Treatment-related changes in serum neutrophil gelatinase-associated lipocalin (NGAL) in psoriatic arthritis: results from the PIPA cohort study

OBJECTIVES

Obesity and psoriatic arthritis (PsA) have a complicated relationship. While weight alone does not cause PsA, it is suspected to cause worse symptoms. Neutrophil gelatinase-associated lipocalin (NGAL) is secreted through various cell types. Our objective was to assess the changes and trajectories in serum NGAL and clinical outcomes in patients with PsA during 12 months of anti-inflammatory treatment.

METHOD

This exploratory prospective cohort study enrolled PsA patients initiating conventional synthetic or biological disease-modifying anti-rheumatic drugs (csDMARDs/bDMARDs). Clinical, biomarker, and patient-reported outcome measures were retrieved at baseline, and 4 and 12 months. Control groups at baseline were psoriasis (PsO) patients and apparently healthy controls. The serum NGAL concentration was quantified by a high-performance singleplex immunoassay.

RESULTS

In total, 117 PsA patients started a csDMARD or bDMARD, and were compared indirectly at baseline with a cross-sectional sample of 20 PsO patients and 20 healthy controls. The trajectory in NGAL related to anti-inflammatory treatment for all included PsA patients showed an overall change of -11% from baseline to 12 months. Trajectories in NGAL for patients with PsA, divided into treatment groups, showed no clear trend in clinically significant decrease or increase following anti-inflammatory treatment. NGAL concentrations in the PsA group at baseline corresponded to the levels in the control groups. No correlation was found between changes in NGAL and changes in PsA outcomes.

CONCLUSION

Based on these results, serum NGAL does not add any value as a biomarker in patients with peripheral PsA, either for disease activity or for monitoring.

Exercise and education vs intra-articular saline for knee osteoarthritis: a 1-year follow-up of a randomized trial

OBJECTIVE

To assess the longer-term effect of the Good Life with osteoarthritis in Denmark (GLAD) exercise and education program relative to open-label placebo (OLP) on changes from baseline in core outcomes in individuals with knee osteoarthritis (OA).

METHODS

In this 1-year follow-up of an open-label, randomized trial, patients with symptomatic and radiographically confirmed knee OA were monitored after being randomized to either the 8-week GLAD program or OLP given as 4 intra-articular saline injections over 8 weeks. The primary outcome was the change from baseline in the Knee injury and Osteoarthritis Outcome Score questionnaire (KOOS) pain subscale after 1 year in the intention-to-treat population. Key secondary outcomes were the KOOS function and quality of life subscales, and Patients' Global Assessment of disease impact.

RESULTS

206 adults were randomly assigned: 102 to GLAD and 104 to OLP, of which only 137 (63/74 GLAD/OLP) provided data at 1 year. At one year the mean changes in KOOS pain were 8.4 for GLAD and 7.0 for OLP (Difference: 1.5 points; 95% CI -2.6 to 5.5). There were no between-group differences in any of the secondary outcomes.

CONCLUSIONS

In this 1-year follow-up of individuals with knee OA, the 8-week GLAD program and OLP both provided minor longer-term benefits with no group difference. These results require confirmation given the significant loss to follow-up.

TRIAL REGISTRATION NUMBER

NCT03843931.

Who are likely to benefit from the Good Life with osteoArthritis in Denmark (GLAD) exercise and education program? An effect modifier analysis of a randomised controlled trial

OBJECTIVE

To identify contextual factors that modify the treatment effect of the 'Good Life with osteoArthritis in Denmark' (GLAD) exercise and education programme compared to open-label placebo (OLP) on knee pain in individuals with knee osteoarthritis (OA).

METHODS

Secondary effect modifier analysis of a randomised controlled trial. 206 participants with symptomatic and radiographic knee OA were randomised to either the 8-week GLAD programme (n = 102) or OLP given as 4 intra-articular saline injections over 8 weeks (n = 104). The primary outcome was change from baseline to week 9 in the Knee injury and Osteoarthritis Outcome Score questionnaire (KOOS) pain subscale (range 0 (worst) to 100 (best)). Subgroups were created based on baseline information: BMI, swollen study knee, bilateral radiographic knee OA, sports participation as a young adult, sex, median age, a priori treatment preference, regular use of analgesics (NSAIDs or paracetamol), radiographic disease severity, and presence of constant or intermittent pain.

