAS28, DAPSA) and laboratory test (table 2). Minor side effects were reported in 21 patients (gastrointestinal symptoms), and TOFA was discontinued in 29 due to inefficiency mainly.

Conclusion:

Patients of CP had a longer evolution and received a greater number of biologics than those of RCT. TOFA as in RCT seems effective, rapid and relatively safe for refractory PsA.

Table 1.

Baseline features

CLINICAL TRIALGladmanN=131CLINICAL PRACTICEN=87Age, years (mean±SD)49.5±12.352.8±11.4Sex, n (%)67M/64F (51/49)59M/28F (68/32.2)Duration PsA, years (mean±SD)9.6±7.612,3±9.3HAQ-DI1.3±0.71.4±0.7 (n=26)Swollen joint count, mean±SD12.1±10.65.7±5.8Painful joint count, mean±SD20.5±13.08.0±6.6Elevated CRP, n (%)85 (65)55 (63.2)PASI score, median [IQR]7.6 [0.6-32.2]9.0 [4.2-15]Oral glucocorticoid, n (%)37(28)44(50.5)Concomitant synthetic DMARDs, n (%)- Methotrexate98 (75)30 (34.4)- Leflunomide12 (9)15 (17.2)- Sulfasalazine21 (16)6 (6.9)- Others2 (2)N. of previous TNF inhibitors, mean±SD1.7±1.02.4±1.4Previous use of other biological no anti-TNF, n (%)11 (8)68 (78.2)Table 2.

Table 2. Improvement at 1st, 6thand 12thmonth

Baselinen=871st monthn=776th monthn=5212th monthn=20Nail involvement, n (%)17 (19.5)Improvement, n (%)5 (35.7)6 (60)5 (83.3)Enthesitis, n (%)28 (32.2)Improvement, n (%)8 (47.1)10 (58.8)3 (50)Dactylitis, n (%)16 (18.4)Improvement, n (%)9 (69.2)6 (85.7)0 (0)CRP mg/dl, median [IQR]1.9 [0.3-5]0.5 [0.1-2.2]0.5 [0.3-1.2]0.4 [0.4-3.7]p (vs baseline)0.0040.0050.66DAS28, median [IQR]4.8 [4.1-5.403.7 [2.8-4.6]2.8 [2.2-3.8]2.9 [2.2-3.7]p (vs baseline)<0.001<0.001<0.001DAPSA, median [IQR]28 [18.41-34.05]15.5 [10.1-25.7]9 [6.07-15]4.3 [2.4-8]p (vs baseline)<0.001<0.001<0.001PASI, median [IQR]5 [1-14]1.4 [0-7]0 [0-4]0.05 [0-2.7]p (vs baseline)0.1920.1050.300

Disclosure of Interests:

E. Galindez: None declared, D. Prieto-Peña: None declared, José Luis Martín-Varillas Grant/research support from: AbbVie, Pfizer, Janssen and Celgene, Speakers bureau: Pfizer and Lilly, Beatriz Joven-Ibáñez Speakers bureau: Abbvie, Celgene, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, Olga Rusinovich: None declared, RAQUEL ALMODOVAR Speakers bureau: Abbvie, Celgene, Janssen, Lilly, Novartis, Pfizer.

, Juanjo J Alegre-Sancho Consultant of: UCB, Roche, Sanofi, Boehringer, Celltrion, Paid instructor for: GSK, Speakers bureau: MSD, GSK, Lilly, Sanofi, Roche, UCB, Actelion, Pfizer, Abbvie, Novartis, LARA MENDEZ DIAZ: None declared, Agusti Sellas-Fernández Speakers bureau: Abbott, Lilly, Celgene, Pfizer, Schering-Plough, Janssen, Novartis, and Nordic Pharma, À Martínez-Ferrer: None declared, Rosario Garcia de Vicuna Grant/research support from: BMS, Lilly, MSD, Novartis, Roche, Consultant of: Abbvie, Biogen, BMS, Celltrion, Gebro, Lilly, Mylan, Pfizer, Sandoz, Sanofi, Paid instructor for: Lilly, Speakers bureau: BMS, Lilly, Pfizer, Sandoz, Sanofi, Clara Ventín-Rodríguez: None declared, Julio Ramirez: None declared, Manuel Moreno: None declared, Maria jose Moreno: None declared, María del Carmen Castro Villegas: None declared, Antia Crespo Golmar: None declared, Natalia Palmou-Fontana: None declared, FRANCISCO ORTIZ SANJUAN: None declared, Ximena Elizabeth Larco Rojas: None declared, Antonio Juan Mas: None declared, Christian Y Soleto: None declared, Iñigo Gorostiza: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD

AB0799 REAL-WORLD EXPERIENCE OF SECUKINUMAB FOR PSORIATIC ARTHRITIS WITH AXIAL INVOLVEMENT

Background:

Evidence on the efficacy of biologics in the treatment of psoriatic arthritis (PsA) patients with axial manifestations affecting 30-70% of PsA patients is limited. Secukinumab (SEC) has provided significant and sustained improvement in the signs and symptoms of active PsA and ankylosing spondylitis.

Objectives:

This study aims to analyze the experience of using SEC for PsA patients with axial involvement in real-world setting.

Methods:

Multicentric observational, longitudinal, retrospective study conducted in a tertiary hospital between January 2016 and December 2019. Patients with PsA (CASPAR criteria) and clinical and/or image diagnosis of axial involvement receiving at least one dose of SEC were included. Patients with non-pathological sacroiliacs x-ray and MRI had to have spinal pain VAS ≥4/10 after failure to NSAIDs, prior to the onset of SEC, to be included. Medical records were reviewed to collect demographic and clinical data, features of PsA (manifestations, treatments and activity assessment). Descriptive statistics and then a comparative analysis with the Studentt-test to analyze the effectiveness of SEC were performed.

Results:

Of 98 PsA patients treated with SEC, 58 (59.2%) had axial involvement, of which 41 (71%) female. Mean age was 54 y.o (SD 10) and average duration of the disease was 10 years (SD 8). All 58 patients had peripheral disease (33% joint erosions), 55 (95%) had psoriasis, 20 (34%) showed dactilitis and 39 (67%) had enthesitis. Sacroiliacs x-ray was damaged in 38 (66%) patients (grade I-IV) and 23 (40%) pathological MRI, with HLAB27+ at 8 (14%) patients. Average BMI was 29 (SD 8), with an obesity rate of 33% (19 pt). Observed comorbidities were hypertension (27 pt, 47%), diabetes mellitus (6 pt, 10%), dyslipidemia (23 pt, 40%), active smoking (18 pt, 31%) and malignancy (6 pt, 10%). Regarding previous treatments, 90% had received cDMARDs, particularly methotrexate (86%) and 40 (69%) had been exposed to at least one bDMARD (15 pt to one, 9 to two, 6 to three and 10 to four or more). 7 patients were on 300 mg dose and 51 patients on 150 mg dose (dose escalation to 300 mg was performed in 16 patients and 44% respond and maintain SEC). Average drug survival time was 1.4 (SD 1) years. At 6 months of SEC therapy, tender and swollen joint count, spinal pain VAS, CRP, ASDAS-CRP and DAPSA had significantly decreased (Table 1). 29 (50%) patients suspended SEC during follow-up due to primary ineffectiveness (8), secondary ineffectiveness (16), adverse events (3), latex allergy (1) and remission (1). Adverse events do not differ from those reported in clinical trials.

Table 1.

Disease activity assessment at 6 months of secukinumab therapy.

