Evaluation of the current use of MRI to aid the diagnosis of axial spondyloarthritis in the UK: results from a freedom of information request

AIM

To evaluate the impact of recommendations from the 2019 consensus exercise conducted by radiologists and rheumatologists on the use of magnetic resonance imaging (MRI) to investigate axial spondyloarthritis (axSpA) in clinical practice.

MATERIALS AND METHODS

A freedom of information (FOI) request was used to assess the use of MRI in the diagnosis of axSpA and radiologists' awareness of the 2019 guidance across all NHS Trusts and Health Boards in the UK, including England, Scotland, Northern Ireland, and Wales.

RESULTS

The FOI request was sent to 150 Trusts/Health Boards, and 93 full responses were received. Of the 93 respondents (97%), 90 reported familiarity with the term axSpA and 70/93 (75%) reported familiarity with the 2019 recommendations. Awareness of recommendations regarding specific MRI features supportive of the diagnosis of axSpA was 74/93 (80%) for the sacroiliac joints (SIJs) and 66/93 (71%) for the spine. The median wait for MRI acquisition was 2-3 months. Fifty-two of the 93 (56%) reported at least some outsourcing of axSpA MRI (33%/29% for specialist/non-specialist outsourcing respectively); 32/93 (34%) reported some scans being reported in-house by non-musculoskeletal radiologists.

CONCLUSION

There have been several positive developments in the understanding and use of MRI for the diagnosis of axSpA in the UK since the 2017 survey, although substantial scope for further improvement remains. Several new challenges have also emerged, including the increase in waiting times, reliance on outsourcing, and the reporting of MRI by non-musculoskeletal radiologists.

The PROPER Study: A 48-Week, Pan-European, Real-World Study of Biosimilar SB5 Following Transition from Reference Adalimumab in Patients with Immune-Mediated Inflammatory Disease

BACKGROUND

The non-interventional PROPER study generated real-world evidence on clinical outcomes following transition in routine practice from reference adalimumab to the EMA-approved SB5 biosimilar adalimumab in patients with immune-mediated inflammatory disease.

METHODS

Adults with rheumatoid arthritis (RA), axial spondyloarthritis (axSpA), psoriatic arthritis (PsA), Crohn's disease (CD), or ulcerative colitis (UC) were enrolled at 63 sites across Europe. Eligible patients received ≥ 16 weeks of routine treatment with reference adalimumab before transitioning to SB5, and were followed for 48 weeks post-transition. The primary objective was to evaluate candidate predictors (clinically relevant baseline variables with incidence ≥ 15% by indication cohort) associated with persistence on SB5 at 48 weeks post-initiation. Key primary outcome measures were persistence on SB5 (estimated by Kaplan-Meier methodology) and clinical characteristics and disease activity scores at the time of transition to SB5 treatment (baseline).

RESULTS

A total of 955 eligible patients were enrolled (RA, n = 207; axSpA, n = 127; PsA, n = 162; CD, n = 447; UC, n = 12), of whom 932 (97.6%) completed follow-up and 722 (75.6%) were still receiving SB5 at week 48. Kaplan-Meier estimates (95% confidence interval, CI) of persistence on SB5 at week 48 for RA, axSpA, PsA, and CD were 0.86 (0.80-0.90), 0.80 (0.71-0.86), 0.81 (0.74-0.86), and 0.72 (0.67-0.76), respectively. The single candidate predictor associated with probability of SB5 discontinuation before week 48 was female sex [RA, axSpA, and CD cohorts; HR (95% CI): 3.53 (1.07-11.67), 2.38 (1.11-5.14), and 2.21 (1.54-3.18), respectively]. Disease activity scores remained largely unchanged throughout the study, with proportions by cohort in remission at baseline versus week 48 being 59.2% versus 57.2%, 81.0% versus 78.0%, 94.7% versus 93.7%, and 84.0% versus 85.1% for patients with RA, axSpA, PsA, and CD, respectively. Similarly, the SB5 dosing regimen remained unchanged for the majority of patients from baseline to week 48, the most common regimen being 40 mg every 2 weeks. In total, 232 patients (24.3%) reported at least one adverse drug reaction, and most events were mild; eight patients (3.9%) in the RA cohort experienced nine serious adverse events (SAEs; two possibly related to SB5); eight patients (4.9%) in the PsA cohort experienced nine SAEs (one possibly related to SB5); 22 patients (4.9%) in the CD cohort experienced 27 SAEs (four possibly related to SB5); and no SAEs were observed in the UC cohort.

CONCLUSIONS

With the exception of female sex in RA, axSpA, and CD, none of the candidate predictors were associated with SB5 discontinuation. Persistence on SB5 was high, treatment effectiveness was maintained, and no safety signals were detected.

TRIAL REGISTRATION

This trial is registered with ClinicalTrials.gov: NCT04089514.

Diagnostic delay in axial spondylarthritis: A lost battle?

Diagnostic delay in axial spondylarthritis (axSpA) remains an unacceptable worldwide problem; with evidence suggesting significant detrimental impact both clinically on the individual, and economically on society. There is therefore, a need for global action across various healthcare professions that come into contact with patients living, and suffering, with undiagnosed axSpA. Recent estimates of the median diagnostic delay suggest that globally, individuals with axSpA wait between 2 and 6 years for a diagnosis - revealing a clear benchmark for improvement. This timespan presents a window of opportunity for earlier diagnosis and intervention, which will likely improve patient outcomes. This review describes the current diagnostic delay as estimated across countries and over time, before presenting evidence from published strategies that may be implemented to improve this delay across primary and secondary care, including for specialties treating extra-musculoskeletal manifestations of axSpA (ophthalmology, gastroenterology, dermatology). Ongoing campaigns tackling delayed diagnosis in axSpA are also highlighted.

Real-world evidence for secukinumab in UK patients with psoriatic arthritis or radiographic axial spondyloarthritis: interim 2-year analysis from SERENA

Objectives

The aim was to evaluate retention rates for secukinumab in patients with active PsA or radiographic axial spondyloarthritis (r-axSpA) treated in routine UK clinical practice.

Methods

SERENA (CAIN457A3403) is an ongoing, non-interventional, international study of patients with moderate-to-severe chronic plaque psoriasis, active PsA or active r-axSpA, who had received secukinumab for ≥16 weeks before enrolment. The primary objective of this interim analysis was to assess treatment retention rates in patients with PsA or r-axSpA who were enrolled and followed for ≥2 years at centres in the UK. The safety analysis set includes all patients who received at least one dose of secukinumab. The target population set includes all patients who fulfilled the patient selection criteria.

Results

The safety set comprised 189 patients (PsA, n = 81; r-axSpA, n = 108), and the target population set comprised 183 patients (PsA, n = 78; r-axSpA, n = 105). In the safety set, 107 patients (45 of 81 with PsA and 62 of 108 with r-axSpA) had previously received a biologic agent. Retention rates were similar between patients with PsA and r-axSpA after 1 year (PsA 91.0%, 95% CI: 84.0, 98.0; r-axSpA 89.2%, 95% CI: 82.7, 95.7) and 2 years (PsA 77.6%, 95% CI: 67.6, 87.7; r-axSpA 76.2%, 95% CI: 67.4, 85.0) of observation. Overall, 17.5% of patients (33 of 189) experienced at least one treatment-related adverse event, and 12.7% of patients (24 of 189) discontinued secukinumab because of adverse events.

Conclusion

This analysis of real-world data from the UK demonstrates high retention rates for secukinumab over 2 years in patients with PsA or r-axSpA, with a favourable safety profile.

Efficacy and safety of bimekizumab in axial spondyloarthritis: results of two parallel phase 3 randomised controlled trials

OBJECTIVES

Axial spondyloarthritis (axSpA) is a complex disease with diverse manifestations, for which new treatment options are warranted. BE MOBILE 1 (non-radiographic (nr)-axSpA) and BE MOBILE 2 (radiographic axSpA (r-axSpA)) are double-blind, phase 3 trials designed to evaluate efficacy and safety of bimekizumab, a novel dual interleukin (IL)-17A and IL-17F inhibitor, across the axSpA spectrum.

METHODS

In parallel 52-week trials, patients with active disease were randomised 1:1 (nr-axSpA) or 2:1 (r-axSpA) to bimekizumab 160 mg every 4 weeks:placebo. From week 16, all patients received bimekizumab 160 mg every 4 weeks. Primary (Assessment of SpondyloArthritis international Society ≥40% improvement (ASAS40)) and secondary endpoints were assessed at week 16. Here, efficacy and treatment-emergent adverse events (TEAEs) are reported up to week 24.

RESULTS

254 patients with nr-axSpA and 332 with r-axSpA were randomised. At week 16, primary (ASAS40, nr-axSpA: 47.7% bimekizumab vs 21.4% placebo; r-axSpA: 44.8% vs 22.5%; p<0.001) and all ranked secondary endpoints were met in both trials. ASAS40 responses were similar across TNFi-naïve and TNFi-inadequate responder patients. Improvements were observed in Ankylosing Spondylitis Disease Activity Score (ASDAS) states and objective measures of inflammation, including high-sensitivity C-reactive protein (hs-CRP) and MRI of the sacroiliac joints and spine. Most frequent TEAEs with bimekizumab (>3%) included nasopharyngitis, upper respiratory tract infection, pharyngitis, diarrhoea, headache and oral candidiasis. More fungal infections (all localised) were observed with bimekizumab vs placebo; no major adverse cardiovascular events (MACE) or active tuberculosis were reported. Incidence of uveitis and adjudicated inflammatory bowel disease was low.

CONCLUSIONS

Dual inhibition of IL-17A and IL-17F with bimekizumab resulted in significant and rapid improvements in efficacy outcomes vs placebo and was well tolerated in patients with nr-axSpA and r-axSpA.

Comparative Efficacy of Biologic Disease-Modifying Anti-Rheumatic Drugs for Non-Radiographic Axial Spondyloarthritis: A Systematic Literature Review and Bucher Indirect Comparisons

INTRODUCTION

Biologic disease-modifying anti-rheumatic drugs (bDMARDs), including certolizumab pegol (CZP), are effective treatment options for the management of non-radiographic spondyloarthritis (nr-axSpA). In the absence of head-to-head comparisons in nr-axSpA, we conducted a systematic literature review (SLR) and indirect treatment comparison (ITC) to better understand the comparative efficacy of CZP vs. other bDMARDs.

METHODS

Literature searches were conducted in October 2020 in MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials in patients with nr-axSpA who had failed at least one non-steroidal anti-inflammatory drug and were treated with bDMARDs. Outcomes of interest included the Assessment of Spondyloarthritis international Society (ASAS), Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Functional Index (BASFI) and Disease Activity Index (BASDAI), and spinal pain score. Comparative efficacy was examined using a series of Bucher ITCs in subgroups matched by prior exposure to bDMARDs, disease duration, baseline C-reactive protein (CRP) levels/magnetic resonance imaging (MRI) status, and timepoints, to ensure comparability between studies.

RESULTS

At 12-16 weeks, treatment with CZP was significantly more likely to achieve ASAS20/40 response and ASDAS-inactive disease status vs. etanercept (ETN), ixekizumab (IXE), and secukinumab (SEC). CZP showed statistically significant improvement in BASDAI, BASFI, and total spine pain score over adalimumab (ADA), ETN, and IXE, and in BASFI over SEC. Among patients with objective signs of inflammation (OSI; elevated CRP levels and/or inflammation on MRI at baseline), CZP had a statistically significant advantage over ETN and SEC (with or without loading dose) in achieving ASAS40, whereas the comparisons with other bDMARDs did not show any statistically significant differences.

CONCLUSION

In the overall matched population, CZP performed significantly better than most comparators in improving the clinical outcomes. Among patients with OSI, CZP was found to be superior to SEC (in the MRI-/CRP + and MRI + /CRP- subgroups) and ETN (in the MRI + /CRP- subgroup) and it was comparable to golimumab and IXE across the different OSI subgroups.

Treatment of axial spondyloarthritis with biologic and targeted synthetic DMARDs: British Society for Rheumatology guideline scope

Pharmacological management has advanced considerably since the 2015 British Society for Rheumatology axial spondyloarthritis (axSpA) guideline to incorporate new classes of biologic DMARDs (bDMARDs, including biosimilars), targeted synthetic DMARDs (tsDMARDs) and treatment strategies such as drug tapering. The aim of this guideline is to provide an evidence-based update on pharmacological management of adults with axSpA (including AS and non-radiographic axSpA) using b/tsDMARDs. This guideline is aimed at health-care professionals in the UK who care directly for people with axSpA, including rheumatologists, rheumatology specialist nurses, allied health professionals, rheumatology specialty trainees and pharmacists; people living with axSpA; and other stakeholders, such as patient organizations and charities.

Identifying Axial Spondyloarthritis in Inflammatory Bowel Disease Patients Utilising Computed Tomography

OBJECTIVE

The diagnosis of axial spondyloarthritis (axSpA) is hampered by diagnostic delay. Computed Tomography (CT) undertaken for non-musculoskeletal (MSK) indications in patients with inflammatory bowel disease (IBD) offers an opportunity to identify sacroiliitis for prompt rheumatology referral. The study aims to identify what proportion of IBD patients who underwent abdominopelvic CT for non-MSK indications have axSpA and explore the role of a standardised screening tool to prospectively identify axSpA on imaging.

METHODS

Abdominopelvic CT scans of verified IBD patients, age range 18-55, performed for non-MSK indications were reviewed by radiology for presence of CT-defined sacroiliitis (CTSI, using criteria from a validated CT screening tool). All patients identified were sent a screening questionnaire and those with self-reported chronic back pain (CBP), duration > 3 months, onset < 45 years were invited for rheumatology review.

RESULTS

CTSI was identified in 60 of 301 patients. Thirty-two (53%) responded to the invitation to participate and 27 were enrolled. Of these, eight had a pre-existing axSpA diagnosis and five did not report CBP. Fourteen patients underwent rheumatology assessment; three of 14 (21.4% [95% CI: 4.7%, 50.8%]) had undiagnosed axSpA. In total, 11 of 27 (40.7% [95% CI: 22.4%, 61.2%]) patients had a rheumatologist verified diagnosis of axSpA.

CONCLUSION

At least 5.0% of IBD patients (3/60) undergoing abdominopelvic CT for non-MSK indications with CTSI have undiagnosed axSpA, and overall, 18.3% (11/60) have axSpA. This reveals a significant hidden population of axSpA and highlights the need for a streamlined pathway from sacroiliitis detection to rheumatology referral.

Prevalence of undiagnosed axial spondyloarthritis in inflammatory bowel disease patients with chronic back pain: secondary care cross-sectional study

OBJECTIVE

To elucidate the prevalence of undiagnosed rheumatologist-verified diagnosis of axial spondyloarthritis (RVD-axSpA) in patients attending routine secondary care IBD clinics with chronic back pain.

METHODS

Screening questionnaires were sent to consecutive patients attending IBD clinics in a university teaching hospital. Patients fulling the eligibility criteria (gastroenterologist-verified diagnosis, 18-80 years old, biologic therapy naïve, no previous diagnosis of axSpA); and a moderate diagnostic probability of axSpA (self-reported chronic back pain [CBP] > 3 months, onset < 45 years) were invited for rheumatology assessment. This included medical review, physical examination, patient reported outcome measures, human leucocyte antigen B27, C-reactive protein, pelvic radiograph and axSpA protocol magnetic resonance imaging. A diagnosis of RVD-axSpA was made by a panel of rheumatologists.