RESULTS

Participants who reported use of analgesics at baseline seem to benefit from the GLAD programme over OLP (subgroup contrast: 10.3 KOOS pain points (95% CI 3.0 to 17.6)). Participants with constant pain at baseline also seem to benefit from GLAD over OLP (subgroup contrast: 10.0 points (95% CI 2.8 to 17.2)).

CONCLUSIONS

These results imply that patients who take analgesics or report constant knee pain, GLAD seems to yield clinically relevant benefits on knee pain when compared to OLP. The results support a stratified recommendation of GLAD as management of knee OA.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03843931. EudraCT number 2019-000809-71.

OP0302 IS INCREASED RISK OF UROLITHIASIS IN AXIAL SPONDYLOARTHRITIS DRIVEN BY GUT INFLAMMATION? RESULTS FROM THE SPARTAKUS COHORT

Background

A nationwide, Swedish study found a doubled urolithiasis risk in ankylosing spondylitis (AS) compared to population controls.[1] Inflammatory bowel disease (IBD) is a known risk factor for urolithiasis, e.g. via enteric hyperoxaluria causing calcium oxalate stones.[2] With microscopic gut inflammation in around 50% of axial spondyloarthritis (axSpA) patients,[3] and overt IBD in 5-10%, gut inflammation may also drive the increased urolithiasis risk in axSpA.

Objectives

To study whether axSpA patients with a history of urolithiasis have an increased prevalence of comorbid IBD or display elevated biomarkers of gut inflammation/pathology.

Methods

AxSpA patients in the population-based SPARTAKUS cohort study in southern Sweden (non-radiographic axSpA [nr-axSpA] n=86, ASAS criteria; AS n=168, modified New York criteria) self-reported their history of prior urolithiasis (no/yes). Faecal (F) calprotectin and ASCA (anti-Saccharomyces cerevisiae antibodies) in serum were measured by commercially available ELISAs (Calpro AS; ORGENTEC Diagnostika). For a subgroup of patients (n=164), presence of gut dysbiosis was also assessed by the GA-Map Dysbiosis Test (Genetic Analysis). Demographics, disease/treatment characteristics, comorbid IBD and the gastrointestinal biomarkers (F-calprotectin/ASCA/dysbiosis) were compared between patients with versus without prior urolithiasis. Finally, the same biomarkers were also compared between patients with versus without urolithiasis history, after exclusion of subjects with known IBD.

Results

Urolithiasis history was reported by 13% (n=33) of the axSpA patients, and comorbid IBD was significantly more common in this group (27% versus 6.8%, p<0.001; Table 1). F-calprotectin levels were also significantly higher among patients with prior urolithiasis, as was presence of gut dysbiosis (Table 1). ASCA seropositivity did not differ between the groups. Moreover, prior urolithiasis was associated with longer disease duration and AS-phenotype. After exclusion of cases with comorbid IBD, urolithiasis history was reported by 10% (24 of 230 patients). F-calprotectin elevation ≥100 mg/kg remained significantly associated with urolithiasis history also in this population, while only being numerically increased when assessed as a continuous variable (p=0.053; Figure 1). Gut dysbiosis also remained associated with prior urolithiasis in the non-IBD population (56% [9 of 16 patients with prior urolithiasis] versus 30% [40 of 132 patients without], p=0.037), whereas ASCA status did not differ between the groups (data not shown).