Baseline6 months after SECMean differenceP valueSJC4,8±5,41,9±3,1-2,8 (IC95% -3,9 a -1,7)p<0,0001TJC7,7±5,83,9±4,1-3,8 (IC95% -5,1 a -2,4)p<0,0001Spinal pVAS6,1±3,24,2±2,9-1,9 (IC95% -2,4 a -1,4)p<0,0001CRP (mg/L)7,7±9,94,9±5,9-2,9 (IC95% -4,5 a -1,2)p=0,0009ASDAS-CRP2,5±1,91,8±1,3-0,7 (IC95% -0,9 a -0,4)p<0,0001DAPSA27,7±12,116,7±10,4-11 (IC95% -15,3 a -6,8)p<0,0001

SJC: swollen joint count, TJC: tender joint count, Spinal pVAS: spinal pain visual analog scale, CRP: C-reactive protein, SEC: secukinumab.

Conclusion:

Secukinumab in real-world setting provided improvements in the axial and peripheral manifestations of PsA, using both the 150 mg and 300 mg doses.

Disclosure of Interests:

MARIA MARTIN LOPEZ: None declared, Beatriz Joven-Ibáñez Speakers bureau: Abbvie, Celgene, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, José Luis Pablos: None declared

SAT0428 IMPACT OF DOSE ESCALATION OF SECUKINUMAB IN PATIENTS WITH PSORIATIC ARTHRITIS IN REAL-WORLD SETTING

Background:

Secukinumab (SEC) has provided efficacy in clinical trials in patients with psoriatic arthritis (PsA). In PsA patients, a gain in response has been suggested by dose escalation from 150 to 300 mg in the open phase of the FUTURE study1.

Objectives:

To analyze the usefulness of dose escalation of SEC from 150 to 300 in patients with non-responding PsA to 150 mg in real-world setting.

Methods:

Multicentric observational, longitudinal, retrospective study conducted in a tertiary hospital between January 2016 and December 2019. Patients with PsA (CASPAR criteria) receiving at least one dose of SEC were included. Medical records were reviewed to collect demographic and clinical data related to PsA (including activity assessment and treatment). Descriptive statistics and a comparative analysis of the efficacy of SCK by the Studentttest in the different dose groups and by the ANOVA test to compare the response between the three dose groups were performed.

Results:

98 patients with PsA treated with SEC, of which 69(70%) female were included. Mean age was 54 y.o (SD12) and average duration of the disease was 9 (SD 7) years. Three groups were made according to the dose received, SEC150, SEC300 and SEC150-300 (non-responders after SEC150 onset increasing to 300 mg). The SEC150 group includes 58(59%) patients of whom 32(55%) had received at least one biological (16 one biological, 8 two biological and 10 three or more). The survival of SEC was 1.3 (SD1) years and was suspended in 24(41%) patients, due to primary failure in 9, secondary failure 10, adverse events 4 and allergy to latex 1. The SEC300 group includes 12 (12%) patients of whom 10 (83%) had received at least one biological (1 one biological, 3 two and 6 three or more). The survival of the SEC was 1.6 SD (1.3) years and was suspended in 8 (67%) patients, due to primary failure in 2, secondary failure 5 and remission 1. Finally, the SEC150-300 group includes 28 (29%) patients of whom 17 (61%) had received at least one biologic (7 one biologic, 2 two and 8 three or more). The survival of the SEC was 1.6 (SD0.9) years and was suspended in 13 (46%) patients, all due to secondary failure. 54%, therefore, maintains the SCK after responding to the dose increase. The average time of dose increase to 300 mg was 9(SD6) months. In the three treatment groups, a significant decrease in the values of CRP, ASDAS-CRP and DAPSA was observed at 6 months of SEC (Table 1). However, when comparing the difference of means obtained during follow-up (ΔCRP, ΔASDAS and ΔDAPSA) between the 3 dose groups, no significant differences were found (p=0.76 for CRP, p=0.86 for ASDAS and p=0.35 for DAPSA).

Table 1.

Disease activity assessment at 6 months of SEC therapy.