RESULTS

Of the 470 patients approached, 91 had self-reported CBP > 3 months, onset < 45 years, of whom 82 were eligible for clinical assessment. The prevalence of undiagnosed RVD-axSpA in patients attending IBD clinics in a secondary care setting, with self-reported CBP, onset < 45 years is estimated at 5% (95% CI 1.3,12.0) with a mean symptom duration of 12 (S.D. 12.4) years.

CONCLUSION

There is a significant hidden disease burden of axSpA among IBD patients. Appropriate identification and referral from gastroenterology is needed to potentially shorten the delay to diagnosis and allow access to appropriate therapy.

AB0348 THE PROPER STUDY: A 48-WEEK ANALYSIS OF A PAN-EU REAL-WORLD STUDY OF SB5 BIOSIMILAR FOLLOWING TRANSITION FROM REFERENCE ADALIMUMAB IN PATIENTS WITH RHEUMATOID ARTHRITIS, AXIAL SPONDYLOARTHRITIS OR PSORIATIC ARTHRITIS

Background

SB5, a biosimilar to reference adalimumab (ADL), received EU marketing authorisation in 2017, based on pre-clinical and clinical phase I and III studies that demonstrated bioequivalence and comparable efficacy, safety and immunogenicity to ADL.

Objectives

The real-world study ‘PROPER’ is designed to provide insights into outcomes of the transition from ADL to SB5 outside the randomised, controlled, clinical trial setting.

Methods

Under an umbrella design, 1000 patients with immune-mediated inflammatory disease were enrolled at centres in Belgium, Germany, Ireland, Italy, Spain and the UK, and followed for 48 weeks post-transition. Eligible patients with a diagnosis of rheumatoid arthritis (RA), axial spondyloarthritis (axSpA), psoriatic arthritis (PsA), ulcerative colitis or Crohn’s disease had been transitioned to SB5 as part of routine treatment following a minimum of 16 weeks’ treatment with ADL. Data were captured from patient charts retrospectively for 24 weeks prior to and prospectively and/or retrospectively up to 48 weeks after SB5 initiation. This analysis of the rheumatology cohort reports clinical characteristics, disease scores, persistence on SB5, clinical management and safety up to the closing date of November 30th, 2021.

Results

Of the 496 patients included in this analysis, the majority were enrolled in UK (n=174), Germany (n=145) and Spain (n=73); Italy, Ireland and Belgium enrolled 45, 44 and 15 patients respectively. At study close, 487 patients had completed 48 weeks of follow-up; 397 of those remained on SB5 throughout.

Methotrexate was received as concomitant therapy by 37% of patients and 20% had received a biologic therapy prior to reference ADL. Most patients (89.3% of RA, 92.1% of axSpA, 97.3% of PsA) transitioned to SB5 at the same dose regimen received for ADL.

Clinical characteristics, SB5 dose and flare are detailed in Table 1, disease scores in Figure 1.

Table 1.

Patient clinical characteristics, SB5 dose, flare

RA (N=207)axSpA (N=127)PsA (N=162)Age at SB5 initiation (years), mean (SD); IQR60.1 (11.8)53.0, 68.050.3 (13.4)38.0, 61.053.3 (12.0)45.0, 62.0Duration of disease (years), mean (SD); IQR13.3 (11.4)5.0, 19.518.8 (13.5)9.0, 25.012.2 (9.9)4.0, 19.0n%n%n%Women15072.54031.57345.1Patients receiving SB5 40mg Q2WBaseline15273.411590.614992.0Week 4813272.59387.712491.9Episodes of Flare018790.310784.313985.81209.71814.22012.3200.021.631.9How was Flare diagnosedDisease score1155.0731.81038.5Patient-reported symptoms1995.022100.026100.0Secondary Loss of Response315.000.0726.9Action taken for FlareBiologic therapy dose adjusted420.029.1519.2Non-biologic therapy dose adjusted840.0313.6934.6Clinical investigation00.014.5311.5Other*945.01359.11661.5

*Includes cessation of therapy, prescription of corticosteroids, physical exercise, no action.

IQR, interquartile range; SD, standard deviation; Q2W once two-weekly.

Figure 1.

Disease scores (paired patients), mean (95% CI)

Fifteen patients each experienced one unrelated Serious Adverse Event (SAE): 2 in the axSpA cohort [tachycardia, intracranial haemorrhage]; 6 in the PsA cohort [myocardial infarct (2), breast carcinoma, COVID-19, gallbladder calculus, dyspnoea]; 7 in the RA cohort [facial numbness, depression, COVID-19, pneumonia, diverticulitis, parvovirus, coronary occlusion]. Two patients reported SAEs considered causally related to SB5: Herpes zoster and pneumonia (RA cohort), and ALS with worsening (PsA cohort).

Conclusion

This analysis of a large, contemporary cohort of EU patients with established RA, axSpA or PsA shows treatment effectiveness maintained at 48 weeks after switching from ADL to SB5, with most patients continuing on SB5 Q2W throughout. Episodes of flare were uncommon, and the importance of patient-reported symptoms in recognition of flare is evident. No new safety signals were observed.

Acknowledgements

Statistical services were provided by FGK Clinical Research GmbH, Munich, Germany. Data management services were provided by Worldwide Clinical trial, Research Triangle Park, NC, USA. Funding was provided by Biogen International GmbH.

Disclosure of Interests

Ulf Müller-Ladner Consultant of: Biogen, Grant/research support from: Biogen, Karl Gaffney Speakers bureau: Novartis, UCB, AbbVie, Lilly, Consultant of: Novartis, UCB, AbbVie, Lilly, Pfizer, Grant/research support from: NAAS, AbbVie, Pfizer, UCB, Novartis, Lilly, Cellgene, Celltrion, Janssen, Gilead, Biogen, Deepak Jadon Consultant of: AbbVie, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Oxford University Press, Pfizer, Roche, Sandoz, UCB, Grant/research support from: AbbVie, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Oxford University Press, Pfizer, Roche, Sandoz, UCB, Marco Matucci-Cerinic Consultant of: Chemomab, Biogen, Pfizer, Lilly, Behring, Janssen, MSD, Eugenio Chamizo Carmona Speakers bureau: Abbvie, Amgen, Biogen, BMS, Celgene, Eli Lilly, Fresenius-Kabi, Galapagos, Janssen, MSD, Novartis, Pfizer, and UCB, Consultant of: Abbvie, Amgen, Biogen, BMS, Celgene, Eli Lilly, Fresenius-Kabi, Galapagos, Janssen, MSD, Novartis, Pfizer, and UCB, Ulrich Freudensprung Shareholder of: May hold stock in Biogen, Employee of: Biogen, Janet Addison Shareholder of: May hold stock in Biogen, Employee of: Biogen

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

Background

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

Objectives

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

Methods

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

Results

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

Table 1.

Overall safety profile within the study period (Safety set)

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

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

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

Conclusion

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

References

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

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

Disclosure of Interests

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

POS0939 BIMEKIZUMAB IN PATIENTS WITH ACTIVE NON-RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS: 24-WEEK EFFICACY & SAFETY FROM BE MOBILE 1, A PHASE 3, MULTICENTRE, RANDOMISED, PLACEBO‑CONTROLLED STUDY

Background

Bimekizumab (BKZ) is a monoclonal IgG1 antibody that selectively inhibits IL-17F in addition to IL-17A. BKZ has shown rapid and sustained efficacy and was well tolerated up to 156 weeks (wks) in a phase 2b study in patients (pts) with active ankylosing spondylitis.1,2

Objectives

To assess efficacy and safety of BKZ vs placebo (PBO) in pts with active non-radiographic axial spondyloarthritis (nr-axSpA) up to Wk 24 in the ongoing pivotal phase 3 study, BE MOBILE 1.

Methods

BE MOBILE 1 (NCT03928704) comprises a 16-wk double-blind, PBO-controlled period and 36-wk maintenance period. Pts were aged ≥18 yrs, had BASDAI ≥4 and spinal pain ≥4 at BL, and sacroiliitis on MRI and/or elevated CRP at screening. Pts were randomised 1:1, BKZ 160 mg Q4W:PBO. From Wk 16, all pts received BKZ 160 mg Q4W. Primary and secondary efficacy endpoints were assessed at Wk 16.

Results

Of 254 randomised pts (BKZ: 128; PBO: 126), 244 (96.1%) completed Wk 16, 240 (94.5%) Wk 24. BL characteristics were comparable between groups: mean age 39.4 yrs, symptom duration 9.0 yrs; 54.3% pts male, 77.6% HLA-B27+, 10.6% TNFi-experienced. At Wk 16, the primary (ASAS40: 47.7% BKZ vs 21.4% PBO; p<0.001) and all ranked secondary endpoints were met (Table 1). Responses were rapid with BKZ, including in PBO pts who switched to BKZ at Wk 16, and increased to Wk 24 (Figure 1; Table 1). Substantial reductions of hs-CRP by Wk 2 and MRI SIJ inflammation by Wk 16 were achieved with BKZ vs PBO (Table 1). At Wk 24, >50% of pts initially randomised to BKZ had achieved ASDAS <2.1 (Figure 1).

Table 1.

Efficacy at Wks 16 and 24

BLWk 16Wk 24PBO N=126BKZ 160 mg Q4W N=128PBO N=126BKZ 160 mg Q4W N=128p valuePBO→BKZ 160 mg Q4W N=126BKZ 160 mg Q4W N=128Ranked endpoints in hierarchical orderASAS40* [NRI] n (%)--27 (21.4)61 (47.7)<0.00159 (46.8)67 (52.3)BASDAI CfB† [MI] mean (SE)6.7 (0.1)6.9 (0.1)–1.5 (0.2)–3.1 (0.2)<0.001–3.2 (0.2)–3.4 (0.2)ASAS20† [NRI] n (%)--48 (38.1)88 (68.8)<0.00187 (69.0)96 (75.0)ASAS PR† [NRI] n (%)--9 (7.1)33 (25.8)<0.00135 (27.8)37 (28.9)ASDAS-MI† [NRI] n (%)--9 (7.1)35 (27.3)<0.00137 (29.4)41 (32.0)ASAS 5/6† [NRI] n (%)--21 (16.7)49 (38.3)<0.00151 (40.5)57 (44.5)BASFI CfB† [MI] mean (SE)5.3 (0.2)5.5 (0.2)–1.0 (0.2)–2.5 (0.2)<0.001–2.3 (0.2)–2.8 (0.2)Nocturnal spinal pain CfB† [MI] mean (SE)6.7 (0.2)6.9 (0.2)–1.7 (0.2)–3.6 (0.3)<0.001–3.5 (0.2)–4.0 (0.3)ASQoL CfB† [MI] mean (SE)9.4 (0.4)9.5 (0.4)–2.5 (0.4)–5.2 (0.4)<0.001–4.8 (0.4)–5.7 (0.4)SF-36 PCS CfB† [MI] mean (SE)33.6 (0.8)33.3 (0.7)5.5 (0.7)9.5 (0.7)<0.00110.1 (0.8)10.6 (0.8)Other endpointsdEnthesitis-free state†a [NRI] n (%)--22 (23.9)b48 (51.1)c-40 (43.5)b45 (47.9)cASAS40 in TNFi-experienced [NRI] n (%)--2 (11.8)e6 (60.0)f---ASDAS-CRP CfB [MI] mean (SE)3.7 (0.1)3.8 (0.1)–0.6 (0.1)–1.5 (0.1)-–1.5 (0.1)–1.6 (0.1)hs-CRP, mg/L [MI] geometric mean (median)5.0 (6.5)4.6 (6.1)3.8 (4.1)2.0 (1.8)-2.3 (2.6)1.9 (1.8)MRI spine Berlin CfBg [OC] mean (SD)1.9 (3.2)h1.6 (2.9)i–0.1 (1.7)j–0.7 (2.2)k---SPARCC MRI SIJ score CfBg [OC] mean (SD)10.5 (13.8)l8.5 (10.3)m–1.5 (9.2)n–6.3 (10.0)o---

Randomised set. *Primary endpoint; †Secondary endpoint; aMASES=0 in pts with BL MASES >0; bn=92; cn=94; dNominal p values not shown; en=17; fn=10; gIn pts in MRI sub-study; hn=65; in=75; jn=58; kn=73; ln=68; mn=79; nn=60; on=77.

Over 16 wks, 80/128 (62.5%) pts had ≥1 TEAE on BKZ vs 71/126 (56.3%) on PBO; most frequent were nasopharyngitis (BKZ: 9.4%; PBO: 4.8%), upper respiratory tract infection (BKZ: 7.0%; PBO: 7.1%) and oral candidiasis (BKZ: 3.1%; PBO: 0%). No systemic candidiasis was observed. Up to 16 wks, incidence of SAEs was low (BKZ: 0.0%; PBO: 0.8%); no MACE or deaths were reported; 0 IBD cases occurred in pts on BKZ vs 1 (0.8%) in a pt on PBO.

Conclusion

Dual inhibition of IL-17A and IL-17F with BKZ in pts with active nr-axSpA resulted in rapid, clinically relevant improvements in efficacy outcomes vs PBO. No new safety signals were observed.1,2

References

[1]van der Heijde D. Ann Rheum Dis 2020;79:595–604;

[2]Gensler L. Arthritis Rheumatol 2021;73(suppl 10):0491.

Acknowledgements

This study was funded by UCB Pharma. Editorial services were provided by Costello Medical.

Disclosure of Interests

Atul Deodhar Speakers bureau: Janssen, Novartis, and Pfizer, Consultant of: AbbVie, Amgen, Aurinia, BMS, Celgene, Eli Lilly, GSK, Janssen, MoonLake, Novartis, Pfizer, and UCB Pharma, Grant/research support from: AbbVie, Eli Lilly, GSK, Novartis, Pfizer, and UCB Pharma, Désirée van der Heijde Consultant of: AbbVie, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Lilly, Novartis, Pfizer, and UCB Pharma, Employee of: Imaging Rheumatology BV (Director), Lianne S. Gensler Consultant of: AbbVie, Eli Lilly, GSK, Janssen, Novartis, Pfizer, and UCB Pharma, Grant/research support from: Novartis, Pfizer and UCB Pharma, Huji Xu: None declared, Karl Gaffney Speakers bureau: AbbVie, Eli Lilly, Novartis, UCB Pharma, Consultant of: AbbVie, Eli Lilly, Novartis, and UCB Pharma, Grant/research support from: AbbVie, Gilead, Eli Lilly, Novartis, and UCB Pharma, Hiroaki Dobashi Speakers bureau: BMS, Chugai, Eli Lilly, GSK, MSD, Novartis, Pfizer, UCB Pharma, Walter P Maksymowych Consultant of: AbbVie, Boehringer-Ingelheim, Celgene, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer and UCB Pharma, Grant/research support from: AbbVie, Janssen, Novartis and Pfizer, Employee of: Chief Medical Officer for CARE Arthritis, Martin Rudwaleit Speakers bureau: AbbVie, BMS, Boehringer Ingelheim, Chugai, Eli Lilly, Janssen, Novartis, Pfizer, and UCB Pharma, Paid instructor for: Janssen, Novartis, and UCB Pharma, Consultant of: AbbVie, Novartis, and UCB Pharma, Marina Magrey Consultant of: AbbVie, Eli Lilly, Novartis, Pfizer and UCB Pharma, Grant/research support from: AbbVie and UCB Pharma, Dirk Elewaut Speakers bureau: AbbVie, Eli Lilly, Galapagos, Novartis and UCB Pharma, Consultant of: AbbVie, Eli Lilly, Galapagos, Novartis and UCB Pharma, Marga Oortgiesen Employee of: Employee of UCB Pharma, Carmen Fleurinck Employee of: Employee of UCB Pharma, Alicia Ellis Employee of: Employee of UCB Pharma, Thomas Vaux Employee of: Employee of UCB Pharma, julie smith Employee of: Employee of UCB Pharma, Xenofon Baraliakos Speakers bureau: AbbVie, BMS, Chugai, Eli Lilly, Galapagos, Gilead, MSD, Novartis, Pfizer, and UCB Pharma, Paid instructor for: AbbVie, BMS, Chugai, Eli Lilly, Galapagos, Gilead, MSD, Novartis, Pfizer, and UCB Pharma, Consultant of: AbbVie, BMS, Chugai, Eli Lilly, Galapagos, Gilead, MSD, Novartis, Pfizer, and UCB Pharma

P264 Bridging the gap: co-producing a virtual self-management programme for individuals living with axial spondyloarthritis

Background/Aims

Despite the considerable impact axial spondyloarthritis (axSpA) has on quality of life, condition-specific group education programmes are not routinely offered. Many people with axSpA report feeling isolated and often have never met anyone else with the condition. In 2020, the National Axial Spondyloarthritis Society (NASS) worked with patients and rheumatology departments to co-produce a pilot self-management programme (SMP) to explore demand from and assess the impact on patients and healthcare professionals (HCPs).