Table 1.Urolithiasis historyNo, n=221Yes, n=33Male sex115 (52%)23 (70%)Age, years50 (13)59 (12)*Disease duration, years25 (14)31 (14)*AS (versus nr-axSpA)141 (64%)27 (82%)*Inflammatory bowel disease15 (6.8%)9 (27%)*ASAS 3-month NSAID score31 (40)37 (48)Ongoing bDMARD therapy87 (39%)16 (49%)bDMARD therapy ever113 (51%)20 (61%)ASDAS-CRP1.8 (1.0)1.9 (0.8)BASFI2.0 (2.1)2.7 (2.6)BASMI2.9 (1.5)4.3 (2.1)*F-Calprotectin, mg/kg*# Mean (SD)58 (97)115 (176) Median (IQR)29 (49)39 (152)F-Calprotectin ≥100 mg/kg28 (14%)10 (32%)*ASCA IgA ≥10 U/ml12 (5.7%)4 (13%)ASCA IgG ≥10 U/ml45 (21%)10 (33%)Gut dysbiosis†45 (32%)17 (71%)*

Mean (SD) or n (%) if not otherwise stated. † GA-Map Dysbiosis Test, dysbiosis index ≥3. * p<0.05 by Chi2-test or Student t-test, as appropriate. # Log10-transformed values compared. Missing ≤13%, except for gut dysbiosis available in 140/24 patients without/with urolithiasis history.

Conclusion

The current results lend support to the hypothesis that the increased urolithiasis risk in axSpA may be driven by gut inflammation/pathology. Prospective studies are, however, needed to assess the causality.

References

[1]Jakobsen AK, et al. PLoS One. 2014;9:e113602.

[2]Corica D, et al. J Crohns Colitis. 2016;10:226-35.

[3]Van Praet L, et al. Ann Rheum Dis. 2013;72:414-7.

Disclosure of Interests

Johan K Wallman Consultant of: AbbVie, Amgen, Celgene, Eli Lilly, Novartis, Grant/research support from: AbbVie, Amgen, Eli Lilly, Novartis, Pfizer, Elisabeth Mogard Consultant of: Novartis, Jonas Sagard: None declared, Lars Erik Kristensen Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen Pharmaceuticals, Merck Sharp & Dohme, Novartis, Pfizer, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen Pharmaceuticals, Merck Sharp & Dohme, Novartis, Pfizer, UCB Pharma, Elisabet Lindqvist: None declared, Tor Olofsson Consultant of: Eli Lilly, Merck Sharp & Dohme

AB0924 Individual Digit Level Nail Involvement and Joint Assessment in Patients with Nail Psoriasis

Background

The relationship between the evolution of nail disease and the articular features of Psoriatic Arthritis (PsA) is poorly understood. There is a lack of data on the relationship between nail and joint disease, important clinical parameters of disease activity, specifically at the individual digit level.

Objectives

To evaluate the level of association, at digit level, between nail involvement and joint disease at baseline, with a special focus on distal interphalangeal joint (DIP) assessment.

Methods

SPIRIT-H2H (NCT03151551) was a 52 week, multicenter, randomised, open-label, parallel-group, assessor-blinded study evaluating the efficacy and safety of IXE vs ADA in PsA.1 Nail psoriasis was measured using Nail Psoriasis Severity Index (NAPSI). Joint involvement was measured by tender/swollen joint count (TJC/SJC) scores. Here we examine both baseline tenderness and swollenness at the DIP joint, proximal interphalangeal (PIP) joint and metacarpophalangeal (MCP) joint level for each digit and evaluate the level of association between nail involvement (NAPSI>0 vs NAPSI=0) and joint assessment using Chi-square tests and/or Fisher’s exact test where relevant.

Results

Overall, 368 patients (IXE N=191, ADA N=177) out of 566 had a baseline NAPSI >0. The overall level of nail involvement ranged from 52.7% (n=194) (right 5th finger) to 67.9% (n=250) (right 1st finger). When considering a digit-wide assessment of joints (DIP, PIP, and MCP), in general, no clear association was found between NAPSI >0 and joint involvement. However, there was more frequent DIP joint involvement in patients with nail involvement compared to patients without nail involvement. When taking only the DIP joint into account, nail involvement was found to be statistically associated with tenderness and/or swelling at the DIP level (Figure 1), with differences between patients with nail involvement vs. without nail involvement ranging from 7.9% (p=0.023) (right 5th finger) to 19.4% (p<0.001) (left 3rd finger). These differences are mostly driven by tenderness rather than swelling, irrespective of digit. For tenderness, differences (with vs. without nail involvement) ranged from 7.0% (right 2nd finger) to 18.0% (left 3rd finger). Differences due to swelling ranged from 5.0% (left 1st finger) to 12.2% (left 3rd finger).