Baseline6 months after SECMean differencep valueCRP300 (mg/L)9±8,34,7±3,7-4,3 (IC95% -8,9 a 0,2)p=0,06CRP150 (mg/L)7,3±9,14,0±4,7-2,9 (IC95% -4,7 a -1,3)p=0,0009CRP150-300(mg/L)9,9±116,0±7,4-3,9 (IC95% -6,9 a -8,5)p=0,0142ASDAS-CRP3002,3±0,71,6±0,6-0,6 (IC95% -0,9 a -0,3)p=0,0014ASDAS-CRP1502,3±0,61,6±0,7-0,7 (IC95% -0,8 a -0,5)p<0,0001ASDAS-CRP150-3002,2±0,61,6±0,7-0,6 (IC95% -0,8 a -0,4)p<0,0001DAPSA30033,7±19,316,9±10,6-16,8 (IC95% -29,6 a -3,9)p=0,01DAPSA15027,4±11,415,4±10,4-11 (IC95% -14,4 a -7,6)p<0,0001DAPSA150-30028±9,915,8±8,7-12,2 (IC95% -15,3 a -9,1)p<0,0001

CRP300: C-reactive protein in patients with SCK 300 mg, CRP150: in patients with SCK 150, CRP150-300: in patients with dose escalation from 150 to 300 (same for ASDAS-CRP and DAPSA), SEC: secukinumab

Conclusion:

There are no significant differences in the response evaluated by CRP, ASDAS-CRP and DAPSA between the dose of 150 and 300 mg of SEC. However, both doses of treatment provided efficacy in clinical practice with significant reduction of activity parameters. In the case of patients not responding to SEC150 mg and prior failure to TNFi, increasing the dose to 300 mg could be an effective option.

References:

[1]Mease PJ, et al. ACR Open Rheum.2020 Jan;2(1):18-25.

Disclosure of Interests:

MARIA MARTIN LOPEZ: None declared, Beatriz Joven-Ibáñez Speakers bureau: Abbvie, Celgene, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, José Luis Pablos: None declared

SAT0369 SPINAL RADIOGRAPHIC PROGRESSION IN EARLY SPONDYLOARTHRITIS: SIX-YEAR RESULTS FROM THE ESPERANZA COHORT

Background:

There are few studies focused on the development of structural damage over time in patients with early SpA

Objectives:

The aim of this study is to analyze the mSASSS radiographic progression of spine in patients with early spondyloarthritis (SpA) in the Esperanza cohort.

Methods:

In this longitudinal study, 49 patients of the Spanish early spondyloarthritis (SpA) Esperanza cohort were included. Every patient had a baseline and a six years lateral X-Ray of the cervical and lumbar of spine. The assessment of spine structural damage was done by the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Nine readers, blinded for the diagnosis, participated in the reliability exercise, all of them experienced rheumatologists and members of the Spanish spondyloarthritis working group (GRESSER). The mSASSS progression and development of new syndesmophytes was analyzed. The gold standard of every elemental lesion of the mSASSS and the total mSASSS score was the agreement achieved by the independent categorical opinion of at least five of the nine readers. For reliability, intraclass correlation coefficient (ICC) two-way mixed, absolute agreement was used.

Results:

Forty-nine patients were included, 69 % were males and 49%, HLA B27 positive. Mean ± SD baseline ESR, CRP, BASDAI, BASFI and mSASSS were 10.7±11.7, 5.4±7.1, 3.7±2.5, 2.1±2.0 and 0.326±0.85, respectively. Inter-reader ICC reliability of the 9 readers was 0.812 (CI 95%; 0.764-0.857). The mSASSS score at the six-year visit was 0.67 ± 1.6: thirty-nine patients did not present any changes in this score at the end of the follow-up, two patients had Δ mSASSS of – 1 and eight patients, an increase in this score (four patients, +1; three patients, +2 and one patient, +9 points).

At baseline, five patients presented one syndesmophyte; at the six-year visit, seven had one syndesmophyte; one patient, two syndesmophytes and another one, one bone bridge. Only 2/5 patients (40%) with syndesmophytes at baseline showed an increase in Δ mSASSS; the two patients with a Δ mSASSS of -1 did not have syndesmophytes at baseline. Five out of eight patients (62.5%) with an increase of the Δ mSASSS presented this lesion at the six-year visit but only two of them showed syndesmophytes at baseline. On the other hand, two of the three patients who showed an increase of the ΔmSASSS without syndesmophytes at baseline presented an erosion in the anterior vertebral corner and the patient with the bone bridge had a previous syndesmophyte. Our results indicate that in early SpA much of the progression appears in patients without previous syndesmophytes.