Methods

NASS identified six NHS centres to host the pilot SMP sessions. These centres represented a range of axSpA services. HCPs invited their axSpA cohort to attend by post or e-mail and NASS invited local NASS members. Attendees booked online via private URL. NASS developed content following consultation with rheumatology HCPs and people living with axSpA. The first session covered pain, flares, fatigue and emotional wellbeing. Following attendee feedback, three centres hosted a second session on medication and exercise. One centre held a third session covering night pain, sleep and stress. Sessions were delivered via online meeting software and included teaching, group discussions, polls and exercise. HCPs of the host rheumatology departments led these sessions in tandem with NASS staff, one of whom has lived experience of axSpA. Content and format were continually reviewed and improved using feedback from attendees and HCPs (Table 1); feedback was gathered by email, informal focus groups and anonymous surveys.

Results

A total of 266 patients attended. 55% were female and 27% were aged under 45.

10% were diagnosed within the past year; 26% within the last 5 years; &gt;50% more than 10 years ago.

No attendees had previously attended a hospital axSpA SMP session.

Conclusion

There is demand from patients and HCPs for an axSpA virtual patient SMP. Co-producing the programme can be effective for: engaging with a range of patients; educating and empowering patients to self-manage their condition; building relationships between HCPs and patients; reducing patient isolation; enabling appropriate self-referral to rheumatology services. This pilot has informed our next steps to expand the online sessions to new centres and explore co-producing an e-learning programme.

Disclosure

Z.E. Clark: Grants/research support; National Axial Spondyloarthritis Society receives grant funding from AbbVie, Biogen, Eli Lilly, Janssen, Novartis, UCB. W. Gregory: Honoraria; Speaker, conference registration and advisory board fees from AbbVie, Pfizer, Novartis, UCB. A. Chan: Member of speakers’ bureau; UCB, Novartis, Sanofi, AbbVie, Jannsen. A. Coy: None. Z. Cox: None. S. Dickinson: Grants/research support; National Axial Spondyloarthritis Society receives grant funding from AbbVie, Biogen, Eli Lilly, Janssen, Novartis, UCB. K. Gaffney: Shareholder/stock ownership; SpA Academy. Honoraria; Novartis, AbbVie, UCB, Lilly, Pfizer, Biogen. Member of speakers’ bureau; Celltrion, Novartis, UCB, AbbVie. Grants/research support; NASS, AbbVie, Pfizer, UCB, Novartis, Lilly, Jannsen, Gilead, Biogen. Other; Meeting expenses: AbbVie, Lilly, Roche, Novartis, Pfizer, UCB. B. Harrison: None. H. Herbert: None. C. Lewis: None. C. McCoy: None. K. Noel: None. K. Porthouse: None. K. Rigler: None. K. Weight: None. T. Williams: None. D. Webb: Grants/research support; National Axial Spondyloarthritis Society receives grant funding from AbbVie, Biogen, Eli Lilly, Janssen, Novartis, UCB. L. Dunkley: Honoraria; Honoraria with UCB, AbbVie, Pfizer.

P268 Impact of intermediate treatment interruption on secukinumab efficacy in patients with active psoriatic arthritis and ankylosing spondylitis: interim analysis results from the SERENA study

Background/Aims

Secukinumab has demonstrated long-lasting efficacy and a favorable safety profile in patients with psoriatic arthritis (PsA) and ankylosing spondylitis (AS). SERENA is an ongoing, longitudinal, observational study in &gt; 2900 patients with moderate to severe psoriasis, active PsA, and AS. We report interim data on impact of intermediate treatment interruption on secukinumab effectiveness in patients with active PsA or AS.

Methods

This analysis included data for 534 PsA and 470 AS patients enrolled in SERENA between Oct 2016 and Oct 2018 and followed-up for at least 2 years. Patients (≥18 years) with active PsA or AS were required to have received ≥16 weeks of secukinumab treatment before enrolment. Treatment interruption was defined as interruption of secukinumab therapy for at least 3 months between the last injection and re-initiation. Effectiveness assessments included swollen and tender joint count in PsA patients, and Patient Global Assessment (PtGA) and BASDAI score in AS patients before and during treatment interruption and post secukinumab re-initiation. Patients with assessments in ≥ 2 of the time periods were included. Last assessment prior to intermediate treatment interruption was used as baseline. The assessment closest to 6 months after re-initiation was considered the post-secukinumab re-initiation assessment.

Results

A total of 31 (5.8%) PsA patients and 42 (8.9%) AS patients had an intermediate treatment interruption since initiation of secukinumab treatment. The mean (SD) duration of treatment interruption was 24.8 (16.4) and 26.4 (22.9) weeks for PsA and AS patients, respectively. The mean (SD) duration of secukinumab treatment before the treatment interruption was 86.8 (50.3) and 90.2 (46.9) weeks, and after the treatment interruption was 73.6 (44.4) and 63.2 (46.8) weeks. The most commonly reported reasons included adverse events (AEs; 18 [58.1%] PsA, 19 [45.2%] AS), patient decision (3 [9.7%] PsA, 3 [7.1%] AS), and COVID-19 outbreak-related reasons (1 [3.2%] PsA, 6 [14.3%] AS patients). More than 80% of PsA patients and 76% of AS patients reinitiated secukinumab without a loading phase after the treatment interruption. The swollen and tender joint count increased in PsA patients from the last assessment prior to the treatment interruption (1.3 [1.0] and 7.2 [11.4]; n = 6) to the first assessment during the treatment interruption (4.0 [1.4] and 16.5 [19.1]; n = 2), and gradually decreased post secukinumab re-initiation (0.4 [0.5] and 2.0 [0.7]; n = 5). PtGA and BASDAI remained stable in AS patients from the last assessment prior to the treatment interruption to the first assessment during the treatment interruption and after secukinumab re-initiation.

Conclusion

Secukinumab intermediate treatment interruption occurred due to a variety of reasons in the real-world setting, mainly AEs and patient decision. Most patients re-initiated secukinumab treatment without a loading phase. No notable impact of the intermediate treatment interruption was observed on the effectiveness of secukinumab.

Disclosure

K. Gaffney: Consultancies; AbbVie, Celgene, Lilly, Pfizer, Gilead, MSD, Novartis, UCB. Member of speakers’ bureau; AbbVie, Celgene, Lilly, Pfizer, Gilead, MSD, Novartis, UCB. Grants/research support; AbbVie, Celgene, Lilly, Pfizer, Gilead, MSD, Novartis, UCB. U. Kiltz: Consultancies; AbbVie, Biocad, Biogen, Chugai, Eli Lilly, Grünenthal, Hexal, Janssen, MSD, Novartis, Pfizer, Roche, UCB. Grants/research support; AbbVie, Biocad, Biogen, Chugai, Eli Lilly, Grünenthal, Hexal, Janssen, MSD, Novartis, Pfizer, Roche, UCB. P. Sfikakis: Consultancies; AbbVie, Amgen, Boehringer Ingelheim, Celgene, Eli-Lilly, Janssen, Novartis, Pfizer. Grants/research support; AbbVie, Amgen, Boehringer Ingelheim, Celgene, Eli-Lilly, Janssen, Novartis, Pfizer. N. Gullick: Consultancies; AbbVie, Celgene, Eli Lilly, Izana, Janssen, Novartis, UCB. Member of speakers’ bureau; AbbVie, Celgene, Eli Lilly, Izana, Janssen, Novartis, UCB. Grants/research support; AbbVie, Celgene, Eli Lilly, Izana, Janssen, Novartis, UCB. G. Katsifis: Consultancies; Abbvie, Amgen, Genesis Pharma, Janssen, MSD, Novartis, Pfizer, Roche, Sobi, UCB. Honoraria; AbbVie, Aenorasis, Amgen, Genesis Pharma, Janssen, MSD, Novartis, Pfizer, Roche, UCB. A. Kandili: None. J. Brandt-Juergens: Consultancies; AbbVie, Pfizer, Roche, Sanofi-Aventis, Novartis, Lilly, MSD, UCB, BMS, Janssen, Janssen. Member of speakers’ bureau; AbbVie, Pfizer, Roche, Sanofi-Aventis, Novartis, Lilly, MSD, UCB, BMS, Janssen, Medac. P. Goupille: Consultancies; AbbVie, Amgen, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, UCB. Honoraria; AbbVie, Amgen, Biogen, BMS, Chugai, Lilly, Medac, MSD, Nordic Pharma, Novartis, Pfizer, Sanofi, UCB. N. Maiden: Member of speakers’ bureau; Eli-Lilly, UCB. M. Aassi: Shareholder/stock ownership; Novartis. Other; Employee of Novartis. B. Schulz: Other; Employee of Novartis. E. Pournara: Shareholder/stock ownership; Novartis. Other; Employee of Novartis. P. Jagiello: Other; Employee of Novartis.

P270 ‘Act on Axial SpA': a gold standard time to diagnosis

Background/Aims

A lack of public understanding of the symptoms of axial spondyloathritis (axial SpA) is a significant factor in diagnostic delay. Research commissioned by The National Axial Spondyloarthritis Society (NASS) found that 91% of the UK population had never heard of axial SpA, despite more people living with the condition than MS and Parkinson’s combined. Additionally, 8 in 10 people could not identify the symptoms of axial SpA when prompted. As part of a 5-year programme called ‘Act on Axial SpA’, NASS created the first phase of a campaign to increase public awareness, help people recognise symptoms, and encourage them to visit their GP if concerned. Aims: 1) Ensure people have heard of axial SpA. 2) Help people understand that it’s a condition that affects young people. 3) Ensure people recognise the signs and symptoms of the condition. 4) Get people to visit actonaxialspa.com to use the symptom checker and visit their GP if concerned.

Methods

1) Raise awareness about the condition: to make an emotional connection with a cold audience, who are unlikely to have heard of axial SpA (AS) and show them why the campaign is relevant to them. We told stories about people with the condition and their families, so people can see that the condition could affect someone like ‘them’. We ensured our campaign key messages are highly visible in the places, publications and online media people in our target audiences are likely to see every day. 2) Identify a core set of symptoms using a newly developed acronym (SPINE). 3) Direct people to an online symptom checker which combines the ASAS, Berlin and Calin inflammatory back pain criteria. 4) Provide information for the patient and primary care professional on the results of the symptom checker and next steps as per the NICE guidelines 5) Provide information for the patient on preparing for their GP and rheumatologist appointments.

Results

We report results from June 23 - October 13 2021. 1) Case studies have featured in 11 national media publications with a combined reach of over 101 million. 2) Social media activity has a reach of 440,000. 3) Video content has been viewed 375,000 times. 4) 1,264 people have used the symptom checker. 5) We are reaching new audiences, in particular those aged 18-45 and a larger proportion of women.

Conclusion

The first phase of the campaign has demonstrated cut through to new audiences. People are interested, engaged and eager to learn more about axial SpA. When people are aware of the condition and its symptoms, they are more likely to act. We are confident that, with time, the ‘Act on Axial SpA’ public awareness campaign will play a huge part in reducing diagnosis times for people with axial SpA.

Disclosure

L. Marshall: None. D. Webb: None. F. MacAulay: None. K. Gaffney: Consultancies; Novartis, AbbVie, UCB, Lilly, Pfizer. Shareholder/stock ownership; SpA Academy www.spaacademy.org. Honoraria; Novartis, AbbVie, UCB, Lilly, Pfizer. Member of speakers’ bureau; Novartis, UCB, AbbVie, Lilly. Grants/research support; NASS, AbbVie, Pfizer, UCB, Novartis, Lilly, Cellgene, Celltrion, Janssen, Gilead, Biogen. Other; Expenses: Abbvie, Lilly, Roche, Novartis, Pfizer and UCB. R. Sengupta: Consultancies; Abbvie, Biogen, Celgene, Chugai, Lilly, MSD, Novartis, UCB. Honoraria; Abbvie, Biogen, Celgene, Chugai, Lilly, MSD, Novartis, UCB. Grants/research support; Abbvie, Celgene, Novartis, UCB. Other; Advisory boards:, Abbvie, Biogen, Chugai, Lilly, Novartis, UCB.

P254 Secukinumab retention and safety in patients with active psoriatic arthritis or ankylosing spondylitis: two-year interim results of the observational SERENA study

Background/Aims

SERENA is an ongoing, prospective, non-interventional study evaluating retention, effectiveness, safety/tolerability and quality of life in &gt; 2,900 patients with moderate to severe plaque psoriasis, active psoriatic arthritis (PsA) or active ankylosing spondylitis (AS) treated with secukinumab at 438 sites across Europe for up to 5 years. We present interim results reporting secukinumab treatment retention and safety data through two years in PsA and AS patients.

Methods

This interim analysis presents data from 534 PsA and 470 AS patients enrolled (target population fulfilling eligibility criteria) and followed for at least two years. Patients (≥18 years) with active PsA or AS should have received at least 16 weeks secukinumab treatment before enrolment in the study. Retention rate was defined as percentage of patients who did not discontinue secukinumab treatment. Treatment break was defined as interruption of therapy for at least three months after last injection.

Results

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

Conclusion

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

Disclosure

K. Gaffney: Consultancies; AbbVie, Celgene, Lilly, Pfizer, Gilead, MSD, Novartis, UCB. Member of speakers’ bureau; AbbVie, Celgene, Lilly, Gilead, MSD, Novartis, UCB, Pfizer. Grants/research support; AbbVie, Celgene, Lilly, Pfizer, Gilead, MSD, Novartis, UCB. U. Kiltz: Consultancies; AbbVie, Biocad, Biogen, Chugai, Eli Lilly, Grünenthal, Hexal, Janssen, MSD, Novartis, Pfizer, Roche, UCB. Grants/research support; AbbVie, Biocad, Biogen, Chugai, Eli Lilly, Grünenthal, Hexal, Janssen, MSD, Novartis, Pfizer, Roche, UCB. P. Sfikakis: Consultancies; AbbVie, Amgen, Boehringer Ingelheim, Celgene, Eli-Lilly, Janssen, Novartis, Pfizer. Grants/research support; AbbVie, Amgen, Boehringer Ingelheim, Celgene, Eli-Lilly, Janssen, Novartis, Pfizer. N. Gullick: Consultancies; AbbVie, Celgene, Eli Lilly, Izana, Janssen, Novartis, UCB. Member of speakers’ bureau; AbbVie, Celgene, Eli Lilly, Izana, Janssen, Novartis, UCB. Grants/research support; AbbVie, Celgene, Eli Lilly, Izana, Janssen, Novartis, UCB. A. Theodoridou: Consultancies; UCB, Amgen, Novartis. J. Brandt-Juergens: Consultancies; AbbVie, Pfizer, Roche, Sanofi-Aventis, Novartis, Lilly, MSD, UCB, BMS, Janssen, Medac. Member of speakers’ bureau; AbbVie, Pfizer, Roche, Sanofi-Aventis, Novartis, Lilly, MSD, UCB, BMS, Janssen, Medac. E. Lespessailles: Consultancies; Amgen, Expanscience, Lilly, MSD. Member of speakers’ bureau; Amgen, Expanscience, Lilly, MSD. Grants/research support; Abbvie, Amgen, Lilly, MSD, UCB,. J. Fang: Other; Employee of Novartis. E. Pournara: Shareholder/stock ownership; Novartis. Other; Employee of Novartis. B. Schulz: Other; Employee of Novartis. P. Jagiello: Other; Employee of Novartis.