Figure 1.

Digit level association between nail assessment and DIP joint.

Significant difference between nail involvement and no nail involvement denotated by * (p≤0.05), ** (p≤0.01), *** (p≤0.001). Abbreviation: DIP= Distal interphalangeal joint.

Conclusion

In SPIRIT-H2H, tenderness and/or swelling at the DIP joint was significantly associated with nail involvement in individual digits.

References

[1]Mease et al. Ann Rheum Dis. 2020;79(1):123-31.

Disclosure of Interests

Christopher T. Ritchlin: None declared, Lars Erik Kristensen Speakers bureau: Pfizer, AbbVie, Amgen, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly and Company and Janssen., Consultant of: Pfizer, AbbVie, Amgen, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly and Company and Janssen., Grant/research support from: IIT research grants from Pfizer, AbbVie, UCB, Gilead, Biogen, Novartis, Eli Lilly and Company and Janssen., Bruce Strober Shareholder of: Connect Biopharma, Mindera Health., Speakers bureau: AbbVie, Eli Lilly and Company, Incyte, Janssen, Regeneron, Sanofi-Genzyme., Consultant of: AbbVie, Almirall, Amgen, Arcutis, Arena, Aristea, Asana, Boehringer Ingelheim, Immunic Therapeutics, Bristol-Myers-Squibb, Connect Biopharma, Dermavant, EPI Health, Evelo Biosciences, Janssen, Leo, Eli Lilly, Maruho, Meiji Seika Pharma, Mindera Health, Novartis, Ono, Pfizer, UCB Pharma, Sun Pharma, Regeneron, Sanofi-Genzyme, Union Therapeutics, Ventyxbio, vTv Therapeutics, CorEvitas (formerly Corrona) Psoriasis Registry., Arthur Kavanaugh Consultant of: AbbVie, Amgen, Eli Lilly and Comapny, Pfizer, Novartis, UCB, BMS, Rebecca Bolce Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Jeffrey Lisse Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Jennifer Pustizzi Employee of: Eli Lilly and Company, Najwa Somani Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Christophe Sapin Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Joseph F. Merola Consultant of: Abbvie, Amgen, Bayer, Dermavant, Eli Lilly, Novartis, Janssen, UCB, Celgene, Sanofi-Regeneron, Biogen, Pfizer, and BMS.

AB0750 Back pain and morning stiffness as mediators of tofacitinib treatment effect on fatigue in patients with ankylosing spondylitis: a mediation analysis

Background

Fatigue is a prevalent symptom of ankylosing spondylitis (AS)1 and can contribute to higher levels of disease, disability and poor health-related quality of life.2 Back pain and morning stiffness are also commonly reported symptoms.3 Tofacitinib is an oral Janus kinase inhibitor for the treatment of adult patients (pts) with AS. In randomised studies, pts with active AS treated with tofacitinib experienced greater improvements in fatigue, back pain and morning stiffness at Week 12 and 16 of treatment compared with placebo (PBO).4,5 Treatment of these symptoms is a priority for pts with AS and their healthcare providers, however, the mechanisms underlying the interrelationships between fatigue, back pain, morning stiffness and treatment are unclear.

Objectives

To describe the interrelationships between fatigue, back pain, morning stiffness and tofacitinib treatment in pts with AS, using mediation modelling.