Conclusion:

Spinal radiographic progression was very low in our early SpA cohort, with a mean progression of 0.3 mSASSS units. Only eight patients (16.3%) presented spinal structural progression, most of them not showing syndesmophytes at baseline. It is reasonable to consider that an early diagnosis and monitoring could result in a low radiographic progression.

Disclosure of Interests:

Eugenio de Miguel Grant/research support from: Yes (Abbvie, Novartis, Pfizer), Consultant of: Yes (Abbvie, Novartis, Pfizer), Paid instructor for: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi), Speakers bureau: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi), Jose Francisco Garcia LLorente: None declared, Claudia Urrego-Laurín: None declared, Maria Luz García-Vivar: None declared, Cristina Fernández-Carballido Consultant of: Yes, I have received fees for scientific advice (Abbvie, Celgene, Janssen, Lilly and Novartis), Speakers bureau: Yes, I have received fees as a speaker (Abbvie, Celgene, Janssen, Lilly, MSD, Novartis), María del Carmen Castro Villegas: None declared, Beatriz Joven-Ibáñez Speakers bureau: Abbvie, Celgene, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, Xavier Juanola-Roura: None declared, Carolina Tornero: None declared, E. Galindez: None declared

SAT0398 PERSISTENCE OF USTEKINUMAB (UST) OR TNF INHIBITOR (TNFI) TREATMENT IN PSORIATIC ARTHRITIS (PsA): INSIGHTS FROM THE LARGE, PROSPECTIVE, MULTINATIONAL, REAL-WORLD PsABio COHORT

Background:

Several biologic DMARDs (bDMARDs) exist for PsA, TNFi and UST being the earliest on European markets. When bDMARDs are insufficiently effective, later-line bDMARDs typically have shorter persistence. Treatment persistence reflects a mix of effectiveness and adverse events (AEs), and persistence data are limited in PsA.

Objectives:

Comparative analysis of 1-year persistence of UST and TNFi within the prospective PsABio cohort.

Methods:

PsABio is an observational, multinational study of PsA patients (pts) treated with 1st to 3rd line UST or TNFi at their rheumatologist’s discretion.1Treatment persistence (up to 15 months of follow-up) was defined as time between start of first bDMARD treatment in PsABio, and either stop or switch to another bDMARD, or withdrawal.

Persistence of UST and TNFi is shown by Kaplan-Meier curves and compared using Cox regression analysis, with propensity score (PS) to adjust for baseline imbalanced demographic and disease-related covariates (age, sex, bDMARD line, BMI, Clinical Disease Activity index for PSoriatic Arthritis [cDAPSA], 12-item PsA Impact of Disease [PsAID-12], Fibromyalgia Rapid Screening Tool [FiRST] score, co-treatments with MTX, NSAIDs, glucocorticoids, cardiovascular/metabolic comorbidities, dactylitis, enthesitis and body surface area [BSA]). Factors including concomitant MTX use and skin involvement: <3%, 3–10% and >10%, were added to the Cox model to investigate their impact on the PS-adjusted treatment effect.

Results:

Of 438 and 455 pts who started UST and TNF, respectively, 121 (28%) and 134 (29%) stopped or switched treatment before Month 15, with differences (as expected) according to treatment line (Fig. 1a, b). Reasons for stop/switch were related to safety/AEs in 12% (UST) and 28% (TNFi), and effectiveness (joints, nails or skin) in 77% (UST) and 69% (TNFi) of pts.