Current evidence on the use of the adalimumab biosimilar SB5 (ImraldiTM): a multidisciplinary perspective

INTRODUCTION

This review provides an overview of data from trials and real-world studies available for SB5 (Imraldi^TM) across three main therapeutic areas: rheumatology, gastroenterology, and dermatology.

AREAS COVERED

A literature search for publications on data for SB5 efficacy/effectiveness, safety, and immunogenicity was undertaken.

EXPERT OPINION

Evidence derived from clinical studies suggest that the biosimilar SB5 is a safe and effective alternative to reference adalimumab. Considering that patients suffering from immune-mediated inflammatory diseases such as inflammatory arthritis, inflammatory bowel disease and psoriasis often require long-term biologic treatment, biosimilar medicines (such as SB5) can reduce healthcare costs while increasing access to effective treatments.

The ASAS-OMERACT core domain set for axial spondyloarthritis

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Inflammatory back pain: a concept, not a diagnosis

PURPOSE OF REVIEW

The concept of inflammatory back pain (IBP) describes a cohort of patients with chronic back pain (CBP) who have distinct clinical characteristics, rather than being a diagnosis in and of itself. IBP is a common and important feature of axial spondyloarthritis (axSpA) but this is not the only differential. This review examines the utility of IBP in both primary and secondary care settings.

RECENT FINDINGS

There are a number of suggested referral strategies for patients with suspected axSpA that include IBP. These strategies attempt to strike a balance between ensuring potential axSpA patients are not overlooked, whilst simultaneously not overwhelming secondary care services. Their success relies on the clinicians who first encounter these patients being familiar with IBP as a concept; however, it is still poorly recognized by many healthcare professionals. IBP may be helpful as part of a referral strategy; however, other clinical features, laboratory investigations and radiology must be incorporated for the final diagnostic outcome in axSpA.

SUMMARY

Delayed diagnosis is a major clinical problem in axSpA and is associated with worse clinical outcomes. When recognized and utilized correctly, IBP can be a useful tool to promote prompt referral to rheumatology services.

POS0059-PARE DELAY TO DIAGNOSIS IN AXIAL SPONDYLOARTHRITIS – TIME FOR A GOLD STANDARD APPROACH

Background:

In the UK, the average time to diagnosis of axial SpA is 8.5 years (1). There is little evidence this has improved, despite the acceptance of MRI use in diagnosis (2). A recent review identified significant clinical, economic and humanistic burden from delayed diagnosis (3). Urgent action is needed to ensure delayed diagnosis is not normalized.

Objectives:

We created a proposal for a Gold Standard time to diagnosis for axial SpA and a national implementation plan (4) through consensus development with patients, healthcare professionals and professional bodies.

Methods:

A.A scoping literature review identifying where delays occur, from first symptom onset to diagnosis by a rheumatologist, and potential solutions. From this, a summary report / draft plan was produced for consultation

B.A national consultation survey to elicit views on the proposals from clinicians, healthcare professionals, professional societies and patients

C.Structured feedback to written proposals via e-consultation with clinicians and patients

D.A consensus development workshop to finalise the Gold Standard and implementation plan.

Results:

The literature review identified four delays:

1. People do not know axial SpA may be a cause of their chronic back pain

2. Primary care practitioners may not recognise features of axial SpA

3. People may be referred to non-rheumatologists who may not recognise axial SpA promptly

4. Rheumatology and radiology teams may not optimally request or interpret investigations.

202 participants responded to the summary report (74% patients, 21% healthcare professsionals, 5% professional societies). All supported the principles behind the gold standard time to diagnosis. Qualitive analysis confirmed agreement with the proposed solutions, underscoring the importance of education and visibility for axial SpA within primary care and increased public awareness. Additional proposals were suggested, including a tool in primary care to run audits on IT systems.

40 clinicians contributed to the e-consultation and 55 clinicians, policy makers, social marketing experts, health journalists and patients attended the consensus workshop. Consensus was reached on a gold standard time to diagnosis of one year, and the principles, key components and phasing of the implemention plan. This included: public awareness about axial SpA symptoms; a primary care clinical champions programme; creating a referral pathway from primary care direct to rheumatology; a secondary care service educational programme.

Conclusion:

There is consensus from UK axial SpA clinicians, patients and professional societies on the need for a Gold Standard time to diagnosis of axial SpA of one year, so that patients can live happy, healthy and productive lives.

References:

[1]Hamilton L, Gilbert A, Skerett J, et al. Services for people with ankylosing spondylitis in the UK - a survey of rheumatologists and patients. Rheumatology 2011:50:1991

[2]Sykes MP, Doll H, R Sengupta, Gaffney, K. Delay to diagnosis in axial spondyloarthritis: are we improving in the UK? Rheumatology, July 2015

[3]Yi E, Ahuja A, Rajput T, et al. Clinical, Economic, and Humanistic Burden Associated With Delayed Diagnosis of Axial Spondyloarthritis: A Systematic Review. Rheumatol Ther. 2020 Mar;7(1):65–87.

[4]Webb D, Zhao S, Whalley S, et al. Gold Standard Time to Diagnosis in axial Spondyloarthritis: Consultation Document. 2020, NASS.

Disclosure of Interests:

Dale Webb Speakers bureau: Janssen, Novartis, Grant/research support from: NASS receives grants from AbbVie, Biogen, Eli Lilly, Novartis and UCB, Karl Gaffney Speakers bureau: Abbvie, Lilly, Novartis, UCB, Consultant of: Abbvie, Celltrion, Lilly, Grant/research support from: Abbvie, Pfizer, Lilly, UCB, Raj Sengupta Speakers bureau: Abbvie, Biogen, Celgene, Novartis, Roche, UCB, Consultant of: Advisory boards for Abbvie, Biogen, Novartis, UCB, Grant/research support from: Abbvie, Celgene, Novartis, Sizheng Steven Zhao: None declared, Lisa Swingler Grant/research support from: NASS receives grants from AbbVie, Biogen, Eli Lilly, Novartis and UCB.

POS0959 DIAGNOSTIC DELAY IN AXIAL SPONDYLOARTHRITIS: RESULTS FROM THE NATIONAL EARLY INFLAMMATORY ARTHRITIS AUDIT

Background:

Diagnostic delay is a significant problem in axial spondyloarthritis (axSpA), and there is a growing body of evidence showing that delayed axSpA diagnosis is associated with worse clinical, humanistic and economic outcomes.1 International guidelines have been published to inform referral pathways and improve standards of care for patients with axSpA.2,3

Objectives:

To describe the sociodemographic and clinical characteristics of newly-referred patients with axSpA in England and Wales in the National Early Inflammatory Arthritis Audit (NEIAA), with rheumatoid arthritis (RA) and mechanical back pain (MBP) as comparators.

Methods:

The NEIAA captures data on all new patients over the age of 16 referred with suspected inflammatory arthritis to rheumatology departments in England and Wales.4 We describe baseline sociodemographic and clinical characteristics of axSpA patients (n=784) recruited to the NEIAA between May 2018 and March 2020, compared with RA (n=9,270) and MBP (n=370) during the same period.

Results:

Symptom duration prior to initial rheumatology assessment was significantly longer in axSpA than RA patients (p<0.001), and non-significantly longer in axSpA than MBP patients (p=0.062): 79.7% of axSpA patients had symptom durations of >6 months, compared to 33.7% of RA patients and 76.0% of MBP patients; 32.6% of axSpA patients had symptom durations of >5 years, compared to 3.5% of RA patients and 24.6% of MBP patients (Figure 1A). Following referral, median time to initial rheumatology assessment was longer for axSpA than RA patients (36 vs. 24 days; p<0.001), and similar to MBP patients (39 days; p=0.30). The proportion of axSpA patients assessed within 3 weeks of referral increased from 26.7% in May 2018 to 34.7% in March 2020; compared to an increase from 38.2% to 54.5% for RA patients (Figure 1B). A large majority of axSpA referrals originated from primary care (72.4%) or musculoskeletal triage services (14.1%), with relatively few referrals from gastroenterology (1.9%), ophthalmology (1.4%) or dermatology (0.4%).

Of the subset of patients with peripheral arthritis requiring EIA pathway follow-up, fewer axSpA than RA patients had disease education provided (77.5% vs. 97.8%; p<0.001), and RA patients reported a better understanding of their condition (p<0.001). HAQ-DI scores were lower at baseline in axSpA EIA patients than RA EIA patients (0.8 vs 1.1, respectively; p=0.004), whereas baseline Musculoskeletal Health Questionnaire (MSK-HQ) scores were similar (25 vs. 24, respectively; p=0.49). The burden of disease was substantial across the 14 domains comprising MSK-HQ in both axSpA and RA (Figure 1C).

Conclusion:

We have shown that diagnostic delay remains a major challenge in axSpA, despite improved disease understanding and updated referral guidelines. Patient education is an unmet need in axSpA, highlighting the need for specialist clinics. MSK-HQ scores demonstrated that the functional impact of axSpA is no less than for RA, whereas HAQ-DI may underrepresent disability in axSpA.

References:

[1]Yi E, Ahuja A, Rajput T, George AT, Park Y. Clinical, economic, and humanistic burden associated with delayed diagnosis of axial spondyloarthritis: a systematic review. Rheumatol Ther. 2020;7:65-87.

[2]NICE. Spondyloarthritis in over 16s: diagnosis and management. 2017.

[3]van der Heijde D, Ramiro S, Landewe R, et al. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis. 2017;76(6):978-91.

[4]British Society for Rheumatology. National Early Inflammatory Arthritis Audit (NEIAA) Second Annual Report. 2021.

Acknowledgements:

The National Early Inflammatory Arthritis Audit is commissioned by the Healthcare Quality Improvement Partnership, funded by NHS England and Improvement, and the Welsh Government, and carried out by the British Society for Rheumatology, King’s College London and Net Solving.

Disclosure of Interests:

Mark Russell Grant/research support from: UCB, Pfizer, Fiona Coath: None declared, Mark Yates Grant/research support from: UCB, Abbvie, Katie Bechman: None declared, Sam Norton: None declared, James Galloway Grant/research support from: Abbvie, Celgene, Chugai, Gilead, Janssen, Lilly, Pfizer, Roche, UCB, Jo Ledingham: None declared, Raj Sengupta Grant/research support from: AbbVie, Biogen, Celgene, Lilly, MSD, Novartis, Pfizer, Roche, UCB, Karl Gaffney Grant/research support from: AbbVie, Biogen, Cellgene, Celltrion, Janssen, Lilly, Novartis, Pfizer, Roche, UCB.

AB0204 THE PROPER STUDY: INTERIM ANALYSIS OF A PAN-EU REAL-WORLD STUDY OF SB5 BIOSIMILAR FOLLOWING TRANSITION FROM REFERENCE ADALIMUMAB IN PATIENTS WITH RHEUMATOID ARTHRITIS, AXIAL SPONDYLOARTHRITIS, OR PSORIATIC ARTHRITIS

Background:

SB5, a biosimilar to reference adalimumab (ADL), received EU marketing authorisation in August 2017, based on the totality of evidence from pre-clinical and clinical Phase I and III studies that demonstrated bioequivalence, similar efficacy, and comparable safety and immunogenicity to the reference. This real-world study provides data on outcomes of the transition from reference to biosimilar ADL outside the controlled, randomised, clinical trial setting.

Objectives:

To evaluate candidate predictors of persistence on SB5 in EU patients (pts) across multiple indications.

Methods:

This ongoing observational study enrolled 1000 pts with rheumatoid arthritis (RA), axial spondyloarthritis (axSpA), psoriatic arthritis (PsA), ulcerative colitis, or Crohn’s disease who initiated SB5 as part of routine clinical practice following a minimum of 16 weeks’ treatment with reference ADL, at clinics in Belgium, Germany, Ireland, Italy, Spain, and the UK. Data are captured from clinic records retrospectively for the 24 weeks prior to transition, and prospectively and/or retrospectively for 48 weeks following transition. Primary outcome measures include baseline clinical characteristics, disease activity scores and clinical management over time; data on COVID-19 infection has recently been captured. This interim analysis (IA) provides an overview of baseline characteristics, disease scores and dose regimen up to 48 weeks post-initiation of SB5, and COVID-19 infection reported to date, in subjects with RA, axSpA, or PsA enrolled at 35 specialist sites and followed up to the data extract date of 18th December 2020.

Results:

Of the 504 pts included in this IA, 201 have RA, 169 have PsA, and 134 axSpA. At time of data extract, 216 pts had completed 48 weeks on SB5, 73 pts had discontinued SB5, and 8 had discontinued the study.

RA (N=201)axSpA (N=134)PsA (N=169)Mean (SD)Q1, Q3Mean (SD)Q1, Q3Mean (SD)Q1, Q3Age at SB5 initiation (years)60.2 (11.7)53, 6850.5 (13.6)38, 6153.0 (12.2)43, 62Duration of disease (years)13.5 (11.7)4.5, 2018.7 (13.2)9, 2512.7 (9.9)4, 20n%n%n%Women14471.64130.67745.6SB5 Dosing regimen:Baseline 40 mg Q2W14974.112089.615692.3Week 48 40mg Q2W6977.56785.99892.5Baseline Other*5225.91410.4137.7Week 48 Other*2022.41114.187.5Disease Score(paired patients)DAS28FFbHBASDAITender Joint CountSwollen Joint CountBaseline, n, mean (95% CI)692.5 (2.3–2.7)2273.9 (65.6–82.1)422.8 (2.3–3.4)491.8 (0.1–3.0)490.6 (0.2–0.9)Week 48, n, mean (95% CI)692.6 (2.3–2.8)2272.1 (64.0–80.2)423.0 (2.4–3.7)491.9 (0.5–3.3)490.6 (0.1–1.1)Patient diagnosed with COVID-19 at any time on-study, n (%)No14295.39688.114098.6Yes32.010.910.7Unknown42.71211.010.7Imraldi regimen stopped or changed due to COVID-19, regardless of diagnosis, n (%)No13098.510697.2134100Yes21.532.800

SD standard deviation; Q1 1st quartile, Q3 3rd quartile; CI Confidence Interval

*Other includes all other reported doses and/or dosing intervals: 40mg QW, 80mg Q2W, and unspecified frequency

DAS28 Disease Activity Score 28; FFbH Hanover Functional Ability Questionnaire; BASDAI Bath Ankylosing Spondylitis Disease Activity Index

Conclusion:

This IA provides a first insight into clinical management of pts over 48 weeks, in a contemporary cohort of EU pts with established RA, axSpA and PsA, switched from reference to biosimilar ADL SB5 in clinical practice. The majority of pts showed no meaningful difference in disease score or dose regimen of SB5 by Week 48 post-transition. As of data extract date, the proportion of pts with a known positive COVID-19 test was low (1.3%) and a small minority (1.3%) had SB5 treatment changed or interrupted as a result of the COVID-19 pandemic. With follow-up of pts ongoing to Q4 2021, the study will continue to provide pertinent information about clinical outcomes of transition from reference to biosimilar ADL in real-world practice and in indications not investigated in controlled studies.