Methods

Data from Phase 2 (NCT01786668)4 and Phase 3 (NCT03502616)5 studies of pts with active AS treated with tofacitinib 5 mg twice daily (BID) or PBO were used. Mediation modelling, a statistical method to assess the extent to which the effect of an independent variable on a dependent variable is indirect, via identified mediators, or direct, capturing all other (unmeasured) effects, was applied.6,7 The initial model included: treatment as the independent binary variable (tofacitinib 5 mg BID vs PBO); fatigue (measured by Functional Assessment of Chronic Illness Therapy-Fatigue) as the dependent variable; mediators included back pain (measured by total back pain/nocturnal spinal pain [numerical rating scale, 0–10]) and morning stiffness (represented by the mean of Bath Ankylosing Spondylitis Disease Activity Index questions 5 and 6).

Results

Pooled data from 370 pts were included in the analysis. The initial model showed that 57.5% (p<0.001) of the tofacitinib treatment effect on fatigue was mediated via back pain and morning stiffness (indirect effect); mediation via morning stiffness alone was 49.7% (p<0.01), and 21.2% (p=0.02) via back pain alone. The effect of treatment attributable to factors other than back pain and morning stiffness (ie, direct effect) was not statistically significant (-28.4%; p=0.33). As a result, the initial model was re-specified to exclude the direct treatment effect on fatigue. In the re-specified model (Figure 1), 44.0% (p<0.0001) of the indirect effect of tofacitinib on fatigue was mediated via back pain and morning stiffness; mediation via morning stiffness alone was 40.0% (p<0.001), and 16.0% (p<0.01) via back pain alone. Analyses of the individual study data gave results generally consistent with those from the pooled data.

Conclusion

Overall, indirect pathways via morning stiffness accounted for ~84% of the effect of tofacitinib treatment on fatigue: (1) treatment affects morning stiffness, which impacts fatigue; and (2) treatment affects morning stiffness, which affects back pain and, ultimately, back pain affects fatigue. The indirect pathway via back pain alone accounted for ~16% of treatment effect on fatigue. These results suggest that in tofacitinib-treated pts with AS, improvements in fatigue are fully mediated through combined treatment effects on morning stiffness and back pain.

References

[1]Schneeberger EE et al. Clin Rheumatol 2015; 34: 497-501.

[2]Connolly D et al. Occup Ther Int 2019; 2019: 3027280.

[3]Braun J. Rheumatology (Oxford) 2018; 57: vi1-vi3.

[4]van der Heijde D et al. Ann Rheum Dis 2017; 76: 1340-1347.

[5]Deodhar A et al. Ann Rheum Dis 2021; 80: 1004-1013.

[6]Richiardi L et al. Int J Epidemiol 2013; 42: 1511-1519.

[7]Cappelleri JC et al. Boca Raton, FL: CRC Press, 2013.

Acknowledgements

Study sponsored by Pfizer Inc. Medical writing support was provided by Robyn Wilson, CMC Connect, and funded by Pfizer Inc.

Disclosure of Interests

Lars Erik Kristensen Speakers bureau: AbbVie, Biogen, Eli Lilly, Galapagos NV, Gilead Sciences, Janssen, Pfizer Inc, Sanofi, UCB, Consultant of: AbbVie, Biogen, Eli Lilly, Galapagos NV, Gilead Sciences, Janssen, Pfizer Inc, Sanofi, UCB, Grant/research support from: AbbVie, Eli Lilly, Pfizer Inc, UCB, Peter C. Taylor Consultant of: AbbVie, BMS, Biogen, Celltrion, Eli Lilly, Fresenius, Galapagos NV, Gilead Sciences, GSK, Janssen, Nordic Pharma, Pfizer Inc, Sanofi, UCB, Grant/research support from: Celgene, Galapagos, Victoria Navarro-Compán Speakers bureau: AbbVie, Janssen, Lilly, MSD, Pfizer Inc, UCB, Consultant of: AbbVie, Janssen, Lilly, Moonlake, MSD, Pfizer Inc, UCB, Grant/research support from: AbbVie, Novartis, Marina Magrey Consultant of: AbbVie, Eli Lilly, Janssen, Novartis, Pfizer Inc, UCB, Grant/research support from: AbbVie, UCB, Joseph C Cappelleri Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Andrew G Bushmakin Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Arne Yndestad Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Oluwaseyi Dina Shareholder of: Pfizer Inc, Employee of: Pfizer Inc.