The observed mean time on drug was 397 days for UST and 385 days for TNFi pts (1st line 410/397 days, 2nd 390/382 days, 3rd 381/338 days). Fig. 1b shows similar persistence for all drugs and treatment lines, except for lower persistence in TNFi 3rd line vs 1st/2nd. In PS-adjusted Cox analysis, no statistically significant difference between UST and TNFi persistence was seen; hazard ratio (HR; 95% CI) for stop/switch bDMARD (UST vs TNFi) was 0.82 (0.60, 1.13). In the model, bDMARD monotherapy (without MTX) and extensive skin involvement (BSA >10%), showed significantly better persistence for UST (HR 0.61 [0.42, 0.90] and 0.41 [0.19, 0.89] respectively; unadjusted Kaplan-Meier graphs shown in Fig. 1c, d). MTX co-therapy and low BSA did not affect the PS-adjusted treatment effect. Other factors added to the PS-adjusted Cox model did not show significant effects.

Conclusion:

In this real-world PsA cohort undergoing bDMARD treatment, persistence was generally comparable for UST and TNFi, but some clinical situations led to better drug persistence with UST compared to TNFi – particularly monotherapy, more extensive skin involvement, and in 3rd-line treatment. Our data emphasise the importance of skin involvement for pts with PsA.

References:

[1]Gossec L, et al.Ann Rheum Dis. 2018;77(suppl 2):Abstract AB0928

Acknowledgments:

This study was funded by Janssen.

Disclosure of Interests:

Laure Gossec Grant/research support from: Lilly, Mylan, Pfizer, Sandoz, Consultant of: AbbVie, Amgen, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Sandoz, Sanofi-Aventis, UCB, Stefan Siebert Grant/research support from: BMS, Boehringer Ingelheim, Celgene, GlaxoSmithKline, Janssen, Novartis, Pfizer, UCB, Consultant of: AbbVie, Boehringer Ingelheim, Janssen, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, Celgene, Janssen, Novartis, Paul Bergmans Shareholder of: Johnson & Johnson, Employee of: Janssen, Kurt de Vlam Consultant of: Celgene Corporation, Eli Lilly, Novartis, Pfizer, UCB – consultant, Speakers bureau: Celgene Corporation, Eli Lilly, Novartis, Pfizer, UCB – speakers bureau and honoraria, Elisa Gremese Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Sanofi, UCB, Roche, Pfizer, Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Sanofi, UCB, Roche, Pfizer, Beatriz Joven-Ibáñez Speakers bureau: Abbvie, Celgene, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, Tatiana Korotaeva Grant/research support from: Pfizer, Consultant of: Abbvie, BIOCAD, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Novartis-Sandoz, Pfizer, UCB, Speakers bureau: Abbvie, BIOCAD, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Novartis-Sandoz, Pfizer, UCB, Wim Noel Employee of: Janssen Pharmaceuticals NV, Michael T Nurmohamed Grant/research support from: Abbvie, Bristol-Myers Squibb, Celltrion, GlaxoSmithKline, Jansen, Eli Lilly, Menarini, Merck Sharp & Dohme, Mundipharma, Pfizer, Roche, Sanofi, USB, Consultant of: Abbvie, Bristol-Myers Squibb, Celltrion, GlaxoSmithKline, Jansen, Eli Lilly, Menarini, Merck Sharp & Dohme, Mundipharma, Pfizer, Roche, Sanofi, USB, Speakers bureau: Abbvie, Bristol-Myers Squibb, Celltrion, GlaxoSmithKline, Jansen, Eli Lilly, Menarini, Merck Sharp & Dohme, Mundipharma, Pfizer, Roche, Sanofi, USB, Petros Sfikakis Grant/research support from: Grant/research support from Abvie, Novartis, MSD, Actelion, Amgen, Pfizer, Janssen Pharmaceutical, UCB, Elke Theander Employee of: Janssen-Cilag Sweden AB, Josef S. Smolen Grant/research support from: AbbVie, AstraZeneca, Celgene, Celltrion, Chugai, Eli Lilly, Gilead, ILTOO, Janssen, Novartis-Sandoz, Pfizer Inc, Samsung, Sanofi, Consultant of: AbbVie, AstraZeneca, Celgene, Celltrion, Chugai, Eli Lilly, Gilead, ILTOO, Janssen, Novartis-Sandoz, Pfizer Inc, Samsung, Sanofi