Acknowledgements:

Statistical services gave been provided by FGK Clinical Research GmbH, Munich, Germany. Data management services were provided by Worldwide Clinical trial, Research Triangle Park, NC, USA; funding was provided by Biogen International GmbH.

Disclosure of Interests:

Ulf Müller-Ladner Consultant of: Biogen, Grant/research support from: Biogen, Karl Gaffney Consultant of: AbbVie, Celgene, Gilead, Lilly, MSD, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Celgene, Gilead, Lilly, MSD, Novartis, Pfizer, and UCB, Deepak Jadon Consultant of: AbbVie, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Oxford University Press, Pfizer, Roche, Sandoz, UCB, Grant/research support from: AbbVie, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Oxford University Press, Pfizer, Roche, Sandoz, UCB, Ulrich Freudensprung Shareholder of: Biogen, Employee of: Biogen, Janet Addison Shareholder of: Biogen, Employee of: Biogen

POS0919 BIMEKIZUMAB SHOWS SUSTAINED LONG-TERM IMPROVEMENTS IN PATIENT-REPORTED OUTCOMES AND QUALITY OF LIFE IN ANKYLOSING SPONDYLITIS: 3-YEAR RESULTS FROM A PHASE 2B STUDY

Background:

Bimekizumab (BKZ), a monoclonal antibody that selectively inhibits interleukin (IL)-17A and IL-17F, has demonstrated clinical efficacy and safety in patients with ankylosing spondylitis (AS) treated over a period up to 96 weeks.1,2

Objectives:

To report 3-year interim patient-reported outcomes (PROs) in patients with active AS treated with BKZ in a phase 2b dose-ranging study (BE AGILE; NCT02963506) and its open-label extension (OLE; NCT03355573).

Methods:

BE AGILE study design has been described previously.1 Patients treated with BKZ 160 mg or 320 mg every 4 weeks (Q4W) at Week 48 in BE AGILE were eligible for OLE entry. All OLE patients received BKZ 160 mg Q4W. Outcome measures are reported for the OLE full analysis set (patients who entered the OLE and had ≥1 dose of BKZ and ≥1 valid efficacy variable measurement in the OLE), and include: BASDAI, BASDAI50 responder rate, BASFI, fatigue (BASDAI Q1), morning stiffness (mean of BASDAI Q5 + 6), total spinal pain (numeric rating scale [NRS]), SF-36 PCS and MCS, and ASQoL. Missing data were imputed using multiple imputation (MI; based on the missing at random assumption) for continuous variables and non-responder imputation (NRI) for dichotomous variables.

Results:

262/303 (86%) patients randomised at BE AGILE study baseline (BL) completed Week 48 on BKZ 160 mg or 320 mg, of whom 255/262 (97%) entered the OLE (full analysis set: 254). From baseline to Week 48 in BE AGILE, BKZ-treated patients showed clinically relevant improvements in disease activity (BASDAI, BASDAI50), physical function (BASFI), fatigue, morning stiffness, spinal pain, and quality of life (SF-36 PCS and MCS, ASQoL) (Figure 1). Group-level improvements in all reported continuous efficacy measures exceeded published minimally important difference (MID), minimum clinically important improvement (MCII), and/or minimum clinically important difference (MCID) thresholds (Figure 1).3,4 Efficacy in all reported outcome measures was maintained or continued to improve from Week 48 to Week 144 or 156 (Figure 1).

Conclusion:

BKZ treatment was associated with sustained and consistent efficacy in patients with active AS over 3 years, including patient-reported disease activity, physical function, fatigue, morning stiffness, spinal pain, and quality of life.

References:

[1]van der Heijde D. Ann Rheum Dis 2020;79:595–604.

[2]Baraliakos X. Arthritis Rheumatol 2020;72 (suppl 10).

[3]Ogdie A. Arthritis Care Res 2020;72 (S10):47–71.

[4]Maruish ME. User’s manual for the SF-36v2 Health Survey (3rd ed). 2011; Lincoln, RI: QualityMetric Incorporated.

Acknowledgements:

This study was funded by UCB Pharma. Editorial services were provided by Costello Medical.

Disclosure of Interests:

Xenofon Baraliakos Speakers bureau: AbbVie, BMS, Chugai, Eli Lilly, Galapagos, Gilead, MSD, Novartis, Pfizer, UCB Pharma, Paid instructor for: AbbVie, BMS, Chugai, Eli Lilly, Galapagos, Gilead, MSD, Novartis, Pfizer, UCB Pharma, Consultant of: AbbVie, BMS, Chugai, Eli Lilly, Galapagos, Gilead, MSD, Novartis, Pfizer, UCB Pharma, Maxime Dougados Consultant of: AbbVie, Eli Lilly, Novartis, Pfizer and UCB Pharma, Grant/research support from: AbbVie, Eli Lilly, Novartis, Pfizer and UCB Pharma, Karl Gaffney Speakers bureau: AbbVie, Eli Lilly, Novartis, UCB Pharma, Consultant of: AbbVie, Eli Lilly, Novartis, UCB Pharma, Grant/research support from: AbbVie, Gilead, Eli Lilly, Novartis, UCB Pharma, Raj Sengupta Speakers bureau: AbbVie, Biogen, Celgene, MSD, Novartis, UCB Pharma, Consultant of: AbbVie, Biogen, Celgene, Eli Lilly, MSD, Novartis, UCB Pharma, Grant/research support from: AbbVie, Celgene, UCB Pharma, Marina Magrey Consultant of: AbbVie, Eli Lilly, Novartis, Pfizer, UCB Pharma, Grant/research support from: AbbVie, UCB Pharma, Natasha de Peyrecave Employee of: UCB Pharma, Marga Oortgiesen Employee of: UCB Pharma, Thomas Vaux Employee of: UCB Pharma, Carmen Fleurinck Employee of: UCB Pharma, Valerie Ciaravino Employee of: UCB Pharma, Atul Deodhar Speakers bureau: Janssen, Novartis, Pfizer, Consultant of: AbbVie, Amgen, BMS, Boehringer Ingelheim, Celgene, Eli Lilly, Gilead, GSK, Janssen, Novartis, Pfizer, UCB Pharma, Grant/research support from: AbbVie, Eli Lilly, GSK, Novartis, Pfizer, UCB Pharma

POS0035 ONE IN TWENTY INFLAMMATORY BOWEL DISEASE PATIENTS WHO UNDERWENT ABDOMINOPELVIC COMPUTED TOMOGRAPHY HAVE UNDIAGNOSED AXIAL SPONDYLOARTHRITIS

Background:

The diagnosis of axial spondyloarthritis (axSpA) is challenging and hindered by delay. There may be an opportunity to identify sacroiliitis for further rheumatology review in inflammatory bowel disease (IBD) patients who undergo Computed Tomography (CT) for non-musculoskeletal (MSK) indications.

Objectives:

To identify what proportion of IBD patients who underwent abdominopelvic CT for non-MSK indications have axSpA and to explore the role of an imaging strategy for identifying axSpA.

Methods:

Abdominopelvic CT scans of verified IBD patients were identified retrospectively from eight years of imaging archive. Patients between 18-55 yrs. were selected as having the highest diagnostic yield for axSpA. CT review (using criteria from a validated CT screening tool developed by Chan1) was undertaken by a trained radiology team for presence of CT-defined sacroiliitis (CTSI). All CTSI patients were sent a screening questionnaire. Those with self-reported chronic back pain (CBP), duration > 3 months, onset < 45 years were invited for rheumatology review. This included a medical interview, physical examination (joint count, MASES, dactylitis count, BASMI), patient reported outcomes (BASDAI, BASFI, BASGI, Harvey-Bradshaw-Index, Partial-Mayo-Index), relevant laboratory tests (CRP, ESR, HLA-B27), axSpA protocol MRI, and remote review by a panel of experienced rheumatologists with a special interest in axSpA.

Results:

CTSI was identified in 60 of 301 patients. Thirty-two (53%) responded to the invitation to participate and 27 (84%) were enrolled. Of these, eight had a pre-existing axSpA diagnosis and five did not report chronic back pain. Fourteen patients underwent rheumatological assessment; three of 14 (21.4% [95% CI: 4.7%, 50.8%]) had undiagnosed axSpA. In total, 11 of 27 (40.7% [95% CI: 22.4%, 61.2%]) patients had a rheumatologist verified diagnosis of axSpA.

Conclusion:

One in five patients (60/301) with IBD who underwent abdominopelvic CT for non-MSK indications have CTSI and at least one in five (11/60) have axSpA. Five percent (3/60) were previously undiagnosed. This highlights a hidden disease burden and a potential strategy for identifying new cases.

References:

[1]Chan J, Sari I, Salonen D, Inman RD, Haroon N. Development of a Screening Tool for the Identification of Sacroiliitis in Computed Tomography Scans of the Abdomen. J Rheumatol 2016; 43(9); 1687-94.

Acknowledgements:

We are indebted to Baljeet Dhillon and Shin Azegami for their assistance in the scoring of the CTSI.

Disclosure of Interests:

Chong Seng Edwin Lim Grant/research support from: AbbVie, Louise Hamilton: None declared, Samantha Low: None declared, Andoni Toms: None declared, Alex MacGregor: None declared, Karl Gaffney Speakers bureau: AbbVie, Eli Lilly, Novartis, UCB Pharma, Consultant of: AbbVie, Eli Lilly, Novartis, UCB Pharma, Grant/research support from: AbbVie, Gilead, Eli Lilly, Novartis, UCB Pharma.

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Table 1.

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

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

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

Conclusion:

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

References:

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

Disclosure of Interests:

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

Diagnostic delay is common for patients with axial spondyloarthritis: results from the National Early Inflammatory Arthritis Audit

Objectives

Updated guidelines for patients with axial SpA (axSpA) have sought to reduce diagnostic delay by raising awareness among clinicians. We used the National Early Inflammatory Arthritis Audit (NEIAA) to describe baseline characteristics and time to diagnosis for newly referred patients with axSpA in England and Wales.

Methods

Analyses were performed on sociodemographic and clinical metrics, including time to referral and assessment, for axSpA patients (n = 784) recruited to the NEIAA between May 2018 and March 2020. Comparators were patients recruited to the NEIAA with RA (n = 9270) or mechanical back pain (MBP; n = 370) in the same period.

Results

Symptom duration prior to initial rheumatology assessment was longer in axSpA than RA patients (P < 0.001) and non-significantly longer in axSpA than MBP patients (P = 0.062): 79.7% of axSpA patients had symptom durations of >6 months, compared with 33.7% of RA patients and 76.0% of MBP patients. Following referral, the median time to initial rheumatology assessment was longer for axSpA than RA patients (36 vs 24 days; P < 0.001) and similar to MBP patients (39 days; P = 0.30). Of the subset of patients deemed eligible for early inflammatory arthritis pathway follow-up, fewer axSpA than RA patients had disease education provided (77.5% vs 97.8%) and RA patients reported a better understanding of their condition and treatment.

Conclusion

Diagnostic delay in axSpA remains a major challenge despite improved disease understanding and updated referral guidelines. Disease education is provided to fewer axSpA than RA patients, highlighting the need for specialist clinics and support programmes for axSpA patients.

P186 Secukinumab effectiveness and safety in patients with active psoriatic arthritis or ankylosing spondylitis: interim analysis of an observational study in the real-world setting

Background/Aims 

SERENA is an ongoing, non-interventional study involving ∼400 European sites with an observation period of ≤ 5 years to evaluate retention, effectiveness, safety/tolerability and quality of life with secukinumab (SEC) in patients with moderate-to-severe plaque psoriasis, active psoriatic arthritis (PsA) or active ankylosing spondylitis (AS) in the real world. We present effectiveness and safety data through 1 year in the 577 PsA and 507 AS patients enrolled, of which 533 PsA and 461 AS patients comprised the target study population (fulfilling all eligibility criteria).

Methods 

Patients (aged ≥18 years) with active PsA or AS who were treated for at least 16 weeks with SEC were enrolled. Effectiveness assessments included 78 tender joint count/76 swollen joint count, PGA, total pain (VAS, 0-100 mm), presence of enthesitis/dactylitis and PASI75/90/100 in patients with PsA, and BASDAI, PtGA, C-reactive protein, ASDAS and total spinal pain in patients with AS.

Results 

Mean disease duration from diagnosis to enrolment was 8.6 and 9.8 years for PsA and AS patients. Patients received SEC for a mean duration of 1 year prior to enrolment (range: 0.90-1.00). In total, 64.7% (N = 533) of PsA and 60.7% (N = 461) of AS patients received other biologic drugs prior to SEC treatment, with 59.7% and 52.7% of PsA and AS patients receiving at least two different biologic drugs. Most patients pre-treated with biologics discontinued biologic treatment due to lack of efficacy (88.0% PsA; 86.8% AS). Retention rates for SEC after 1 year were 85.9% and 86.5% in PsA and AS patients. Responses across all effectiveness assessments in both cohorts were maintained or improved after 1 year of observation (Table 1). No new or unexpected safety signals were reported. P186 Table 1:Effectiveness outcomes in patients with PsA or AS at enrolment and Year 1Characteristic, mean±SD (M), unless otherwise specifiedPsA (N = 533)PsA (N = 533)AS (N = 461)AS (N = 461)EnrolmentYear 1EnrolmentYear 1Total pain (VAS 0-100 mm)31.80±24.28a (432)30.77±24.57a (322)34.68±24.23b (350)34.16±24.49b (228)Presence of tender or swollen joint, n/M (%)280/520 (53.8%)158/373 (42.4%)--Tender joint count, mean [min-max] (m)6.5 [0-68] (203)6.8 [0-78] (140)--Swollen joint count, mean [min-max] (m)3.3 [0-38] (203)2.8 [0-23] (140)--Presence of dactylitis, n/M (%)33/516 (6.4%)13/370 (3.5%)--Enthesitis index0.4±1.0c (276)c0.3±0.9c (243)c0.7±1.70d (246)0.6±1.7d (170)HAQ-DI0.83±0.70 (398)0.83±0.72 (268)--BASDAI--3.20±2.28 (436)3.24±2.36 (270)ASDAS-CRP--2.25±0.94 (229)2.27±0.97 (173)hsCRP, mg/L--8.53±13.42 (285)8.10±14.72 (218)PtGA (NRS) (VAS 0-10 cm)--4.18±2.32 (366)4.07±2.37 (246)aTotal pain;bTotal back pain;cLeeds enthesitis index;dMaastricht Ankylosing Spondylitis Enthesitis Score. AS, ankylosing spondylitis; ASDAS-CRP, Ankylosing Spondylitis Disease Activity Score-C-reactive protein; BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; HAQ-DI, Health Assessment Questionnaire Disability Index; hsCRP, high sensitivity C-reactive protein; m, number of patients with detailed assessments of tender or swollen joints; M, number of patients with evaluation; n, number of patients with a positive response; N, number of patients in the study population; NRS, numeric rating scale; PsA, psoriatic arthritis; PtGA, Patient’s Global Assessment; SD, standard deviation; VAS, visual analogue scale.