AB1393 RHEUMABUDDY4.0 LEADING THE PATH TO A PATIENT-DRIVEN ELECTRONIC SUPPORT AND MONITORING TOOL

Background

The use of health apps has become more popular in recent years, but it is still a small and rather unregulated market. Few apps have been designed in collaboration with patients and these mostly address patient reported symptoms. Some clinical registries have already developed patient apps to complete patient-reported outcome measures (PROMs) on smartphones, which normally would have been collected during an outpatient visit and have shown interchangeability. The next step would be providing a patient app offering possibilities not only of individual disease tracking, but to provide automated peer support, health information and behavioural advice.

Objectives

We aimed to further develop and validate RheumaBuddy, a health app for patients with rheumatoid arthritis (RA), from a standard monitoring app to an intelligent health app tailored to the needs of the user that provides transparency to all important stakeholders in Rheumatology care.

Methods

This is an international interdisciplinary project between Austrian and Danish partners funded by the EUREKA program. Rheumatologists, health scientists, digital data experts and patients with RA joined forces in a 4 phase-program, running from 2020 to 2023. Phase 1 continues to develop the app in a co-creation approach in several iterations with patients. Phase 2 concerns developing an automated learning algorithm based on user data to identify patient strata and connect these with helpful non-pharmacological interventions. Phase 3 connects healthcare system data on diagnosis, medication prescription, healthcare facility usage with a large clinical RA database. By that we develop patient pathways that correlate high granularity data with system resources to retrieve results on socioeconomic impact. In phase 4 a randomised clinical trial will evaluate the effect of the developed RB4.0 on clinical disease activity and quality of life.

Results

Currently, RB is regularly being used by more than 3100 patients in 35 countries and 8 languages throughout Europe. The current RheumaBuddy version offers logging of symptoms using Likert scale questions, a joint mannequin to mark painful body parts and a peer-support forum. Additionally, the user can anytime display his/her entries over time in a graphical report and also share data with the healthcare provider. This version is extended with tracking of sleep, working hours and other behaviours. A consultation compass function helps the patient to reflect on goals and issues before the rheumatologist visit.

Within this project, we already established a first version of a Recommender System (RS), which computes correlations between user entries (e.g. between a user’s mood and pain), thus providing individual feedback. Through integration of information obtained from the app with claims data and clinical data from a RA registry, patterns can be identified and translated into different case models that concern the impact of common RA symptoms. By mapping these scenarios with evidence based behaviour and lifestyle advice, the “virtual coach” (advanced RS) will be developed and integrated into the RB4.0 system. During continuous data collection on app users, similarities in user behaviour can be identified, and similar entry patterns can be grouped. This will allow users to exchange and learn from each other regarding certain difficult situations (ex. “life-hack”) etc.

We are creating a comprehensive system in providing feedback to both clinical and psychosocial aspects of coping and disease management, as well as everyday practicalities for living with a chronic disease. Figure 1 displays these aspects, contributing the empowerment of patients.

Figure 1.

RB4.0 shall support people living with RA in dealing with disease impact

Conclusion

RheumaBuddy4.0 will provide RA patients the means to improve their quality of life on an individual level, better understand their needs and therapy which could support overcoming barriers of successful shared decision making to achieve better outcomes.

Disclosure of Interests

Paul Studenic: None declared, Tanja Stamm Speakers bureau: AbbVie, Novartis, Roche, Sanofi, and Takeda, Consultant of: AbbVie and Sanofi Genzyme, Grant/research support from: AbbVie and Roche, Yuki Seidler: None declared, Andreas Dam Speakers bureau: Gilead, Galapagos, BMS, Roche, Takeda, Merck, Consultant of: Gilead, Galapagos, BMS, Roche, Takeda, Merck, Nadine Weibrecht: None declared, Günther Zauner: None declared, Thomas H Jakobsen: None declared, Rebekka L. Hansen: None declared, Nikolas Popper Speakers bureau: Roche, Consultant of: as CSO of dwh GmbH, Tanita-Christina Wilhelmer: None declared, Helga Radner Speakers bureau: Gilead, Merck Sharp, Pfizer, Abbvie, Consultant of: Gilead, Merck Sharp, Pfizer, Abbvie, Romualdo Ramos: None declared, James Rickmann: None declared, Christoph Urach: None declared, Lars Erik Kristensen Speakers bureau: AbbVie, Pfizer Janssen, Novartis, Galapagos, UCB, Biogen and Eli Lilly, Consultant of: AbbVie, Pfizer, Janssen, Novartis, Galapagos, UCB, Biogen and Eli Lilly, Grant/research support from: IIT grants from UCB, Biogen, Eli Lilly, Novartis, Tanja Schjødt Jørgensen Speakers bureau: AbbVie, Pfizer, Roche, Novartis, UCB, Biogen and Eli Lilly, Consultant of: AbbVie, Pfizer, Roche, Novartis, UCB, Biogen and Eli Lilly

AB0879 Interim analysis of baseline characteristics and 12-week outcomes for a subset of patients with moderate-to-severe plaque psoriasis and psoriatic arthritis from the Psoriasis Study of Health Outcomes

Background

Approximately 30% of patients (pts) with plaque psoriasis (PsO) develop psoriatic arthritis (PsA)1, which is associated with high Psoriasis Area and Severity Index (PASI) and nail involvement. The Psoriasis Study of Health Outcomes (PSoHO) is a 3-year (yr), international, prospective, observational cohort study comparing the effectiveness of anti-IL-17A biologics to all other approved biologics in pts with moderate-to-severe PsO.

Objectives

This interim subset analysis describes the baseline characteristics and Week 12 (W12) effectiveness in pts with moderate-to-severe PsO and PsA in PSoHO.

Methods

Adults with moderate-to-severe PsO for ≥6 months who initiated/switched biologic treatment during routine medical care were enrolled. PsA diagnosis was recorded by the dermatologists based on the medical history and/or information provided by the patient. W12 effectiveness was assessed by the proportion of pts achieving almost clear or clear skin defined by ≥90% improvement in PASI, affected Body Surface Area (BSA), Dermatology Life Quality Index (DLQI), and Patient Global Assessment of Disease Severity (PatGA). Musculoskeletal endpoints were not collected. Data were analysed descriptively, using mean (standard deviation [SD]) or median ([Q1/Q3]) for continuous variables and n, % and 95% confidence limits for categorical variables.

Results

Overall, 1981 pts were enrolled in this study, of whom 461 (23.3%) had a PsA diagnosis and received either anti-IL-17A (n=227; 49.2%) or other biologics (n=234; 50.8%). This subset of pts had a mean age of 48.7 yrs and a median disease duration of 18.9 yrs for PsO and 5.6 yrs for PsA (Table 1).

Table 1.

Baseline characteristics for PsO patients with PsA. Mean (SD) reported for all available data for that measure, unless stated otherwise.

Overall (n=461)Anti-IL-17A (n=227)Other Biologics (n=234)Age, yrs48.7 (12.9)50.9 (12.9)46.6 (12.6)Male, n (%)232 (50.3)112 (49.3)120 (51.3)BMI (kg/m2)29.7 (6.2)29.8 (5.9)29.6 (6.4)Smoking status – Current, n (%)100 (25.4)41 (21.1)59 (29.5)Disease duration (PsA), yrs, median (Q1/Q3)5.6(2.2/13.1)5.6(2.0 / 13.8)5.5(2.3 / 12.8)Disease duration (PsO), yrs, median (Q1/Q3)18.9(9.7 / 28.6)18.9(9.2 / 30.3)18.7(10.1 / 27.3)Any previous biologic therapy, n (%)249 (54.0)123 (54.2)126 (53.8)PASI14.3 (9.3)13.6 (8.1)15.0 (10.3)BSA, %21.7 (19.4)19.8 (17.3)23.5 (21.1)mNAPSI16.6 (22.8)16.5 (25.5)16.7 (20.1)Presence of nail PsO, n (%)217 (47.2)103 (45.4)114 (48.9)PatGA3.5 (1.2)3.5 (1.3)3.6 (1.2)DLQI13.6 (7.9)13.4 (7.8)13.7 (8.0)HADS Depression score >10, n (%)73 (19.3)38 (20.5)35 (18.1)HADS Anxiety score >10, n (%)124 (32.8)62 (33.5)62 (32.1)