Conclusion 

Patients in SERENA had long-standing disease with more than half previously treated with biologics, most of whom had discontinued treatment due to lack of efficacy. SEC showed sustained effectiveness, a high retention rate and favourable safety profile in PsA and AS patients in the real world over 1 year of observation. Incomplete data due to lack of rigorous monitoring (an intrinsic weakness of observational studies) must be considered when interpreting real-world findings.

Disclosure 

K. Gaffney: Grants/research support; Research grants, consultancy fees and/or speaker fees from AbbVie, Celgene, Lilly, Pfizer, Gilead, MSD, Novartis and UCB. N. Gullick: Grants/research support; Research support, consultancy fees and/or speakers fees from AbbVie, Celgene, Eli Lilly, Izana, Janssen, Novartis, UCB. U. Kiltz: Grants/research support; Research grants, support and/or consultancy fees from AbbVie, Biocad, Biogen, Chugai, Eli Lilly, Grünenthal, Janssen, MSD, Novartis, Pfizer, Roche and UCB. P. Sfikakis: Grants/research support; Research grants, support and consultancy fees from AbbVie, Amgen, Boehringer Ingelheim, Celgene, Eli Lilly, Janssen, Novartis and Pfizer. A. Theodoridou: Honoraria; Consultancy fees from UCB, Amgen, Novartis. J. Brandt-Jürgens: Honoraria; Consultancy fees and speaker honoraria from AbbVie, Pfizer, Roche, Sanofi-Aventis, Novartis, Lilly, MSD, UCB, BMS, Janssen and Medac. E. Lespessailles: Honoraria; Received speaker and consultant fees from Amgen, Expanscience, Lilly and MSD, and research grants from AbbVie, Amgen, Lilly, MSD and UCB. C. Perella: Other; Novartis employee. E. Pournara: Shareholder/stock ownership; Novartis shareholder. Other; Novartis employee. B. Schulz: Other; Novartis employee. J. Veit: Other; Novartis employee.

Predictors of extra-articular manifestations in axial spondyloarthritis and their influence on TNF-inhibitor prescribing patterns: results from the British Society for Rheumatology Biologics Register in Ankylosing Spondylitis

OBJECTIVES

Extra-articular manifestations (EAMs) are important systemic features of axial spondyloarthritis (axSpA), which may influence the choice of tumour necrosis factor-inhibitor (TNFi). We examined the cumulative incidence and predictors of EAMs and the influence of these on first TNFi choice in a 'real-world' cohort of patients with axSpA.

METHODS

Clinical and patient-reported outcomes of 2420 patients with axSpA from 83 centres were collected by the British Society for Rheumatology Biologics Register in Ankylosing Spondylitis. Lifestyle factors for EAMs (acute anterior uveitis (AAU), inflammatory bowel diseases (IBD), psoriasis) were compared with those without EAMs. Also, the association between pretreatment EAMs and choice of first TNFi (adalimumab, etanercept, certolizumab) was analysed.

RESULTS

AAU was directly associated with human leukocyte antigen (HLA)-B27 (incidence rate ratio (IRR) 1.95, 95% CI 1.40 to 2.73) and inversely associated with ever-smoking (IRR=0.71, 95% CI 0.55 to 0.92). For both psoriasis and IBD, there was an inverse relationship with HLA-B27 (IRR 0.54, 95% CI 0.36 to 0.79 and IRR 0.63, 95% CI 0.43 to 0.91, respectively). A diagnosis of either AAU (OR 3.79, 95% CI 2.11 to 6.80) or IBD (OR 5.50, 95% CI 2.09 to 14.46) was associated with preference for adalimumab versus others. In contrast, a diagnosis of either AAU (OR 0.14, 95% CI 0.06 to 0.33) or IBD (OR 0.17, 95% CI 0.05 to 0.57) was associated with less preference for etanercept over other TNFi.

CONCLUSION

The higher occurrence of AAU and lower occurrence of psoriasis and IBD in HLA-B27-positive patients with axSpA are consistent with current pathophysiology. Patients with previous AAU and IBD are more likely to be prescribed adalimumab and less likely to receive etanercept, consistent with the superior efficacy of monoclonal TNFi for these indications. Future work will determine whether EAMs influence TNFi survival, or effectiveness, and whether this varies between agents.

Feasibility, acceptability and change in health following a telephone-based cognitive behaviour therapy intervention for patients with axial spondyloarthritis

Objective

The aim was to assess the feasibility and acceptability of a telephone-based cognitive behaviour therapy (tCBT) intervention for individuals with axial SpA (axSpA), with and without co-morbid FM, and to measure the change in patient-reported health outcomes.

Methods

A convenience sample of individuals recruited from British Society for Rheumatology Biologics Registry for AS (BSRBR-AS) sites were offered a course of tCBT (framed as coaching). Patient-reported outcomes were measured at baseline and on course completion. Semi-structured qualitative interviews assessed intervention acceptability. Thematic analysis was informed by the theoretical framework of acceptability.

Results

Forty-two participants attended for initial assessment. Those completing at least one tCBT session (n = 28) were younger, more likely to meet classification criteria for FM (57 vs 29%) and reported higher disease activity. Modest improvements were reported across a range of disease activity and wider health measures, with 62% of patients self-rating their health as improved (median 13 weeks post-intervention). Twenty-six participants were interviewed (including six who discontinued after initial assessment). tCBT was widely acceptable, offering a personalized approach. Despite low or unclear expectations, participants described improved sleep and psychological well-being and gained new skills to support self-management. Reasons for non-uptake of tCBT centred on lack of perceived need and fit with individual value systems. Many felt that tCBT would be most useful closer to diagnosis.

Conclusion

Higher uptake among axSpA patients with co-morbid FM suggests that these individuals have additional needs. The findings are helpful in identifying patients most likely to engage with and benefit from tCBT and to maximize participation.

Smoking in spondyloarthritis: unravelling the complexities

Tobacco smoking is a major threat to health. There is no doubt about the need to promote and support cessation at every opportunity. Smoking has a clear role in RA, but what evidence is there that the same relationship exists in SpA? In this review, we examine (the less cited) paradoxes and contradictions in the existing axial SpA (axSpA) and PsA literature; for example, smoking appears to be 'protective' for some axSpA manifestations. We also highlight findings from higher quality evidence: smoking is associated with increased risk of PsA and the risk of psoriasis in axSpA. The relationship between smoking and SpA is far from simple. Our aim is to highlight the harms of smoking in SpA and bring attention to inconsistencies in the literature to inform further research.

Induction of Sustained Clinical Remission in Early Axial Spondyloarthritis Following Certolizumab Pegol Treatment: 48-Week Outcomes from C-OPTIMISE

INTRODUCTION

Achievement of remission is a key treatment goal for patients with axial spondyloarthritis (axSpA). C-OPTIMISE assessed achievement of sustained clinical remission in patients with axSpA, including radiographic (r) and non-radiographic (nr) axSpA, during certolizumab pegol (CZP) treatment, and subsequent maintenance of remission following CZP dose continuation, dose reduction or withdrawal. Here, we report outcomes from the first 48 weeks (induction period) of C-OPTIMISE, during which patients received open-label CZP.

METHODS

C-OPTIMISE (NCT02505542) was a two-part, multicenter, phase 3b study in adult patients with early axSpA (r-/nr-axSpA), including a 48-week open-label induction period followed by a 48-week maintenance period. Patients with active adult-onset axSpA, < 5 years' symptom duration, and fulfilling Assessment of SpondyloArthritis international Society classification criteria, were included. During the induction period, patients received a loading dose of CZP 400 mg at weeks 0, 2, and 4, followed by CZP 200 mg every 2 weeks (Q2W) up to week 48. The main outcome of the 48-week induction period was the achievement of sustained clinical remission (defined as an Ankylosing Spondylitis Disease Activity Score [ASDAS] < 1.3 at week 32 and < 2.1 at week 36 [or vice versa], and < 1.3 at week 48).

RESULTS

In total, 736 patients (407 with r-axSpA, 329 with nr-axSpA) were enrolled into the study. At week 48, 43.9% (323/736) of patients achieved sustained remission, including 42.8% (174/407) of patients with r-axSpA and 45.3% (149/329) with nr-axSpA. Patients also demonstrated substantial improvements in axSpA symptoms, MRI outcomes and quality of life measures. Adverse events occurred in 67.9% (500/736) of patients, of which 6.0% (44/736) were serious.

CONCLUSIONS

Over 40% of patients with early axSpA achieved sustained remission during 48 weeks of open-label CZP treatment. Additionally, patients across the axSpA spectrum demonstrated substantial improvements in imaging outcomes and quality of life following treatment. No new safety signals were identified.

TRIAL REGISTRATION

NCT02505542.

SAT0380 ENHANCING RHEUMATOLOGY REFERRALS AMONG INFLAMMATORY BOWEL DISEASE PATIENTS WITH SUSPECTED AXIAL SPONDYLOARTHRITIS

Background:

Axial spondyloarthritis (axSpA) is associated with inflammatory bowel disease (IBD). In IBD patients, the clinical probability of axSpA increases in those with chronic back pain (CBP) whose symptoms started before the age of forty-five years old. In practice, this should trigger a rheumatology review especially if accompanied by other symptoms suspicious of inflammatory disease. However, in any health system, the goal of identifying all possible cases need to be balanced with the practical realisation of the finite resources available.

Objectives:

The study aimed to define the clinical characteristics of a subgroup of IBD patients who are routinely managed in secondary care who have an increased clinical probability for axSpA. Identification of these characteristics may help improve the quality and specificity of referrals to Rheumatology from Gastroenterology clinics.

Methods:

An analytical cross-sectional study was undertaken. Consecutive IBD patients attending routine Gastroenterology clinics were sent a modified validated back pain questionnaire. The questionnaire included the presence or absence of a previous diagnosis of axSpA; components of validated inflammatory back pain criteria; diagrams to indicate the location of back pain and other musculoskeletal pain; personal and family history of known axSpA manifestations; and details of their IBD course, activity and treatment.

IBD patients, with back pain duration > 3 months with onset before 45 years were considered to have a medium diagnostic probability (MDP) for axSpA. MDP-positive IBD patients were compared with MDP-negative IBD patients and logistic regression was used to model the association with clinical features.

Results:

Four hundred and seventy consecutive IBD patients (mean age 54 years; 46% male) were surveyed. Two hundred and nine patients (59%) replied, of whom 191 patients (69%) consented to participate. One hundred and seventy-three (91%) of those who consented had a valid completed questionnaire and were included for data analysis. Of these, 74% had Ulcerative Colitis and 26% had Crohn’s disease. Their mean age was 58 years, 39% male. Mean age at IBD diagnosis was 39 years, mean IBD disease duration 19 yrs. CBP (back pain greater than three months) was reported by 76%. Inflammatory back pain fulfilling Calin, Berlin, ASAS criteria was seen in 23%, 29%, and 15% respectively. In addition, 80% reported peripheral musculoskeletal pain. Self-reported personal history of enthesitis, reactive arthritis (ReA), acute anterior uveitis (AAU), skin psoriasis (PSO) and dactylitis were 50%, 30%, 24%, 15% and 0% respectively. Self-reported family history of IBD, ReA, PSO, axSpA and AAU were 60%, 36%, 22%, 11%, and 1% respectively.

Ninety-one (53%) patients were MDP-positive and 82 (47%) patients were MDP-negative. The clinical characteristics associated with MDP (adjusted for age at invitation) were: the presence of inflammatory back pain using ASAS criteria [OR 8.84 (1.61,48.67); p=0.01], longer interval between symptom onset and gastroenterologist diagnosis of IBD [OR 1.09 (1.03,1.16); p=0.005], and use of rectal topical 5-aminosalicylic acid [OR 3.27 (1.11,9.68); p=0.03].

Conclusion:

Chronic back pain and peripheral musculoskeletal pain are common in a secondary care IBD population. In IBD patients, with back pain duration > 3 months and onset before 45 years, the presence of inflammatory back pain, longer diagnostic delay of IBD and the use of rectal topical 5-aminosalicylic acid were associated with a higher clinical probability of axSpA. The identification of these clinical features may not only improve the quality and specificity of Rheumatology referrals from Gastroenterology in this subgroup of patients but also lends real world evidence to current ASAS-endorsed recommendations for early referral of patients with a suspicion of axial spondyloarthritis.

Disclosure of Interests:

Chong Seng Edwin Lim Grant/research support from: AbbVie - Research support/grant but NOT for this study., Mark Tremelling: None declared, Louise Hamilton: None declared, Alexander Macgregor: None declared, Karl Gaffney Grant/research support from: AbbVie, Celgene, MSD, Novartis, Pfizer, and UCB Pharma, Consultant of: AbbVie, Celgene, MSD, Novartis, Pfizer, and UCB Pharma, Speakers bureau: AbbVie, Celgene, MSD, Novartis, Pfizer, and UCB Pharma

Secukinumab Use in Patients with Moderate to Severe Psoriasis, Psoriatic Arthritis and Ankylosing Spondylitis in Real-World Setting in Europe: Baseline Data from SERENA Study

INTRODUCTION

Secukinumab, a fully human monoclonal antibody that directly inhibits interleukin-17A, has demonstrated robust efficacy in the treatment of moderate to severe psoriasis (PsO), psoriatic arthritis (PsA) and ankylosing spondylitis (AS), with a rapid onset of action, sustained long-term clinical responses and a consistently favourable safety profile across phase 3 trials. Here, we report the clinical data at enrolment from SERENA, designed to investigate the real-world use of secukinumab across all three indications.

METHODS

SERENA is an ongoing, longitudinal, observational study conducted at 438 sites across Europe in patients with moderate to severe plaque PsO, active PsA or active AS. Patients should have received at least 16 weeks of secukinumab treatment before enrolment in the study.

RESULTS

Overall 2800 patients were included in the safety set; patients with PsA (N = 541) were older than patients with PsO (N = 1799) and patients with AS (N = 460); patients with PsO had a higher mean body weight than patients with PsA and patients with AS; and patients with PsO and patients with AS were predominantly male. Time since diagnosis was longer in patients with PsO compared with patients with PsA and patients with AS, and about 40% of patients were either current or former smokers. The proportion of obese patients (body mass index ≥ 30 kg/m2) was similar across indications. Patients were treated with secukinumab for a mean duration of 1 year prior to enrolment (range 0.89-1.04). The percentages of patients with prior biologics exposure were 31.5% PsO, 59.7% PsA and 55% AS. The percentages of patients prescribed secukinumab monotherapy were 75% (n = 1349) in PsO, 48.2% (n = 261) in PsA and 48.9% (n = 225) in AS groups.

CONCLUSION

Baseline demographics of the study population are consistent with existing literature. This large observational study across all secukinumab indications will provide valuable information on the long-term effectiveness and safety of secukinumab in the real-world setting.

AB0311 THE PROPER STUDY: RESULTS OF THE FIRST INTERIM ANALYSIS OF A PAN-EU REAL-WORLD STUDY OF SB5 BIOSIMILAR FOLLOWING TRANSITION FROM REFERENCE ADALIMUMAB IN PATIENTS WITH RHEUMATOID ARTHRITIS, AXIAL SPONDYLOARTHRITIS OR PSORIATIC ARTHRITIS

Background:

SB5, a biosimilar to reference adalimumab (ADA), received EU marketing authorisation in August 2017, based on the totality of evidence from pre-clinical and clinical Phase I and III studies that demonstrated bioequivalence, similar efficacy, and comparable safety and immunogenicity to the reference. There are few published data on the transition from reference to biosimilar ADA outside the controlled, randomised, clinical trial setting.

Objectives:

To evaluate candidate predictors of persistence on SB5 in EU patients across multiple indications.

Methods:

This ongoing observational study will enrol approximately 1200 subjects with rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) or psoriatic arthritis (PsA), who initiated SB5 as part of routine clinical practice following a minimum of 16 weeks’ treatment with reference ADA, at clinics in Belgium, Germany, Ireland, Italy, Spain and the UK. Data are captured from clinic records retrospectively for the 24 weeks prior to transition, and prospectively and/or retrospectively for 48 weeks following transition. The primary objective is to evaluate candidate predictors of persistence, and primary outcome measures include baseline clinical characteristics, disease activity scores, clinical management and patient satisfaction over time. This interim analysis provides an overview of baseline characteristics for subjects enrolled and followed up by the data extract date of 20thDecember 2019.

Results:

Of the 123 patients included in this interim analysis, 43 suffer from RA, 42 from axSpA and 38 from PsA.

Table 1.

Patient baseline characteristics

RA (N=43)axSpA (N=42)PsA (N=38)Mean (SD)Q1, Q3Mean (SD)Q1, Q3Mean (SD)Q1, Q3Age (years)58.7 (11.3)53, 6452.3 (13.3)41, 6353.7 (14.1)48, 63Duration of disease (years)6.8 (9.5)1, 622.0 (14.4)12.5, 32.513.8 (9.4)5.5, 22n%n%n%Women3172.11638.11642.1Dosing regimen ADA to SB5: 40mg Q2W: 40mg Q2W3485.03685.73489.5 Other*615.0614.3410.5Stable disease (physician opinion)3491.92765.93085.7Disease Activity Score:Mean (SD)95% CIMean (SD)95% CIMean (SD)95% CI DAS28 (n = 26)2.71 (0.88)2.36, 3.06---- BASDAI (n = 31)--3.71 (2.89)2.65, 4.77-- PsA scores (n = 23)0.3 (0.9)  Swollen joint2.9 (5.7)-0.1, 0.8  Tender joint0.4, 5.4Patient Awareness:n%n%n%Instructed in self-administration43100.03790.23594.6Know to remove SB5 from fridge 30 minutes pre-injection43100.03895.03697.3Know SB5 can be stored out of fridge <25oc for 28 days4297.73382.52875.7

DAS-28 Disease Activity Score 28; BASDAI Bath Ankylosing Spondylitis Disease Activity Index; SD standard deviation; Q1 1stquartile, Q3 3rdquartile; CI Confidence Interval

‘Other’ includes all other reported doses and/or dosing intervals: 40mg QW, 80mg Q2W, and unspecified frequency

Conclusion:

This interim analysis provides a first insight into a contemporary cohort of EU patients with established RA, axSpA and PsA, switched from reference to biosimilar ADA in clinical practice. The majority of patients have stable disease at transition, 85% or more of each cohort transitioned to the same dose regimen of biosimilar as received for the reference prior to transition, and most are aware of correct storage and self-administration of their biosimilar medication. With ongoing enrolment and longer follow-up, the study will provide pertinent information about clinical outcomes of transition from reference to biosimilar adalimumab in real-world practice and in indications not investigated in controlled studies.

Disclosure of Interests:

Ulf Müller-Ladner Speakers bureau: Biogen, Karl Gaffney Grant/research support from: AbbVie, Celgene, MSD, Novartis, Pfizer, and UCB Pharma, Consultant of: AbbVie, Celgene, MSD, Novartis, Pfizer, and UCB Pharma, Speakers bureau: AbbVie, Celgene, MSD, Novartis, Pfizer, and UCB Pharma, Deepak Jadon: None declared, Ulrich Freudensprung Shareholder of: Biogen International GmbH, Employee of: Biogen International GmbH, Janet Addison Shareholder of: Biogen Idec, Employee of: Biogen Idec

OP0103 DOES GENDER, AGE OR SUBPOPULATION INFLUENCE THE MAINTENANCE OF CLINICAL REMISSION IN AXIAL SPONDYLOARTHRITIS FOLLOWING CERTOLIZUMAB PEGOL DOSE REDUCTION?

Background:

Previous studies have shown that withdrawing tumour necrosis factor inhibitors (TNFi) in patients (pts) with axial spondyloarthritis (axSpA) who have achieved sustained remission often leads to relapse.1However, none have formally tested TNFi dose reduction strategies in a broad axSpA population or evaluated whether relapse following TNFi dose reduction and withdrawal is associated with a specific demographic subgroup.

Objectives:

C-OPTIMISE evaluated the percentage of pts without flare after TNFi dose continuation, reduction or withdrawal in adults with early axSpA treated with the Fc-free, PEGylated TNFi certolizumab pegol (CZP). Here, we analyse whether responses to reduced maintenance dose were comparable in pts stratified by axSpA subpopulation, gender and age.

Methods:

C-OPTIMISE (NCT02505542) was a multicentre, two-part phase 3b study in adults with early (<5 years’ symptom duration) active axSpA (stratified for radiographic [r]- and non-radiographic [nr]- axSpA). Pts received CZP 200 mg every 2 weeks (wks) (Q2W; 400 mg loading dose at Wks 0, 2 and 4) during the open-label induction period. At Wk 48, pts in sustained remission (Ankylosing Spondylitis Disease Activity Score [ASDAS] <1.3 at Wk 32 or 36 [if ASDAS <1.3 at Wk 32, it must be <2.1 at Wk 36, or vice versa] and at Wk 48) were randomised to double-blind full maintenance dose (CZP 200 mg Q2W); reduced maintenance dose (CZP 200 mg every 4 wks [Q4W]) or placebo (PBO) for a further 48 wks (maintenance period). The primary endpoint was the percentage of pts not experiencing a flare (ASDAS ≥2.1 at two consecutive visits or ASDAS >3.5 at any timepoint) during Wks 48–96. Analyses were conducted on subgroups according to axSpA subpopulation, gender and age ≤/> the median age of the randomised set (32 years).

Results:

During the 48-wk induction period, 43.9% of patients (323/736) achieved sustained remission and 313 pts entered the 48-wk maintenance period (r/nr-axSpA: 168/145 pts; males/females: 247/66 pts; age ≤32/>32: 165/148 pts). During the maintenance period, responses in r- and nr-axSpA pts were comparable across all three randomised arms. 83.9% r-axSpA and 83.3% nr-axSpA pts receiving the full CZP maintenance dose did not experience a flare, and in the reduced maintenance dose arm 82.1% r-axSpA and 75.5% nr-axSpA pts did not experience a flare. In the PBO group this was reduced to 17.9% and 22.9%, respectively. Similar responses were seen in pts stratified by gender or age, with substantially higher percentages of pts randomised to CZP full or reduced maintenance dose remaining free of flares compared to PBO in all subgroups (Figure).

Conclusion:

The results of C-OPTIMISE indicate that a reduced maintenance dose is suitable for pts with axSpA who achieve sustained remission following 1 year of CZP treatment, regardless of axSpA subpopulation, gender or age. Complete treatment withdrawal is not recommended due to the high risk of flare.

References:

[1]Landewe R. Lancet 2018;392:134–44.

Acknowledgments:

This study was funded by UCB Pharma. Editorial services were provided by Costello Medical

Disclosure of Interests:

Robert B.M. Landewé Consultant of: AbbVie; AstraZeneca; Bristol-Myers Squibb; Eli Lilly & Co.; Galapagos NV; Novartis; Pfizer; UCB Pharma, Désirée van der Heijde Consultant of: AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Cyxone, Daiichi, Eisai, Eli-Lilly, Galapagos, Gilead Sciences, Inc., Glaxo-Smith-Kline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, UCB Pharma; Director of Imaging Rheumatology BV, Maxime Dougados Grant/research support from: AbbVie, Eli Lilly, Merck, Novartis, Pfizer and UCB Pharma, Consultant of: AbbVie, Eli Lilly, Merck, Novartis, Pfizer and UCB Pharma, Speakers bureau: AbbVie, Eli Lilly, Merck, Novartis, Pfizer and UCB Pharma, Xenofon Baraliakos Grant/research support from: Grant/research support from: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Consultant of: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Speakers bureau: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Filip van den Bosch Consultant of: AbbVie, Celgene Corporation, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, and UCB, Speakers bureau: AbbVie, Celgene Corporation, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, and UCB, Karl Gaffney Grant/research support from: AbbVie, Celgene, MSD, Novartis, Pfizer, and UCB Pharma, Consultant of: AbbVie, Celgene, MSD, Novartis, Pfizer, and UCB Pharma, Speakers bureau: AbbVie, Celgene, MSD, Novartis, Pfizer, and UCB Pharma, Lars Bauer Employee of: UCB Pharma, Bengt Hoepken Employee of: UCB Pharma, Natasha de Peyrecave Employee of: UCB Pharma, Karen Thomas Employee of: UCB Pharma, Lianne S. Gensler Grant/research support from: Pfizer, Novartis, UCB, Consultant of: AbbVie, Eli Lilly, GSK, Novartis, UCB

AB1178 AN AUDIT OF ORIGINATOR ADALIMUMAB TO BIOSIMILAR SWITCH IN TWO HOSPITALS

Background:

Biological drugs have revolutionized the treatment of immune-mediated inflammatory diseases (IMIDs). Current guidelines reserve these drugs for patients with severe refractory disease.

Biologic drugs are expensive, but as they reach patent expiry, the introduction of lower-cost biosimilars reduces their impact on health care budgets. It is estimated that NHS England could save £300 million by 2021 following the recent launch of adalimumab biosimilars [1]. As part of this process, there has been a mandatory switch of originator adalimumab to biosimilar adalimumab throughout the U.K.

Objectives:

To evaluate the impact of the switch to biosimilar adalimumab in individuals with inflammatory arthritis at two NHS trusts in the East of England and calculate the proportion and reasons for switch back to originator adalimumab or a second biosimilar at 12 weeks.

Methods:

Both hospitals ran dedicated ‘switch’ clinics. All patient records were reviewed retrospectively.

Results:

855 patients with different IMID switched from originator to biosimilar over 13 months. At 12 weeks, 730 patients (85%) maintained the switch, 71 patients (8.7%) switched back to the originator, and 54 patients (6.3%) switched to other biosimilars of the same drug.

Table 1.

Primary outcome analysis of switching from originator to adalimumab biosimilar

DiagnosisTotal patient switched from originatorAverage duration (year) of use of originator before bio switch (for patients continue using bio switch)Total patients continuing (At 12 weeks)Average duration (year) of use of originator before bio switch (for patients switched back to originator)Total patients switched back to originator or other biosimilarRheumatoid Arthritis3567.9314 (88%)4.942 (12%)Axial Spondyloarthritis2606.4213 (82%)4.547 (18%)Psoriatic Arthritis2185.9187 (86%)2.931 (14%)Juvenile Arthritis163.714 (88%)4.52 (12%)Others52.22 (40%)0.83 (60%)Total8557.0730 (85%)4.2125 (15%)Table 2.

Reasons for back to originator or another biosimilar

Reasons for back to originator or another biosimilarNumber back for IntoleranceNumber back for InefficacyPainful injection69BASDAI/Spinal Pain13Pain/Others19TJC, SJC, VAS4Rash/Allergic reaction5DAS3Headache5PsARC2Nausea4No Detail1Total102Total23%82%18%

Conclusion:

Switching to a biosimilar was successful in the vast majority of patients and is associated with significant saving. The list prices for originator Adalimumab is £9,155/person/year and £8,238/person/year for biosimilar Adalimumab respectively [2]. By switching we will save approximately £719,402 per annum (9.2% cost reduction).

References:

[1]NHS England. NHS set to save record £300 million on the NHS’s highest drug spend 2018 [cited 2018 November 30].https://www.england.nhs.uk/2018/11/nhs-set-to-save-record-300-million-on-the-nhss-highest-drug-spend/

[2]https://bnf.nice.org.uk/medicinal-forms/adalimumab.html

Disclosure of Interests:

Rifat Mazumder: None declared, Marianne Loke: None declared, Chetan Mukhtyar: None declared, Karl Gaffney Grant/research support from: AbbVie, Celgene, MSD, Novartis, Pfizer, and UCB Pharma, Consultant of: AbbVie, Celgene, MSD, Novartis, Pfizer, and UCB Pharma, Speakers bureau: AbbVie, Celgene, MSD, Novartis, Pfizer, and UCB Pharma, Emese Balogh: None declared, Emerald Sekaran: None declared, Mushfika Sultana: None declared, Mabel Odonkor: None declared, Karen Miles: None declared

Response to lower dose TNF inhibitors in axial spondyloarthritis; a real-world multicentre observational study

OBJECTIVE

Dose optimization of TNF inhibitors in axial spondyloarthritis (axSpA) is attractive, but it is unclear for which patients this approach might be appropriate.

METHODS

Seventy-one patients with axSpA, from six UK centres, were identified who had reduced their dose of TNF inhibitor after being considered to be stable responders. All completed a questionnaire concerning their approach to and experience of dose reduction. Data on patient characteristics, metrology and CRP were retrieved retrospectively from patient records.

RESULTS

Over 2 years of observation, 60 (84.5%) remained (REM) on reduced-dose medication and 11 (15.5%) reverted (REV) to the original dose. The overall mean dose reduction was 39% for REM patients and 44% for REV patients. Both groups initially responded in a similar manner to treatment, but the data showed a trend that younger women were more likely to revert. Neither BMI nor smoking was associated with continued low-dose responsiveness. Eight of the 11 REV patients reverted by 6 months. None reached criteria of secondary drug failure, and all regained control after increasing back to the original dose. Most patients in both groups reached the decision to reduce the dose jointly with clinicians. A preference for taking the reduced dose was not associated with low-dose drug survival.

CONCLUSION

Many patients with axSpA remain well symptomatically after stepping down the dose of TNF inhibitor, but young women are less likely to do well on a reduced dose. Dose reduction should be one element of the management of patients with axSpA.

Maintenance of clinical remission in early axial spondyloarthritis following certolizumab pegol dose reduction

Background

The best strategy for maintaining clinical remission in patients with axial spondyloarthritis (axSpA) has not been defined. C-OPTIMISE compared dose continuation, reduction and withdrawal of the tumour necrosis factor inhibitor certolizumab pegol (CZP) following achievement of sustained remission in patients with early axSpA.

Methods

C-OPTIMISE was a two-part, multicentre phase 3b study in adults with early active axSpA (radiographic or non-radiographic). During the 48-week open-label induction period, patients received CZP 200 mg every 2 weeks (Q2W). At Week 48, patients in sustained remission (Ankylosing Spondylitis Disease Activity Score (ASDAS) <1.3 at Weeks 32/36 and 48) were randomised to double-blind CZP 200 mg Q2W (full maintenance dose), CZP 200 mg every 4 weeks (Q4W; reduced maintenance dose) or placebo (withdrawal) for a further 48 weeks. The primary endpoint was remaining flare-free (flare: ASDAS ≥2.1 at two consecutive visits or ASDAS >3.5 at any time point) during the double-blind period.

Results

At Week 48, 43.9% (323/736) patients achieved sustained remission, of whom 313 were randomised to CZP full maintenance dose, CZP reduced maintenance dose or placebo. During Weeks 48 to 96, 83.7% (87/104), 79.0% (83/105) and 20.2% (21/104) of patients receiving the full maintenance dose, reduced maintenance dose or placebo, respectively, were flare-free (p<0.001 vs placebo in both CZP groups). Responses in radiographic and non-radiographic axSpA patients were comparable.

Conclusions

Patients with early axSpA who achieve sustained remission at 48 weeks can reduce their CZP maintenance dose; however, treatment should not be completely discontinued due to the high risk of flare following CZP withdrawal.

Trial registration number

NCT02505542, ClinicalTrials.gov.

P281 52-Week efficacy and safety of ixekizumab in r-axSpA/AS patients naïve to biologic treatments or with prior inadequate response/intolerance to tumor necrosis factor inhibitors

Background

Radiographic axial spondylitis (r-axSpA), or ankylosing spondylitis (AS), is a chronic inflammatory disease of the axial skeleton associated with serious pain, stiffness and limited flexibility, impairing quality of life. Two clinical trials demonstrated efficacy and safety of ixekizumab (IXE), a humanised anti-IL-17 IgG4 antibody, in r-axSpA/AS patients naïve to biologics, or with prior inadequate response/intolerance to tumor necrosis factor inhibitors (TNFi) over 16 weeks. This study assessed the treatment effect over 52 weeks. Additionally, the influence of baseline inflammation, measured by C-reactive protein (CRP) and/or spinal MRI on ASAS40 response at week 16 was investigated.

Methods

Data from two Phase 3, randomised, double-blind, placebo (PBO)-controlled trials, with patients who fulfilled the Assessment of Spondylo-Arthritis International Society (ASAS) criteria for AS and were either biologic-naïve (COAST-V, NCT02696785) or TNFi-experienced (COAST-W, NCT02696798), were analysed. We compared the proportion of patients achieving ASAS20/40, a 50% improvement of baseline Bath Ankylosing Spondylitis Disease Activity Index (BASDAI50) and assessed the change in spinal pain. Missing data was handled by using non-responder imputation for ASAS20/40 and BASDAI50 response rates and modified Baseline Observation Carried Forward (mBOCF) for spinal pain change from baseline. To investigate the influence of baseline inflammation on the efficacy, we examined the ASAS40 response at week 16 by baseline CRP (normal; ≤5 or elevated; &gt;5 mg/L) and/or MRI Spondyloarthritis Research Consortium of Canada (SPARCC) spine score (&lt;2 or ≥ 2) using an integrated COAST-V/W dataset.

Results

At week 16, significantly more IXE than PBO-treated patients achieved ASAS20/40 and BASDAI50 and a decrease in spinal pain. Decreases in disease activity were maintained through week 52 (Table 1). These outcomes occurred in both biologic-naïve and TNFi-experienced patients. Safety outcomes were consistent with previous IXE studies. At week 16, in the integrated dataset, significantly more IXE than PBO-treated patients achieved ASAS40 response regardless of baseline CRP or MRI spine SPARCC score.

Conclusion

Through week 52, treatment with IXE resulted in sustained efficacy in biologic-naïve and TNFi-experienced AS patients with no unexpected safety signals. Furthermore, at week 16, IXE demonstrated efficacy (ASAS40) irrespective of baseline CRP levels or spinal MRI score.

Disclosures

K. Gaffney: Consultancies; Abbvie, Eli Lilly, UCB, Novartis. Member of speakers’ bureau; Eli Lilly, UCB, Novartis. Grants/research support; Abbvie, Pfizer. D. Aletaha: Member of speakers’ bureau; Abbvie, Amgen, Celgene, Eli Lilly, Medac, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, Sanofi/Genzyme. Grants/research support; Abbvie, Novartis, Roche. A.J. Bradley: Corporate appointments; Eli Lilly employee. Shareholder/stock ownership; Eli Lilly. M.H. Nassab: Corporate appointments; Eli Lilly employee. S. Liu Leage: Corporate appointments; Eli Lilly employee. R. Micheroli: None.

P263 Should we advocate biologic dose-reduction in patients with AxSpA?

Background

Dose optimisation of biologic drugs is attractive on cost and safety grounds. As in RA, some patients with axSpA who respond well to TNF-inhibitor (TNFi) drugs can reduce the dose and remain symptomatically well. However, there are no clear data to support dose reduction strategies nor to identify those likely, and those unlikely, to respond to lower dose treatment.

Methods

71 patients, from 6 UK centres, who fulfilled criteria for AS (modified New York criteria) or AxSpA (ASAS criteria) and who had reduced their dose of TNFi therapy were identified and followed up for 24 months. All were stable responders to TNFi treatment; their responses to treatment fulfilled NICE criteria and were maintained for at least six months by the time of dose reduction. Those who reverted to full-dose treatment and those who did not were identified and data about demographics, disease activity and patients’ approaches to dose reduction were recorded.

Results

55 (77.5%) patients remained on lower-dose treatment (REM) and 16 (22.5%) reverted to full-dose (REV). Mean dose reduction for each of the 4 agents was adalimumab 39%, etanercept 39%, golimumab 26%, and infliximab 46%. Overall dose reduction was 39% and 44% for REM and REV patients respectively. Both groups responded equally to treatment by all measures at dose reduction. In this small study, the data suggest that female gender and younger age are associated with reversion and that REV patients scored lower on BASDAI and CRP at the initiation of TNFi treatment. REV patients’ mean BASDAI, BASFI, BASMI scores increased from dose reduction to dose reversion but mean CRP scores decreased from 3.76 to 3.5mg/dl (7.9%). Even at the point of reversion REV patients still met original response criteria. The majority of patients in both groups reached the decision jointly with clinicians. 62 (89.9%) patients were either confident or neither worried nor confident about the decision to reduce the dose. Patients’ approach to dose-reduction was not associated with reversion and neither the duration of disease nor the time to initiation of biologic treatment appeared to associate with the likely success or failure of reduced dose TNFi treatment. Men with high initial CRP levels appear likely to respond well to biologic dose-reduction. The worsening of symptoms but maintenance of low CRP levels raises questions as to the mechanisms underpinning dose-reversion.

Conclusion

77.5% patients in this study continued to respond well to a mean 39% reduction in biologic dose for 2 years. In the absence of long-term efficacy data, advocating dose-reduction to stable responders is appropriate.

Disclosures

L. Van Rossen: Consultancies; Novartis, UCB. Honoraria; Abbvie, Novartis, pfizer, UCB. Grants/research support; EKHUFT, UCB. C. Boyle: Honoraria; Novartis. A. Chan: None. K. Gaffney: Consultancies; Abbvie, UCB, Pfizer, Novartis, Lilly. Honoraria; Abbvie, UCB, Pfizer, Novartis, Lilly. Member of speakers’ bureau; Abbvie, UCB, Pfizer, Novartis, Lilly. Grants/research support; Abbvie, UCB, Pfizer, Novartis, Lilly. A. Gilbert: Other; consultant for Boehringer Ingelheim Germany as a Global Patient Relations manager working in Scleroderma. C. Harris: Honoraria; Novartis, UCB. P. Machado: Consultancies; Abbvie, BMS, Celgene, Janssen, MSD, Novartis, Pfizer, Roche and UCB. Honoraria; Abbvie, BMS, Celgene, Janssen, MSD, Novartis, Pfizer, Roche and UCB. S. Liliana: None. R. Sengupta: Consultancies; Abbvie, Biogen, Celgene, Novartis, UCB. Honoraria; Abbvie, Biogen, Celgene, Novartis, UCB. A. Keat: None.

P242 CZP improves work and household productivity and social participation over 1 year of treatment in patients with non-radiographic axSpA

Background

Certolizumab pegol (CZP) treatment has been shown to significantly improve work and household productivity and social participation compared to placebo in active non-radiographic axial spondyloarthritis (nr-axSpA) patients up to 24 weeks. Here, we report the impact of CZP in combination with non-biologic background medication (NBBM) on signs and symptoms of nr-axSpA compared to placebo+NBBM.

Methods

C-axSpAnd (NCT02552212) is a 3-year, phase 3, multicentre study including a 52-week double-blind, placebo-controlled period (completed). Patients had active nr-axSpA, objective signs of inflammation (OSI; elevated CRP and/or positive MRI of the sacroiliac joint), previous inadequate response to ≥ 2 NSAIDs and were randomised 1:1 to CZP (400 mg at Weeks 0/2/4, then 200 mg every 2 weeks) or placebo. The validated arthritis-specific Work Productivity Survey (WPS) assessed the impact of nr-axSpA on work and household productivity and social participation. Missing data were imputed using last observation carried forward (LOCF) post hoc in the Full Analysis Set (randomised patients who received ≥1 dose of CZP).

Results

317 patients were randomised (CZP: 159; placebo: 158). Mean age at baseline was 37.3 years and 51.4% of patients were female. At baseline, most patients were employed (CZP: 124 [77.8%]; placebo: 123 [78.0%]) and reported a mean 3.7 (CZP) and 3.5 (placebo) workdays missed per month due to disease (Table 1). By Week 12, work absenteeism substantially improved in the CZP group compared with placebo (0.9 vs 2.1 days missed per month, LOCF), with further improvements at Week 52 (0.3 vs 2.0 days missed per month, LOCF). Between Week 12 and Week 52, most placebo patients (104, 65.8%) switched to open-label CZP, impacting Week 52 imputed outcomes. Despite this, similar patterns of improvement following CZP treatment were seen for absenteeism, workdays with impaired productivity, household days with missed/reduced productivity and social participation between imputed and observed case data (Table 1). Improvements were similar between male and female patients (data not shown).

Conclusion

CZP treatment resulted in improvements in work and household productivity and social participation for nr-axSpA patients as early as Week 12 compared to background medication only, with benefits maintained to Week 52.

Disclosures

K. Gaffney: Other; Research Grants/Consultancy Fees from Abbvie, Biogen, Celgene, Gilead, Izana, Janssen, Lilly, Novartis, Pfizer, UCB Pharma. A. Deodhar: Consultancies; AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Glaxo Smith and Klein, Janssen, Novartis, Pfizer and UCB. Grants/research support; BMS, Eli Lilly, Glaxo Smith & Kline, Janssen, Novartis, Pfizer and UCB. L. Gensler: Consultancies; Galapagos, Eli Lilly and Janssen. Grants/research support; AbbVie, Amgen, Novartis, UCB Pharma. J. Kay: Consultancies; AbbVie, Boehringer Ingelheim, Celltrion Healthcare, Horizon Therapeutics, Merck Sharp & Dohme, MorphoSys, Novartis, Pfizer, Samsung Bioepis, Sandoz and UCB Pharma. Grants/research support; Gilead Sciences, Novartis AG, Pfizer and UCB Pharma. W. Maksymowych: Other; Consultant and/or speaker fees and/or grants from AbbVie, Amgen, Eli Lilly, Janssen, Merck, Pfizer, Synarc, Sanofi and UCB Pharma. N. Haroon: Consultancies; Abbvie, Amgen, Eli Lilly, Janssen, Novartis and UCB Pharma. R. Landewé: Consultancies; Abbott, Ablynx, Amgen, Astra-Zeneca, Bristol Myers Squibb, Centocor, GlaxoSmithKline, Novartis, Merck, Pfizer, Roche, Schering-Plough, UCB Pharma, Wyeth. Member of speakers’ bureau; Abbott, Amgen, Bristol Myers Squibb, Centocor, Merck, Pfizer, Roche, Schering-Plough, UCB Pharma, Wyeth. Grants/research support; Abbott, Amgen, Centocor, Novartis, Pfizer, Roche, Schering-Plough, UCB Pharma, Wyeth. M. Rudwaleit: Consultancies; Abbott, Bristol-Myers Squibb, Janssen, MSD, Pfizer, Roche, UCB Pharma. S. Hall: Other; Consulting fees/ research grants from AbbVie, Eli Lilly, Novartis, and UCB Pharma. L. Bauer: Other; Employee of UCB Pharma. B. Hoepken: Other; Employee of UCB Pharma. N. de Peyrecave: Other; Employee of UCB Pharma. T. Kumke: Other; Employee of UCB Pharma. D. van der Heijde: Consultancies; AbbVie, Amgen, Astellas, AstraZeneca, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Daiichi, Eli Lilly, Galapagos, Gilead, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, and UCB. Other; Director of Imaging Rheumatology BV.

Awareness of axial spondyloarthritis among chiropractors and osteopaths: findings from a UK Web-based survey

Objective

Chiropractors and osteopaths are important professional partners in the management of axial spondyloarthritis (axSpA). In view of recent advances in diagnosis and treatment, we sought to understand their current knowledge and working practices.

Methods

A Web-based survey was advertised to chiropractors and osteopaths via the Royal College of Chiropractors and the Institute of Osteopathy.

Results

Of 382 completed responses [237 chiropractors (62%) and 145 osteopaths (38%)], all were familiar with AS, but only 63 and 25% were familiar with the terms axSpA and non-radiographic axSpA, respectively. Seventy-seven per cent were confident with inflammatory back pain. Respondents routinely asked about IBD (91%), psoriasis (81%), acute anterior uveitis (49%), peripheral arthritis (71%), genitourinary/gut infection (56%), enthesitis (30%) and dactylitis (20%). Eighty-seven per cent were aware of the association between axSpA and HLA-B27. Only 29% recognized that axSpA was common in women. Forty per cent recommend an X-ray (pelvic in 80%) and, if normal, 27% would recommend MRI of the sacroiliac joints and whole spine. Forty-four per cent were aware of biologic therapies. Forty-three per cent were confident with the process of onward referral to rheumatology via the general practitioner (GP). The principal perceived barrier to onward referral was reluctance by the GP to accept their professional opinion.

Conclusion

Overall knowledge of ankylosing spondylitis is good, but the term axSpA is poorly understood. Specific learning needs include gender preponderance, awareness of acute anterior uveitis and the availability of biological therapies. There is lack of confidence in the onward referral process to rheumatology via the GP.

Exploring sub-optimal response to tumour necrosis factor inhibitors in axial spondyloarthritis

Objectives

The aim was to define sub-optimal response to TNF inhibitors (TNFi), compare long-term drug survival rates and identify predictors of sub-optimal response in axial spondyloarthritis (axSpA) patients in a UK cohort.

Methods

All axSpA patients attending two centres who commenced TNFi between 2002 and 2016 were included. Routinely recorded patient data were reviewed retrospectively. Patients with paired BASDAI at baseline, 3 and/or 6 months were included for analysis. Sub-optimal response was defined as achieving a ≥ 2-point reduction in BASDAI but not BASDAI50, post-treatment BASDAI remaining at ≥4, and in the opinion of the treating physician these patients demonstrated a meaningful clinical response.

Results

Four hundred and ninety-nine patients were included: 82 (16.4%) patients were classified as having a sub-optimal response; 64 (78%) males, 78 (95.1%) AS and 55/67 (82.1%) HLA-B27 positive. Results are reported as the mean (s.d.). Time to diagnosis was 10 (8.6) years, age at diagnosis was 37 (11.7) years, and age at initiating index TNFi was 48 (11.1) years. Individual index TNFi were Humira (adalimumab, n = 41, 50%), Enbrel (etanercept, n = 27, 32.9%), Remicade (infliximab, n = 5, 6.1%), Simponi (golimumab, n = 3, 3.7%) and Cimzia (certolizumab pegol, n = 6, 7.3%). The rate of attrition was greater among sub-optimal responders at 2 and 5 years (P < 0.05), but not at 10 years (P = 0.06), compared with responders. Older age at initiation of TNFi was a predictor of sub-optimal response (odds ratio 1.04, 95% CI 1.01, 1.09, P < 0.05).

Conclusion

A significant proportion of patients continued TNFi despite demonstrated sub-optimal response. Further research needs to be undertaken in order to understand this group.