BMI = Body Mass Index; BSA = Body Surface Area; DLQI = Dermatology Life Quality Index; HADS = Hospital Anxiety and Depression Scale; HADS >10 indicates significant symptoms of depression/anxiety; mNAPSI = Modified Nail Psoriasis Severity Index; PASI = Psoriasis Area and Severity Index; PatGA = Patient Global Assessment of Disease Severity; Q1/Q3 = Quartile 1/3.

At W12, 62.4% and 42.6% of anti-IL-17A-treated pts achieved PASI90 and PASI100, respectively, compared with 34.2% and 16.8% in the other biologics cohort, respectively (Figure 1). BSA <3% was reached by 70.9% of anti-IL-17A-treated pts and 49.5% in the other biologics cohort, while 71.2% and 44.8%, respectively, reached PatGA 0/1. Among pts with baseline DLQI ≥2, 38.0% and 27.1% of the anti-IL-17A and other biologics cohorts, respectively, reached DLQI 0/1.

Figure 1.

Percentage of patients receiving anti-IL-17A or other biologics who achieved PASI75/90/100, absolute PASI ≤1, BSA <3%, PatGA 0/1 and DLQI 0/1 (baseline DLQI ≥2) at Week 12. Bars represent upper 95% confidence limits.

Conclusion

The effectiveness of blocking IL-17A on skin manifestations and on quality-of-life improvements in pts with PsO and PsA in the real-world study was consistent with observations from clinical trials.

References

[1]Zabotti A, et al. RMD Open 2019;5: e001067

Disclosure of Interests

Lars Erik Kristensen Speakers bureau: Pfizer, AbbVie, Amgen, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen pharmaceuticals., Consultant of: Pfizer, AbbVie, Amgen, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen pharmaceuticals., Grant/research support from: IIT research grants from Pfizer, AbbVie, UCB, Gilead, Biogen, Novartis, Eli Lilly, and Janssen pharmaceuticals., Frank Behrens Speakers bureau: Amgen, AbbVie, Pfizer, Roche, Chugai, UCB, BMS, Celgene, MSD, Novartis, Biotest, Janssen, Genzyme, Eli Lilly, Boehringer and Sandoz, Consultant of: Amgen, AbbVie, Pfizer, Roche, Chugai, UCB, BMS, Celgene, MSD, Novartis, Biotest, Janssen, Genzyme, Eli Lilly, Boehringer and Sandoz, Grant/research support from: AbbVie, Pfizer, Roche, Chugai, GSK and Janssen, Luis Puig Speakers bureau: Celgene, Janssen, Eli Lilly, Novartis, Pfizer, Consultant of: Abbvie, Almirall, Amgen, Baxalta, Biogen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Fresenius-Kabi, Janssen, JS BIOCAD, Leo-Pharma, Eli Lilly, Mylan, Novartis, Pfizer, Regeneron, Roche, Sandoz, Samsung-Bioepis, Sanofi, UCB, Grant/research support from: Abbvie, Almirall, Amgen, Boehringer Ingelheim, Celgene, Janssen, Leo-Pharma, Eli Lilly, Novartis, Pfizer, Regeneron, Roche, Sanofi, UCB, Adam Reich Speakers bureau: Abbvie, Novartis, Janssen, Pfizer, Sandoz, Galderma, Eli Lilly, Consultant of: Abbvie, Novartis, Janssen, Pfizer, Sandoz, Galderma, Eli Lilly, Thorsten Holzkaemper Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Alan Brnabic Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Khai Ng Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Soyi Liu Leage Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Christopher Schuster Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Andreas Pinter Speakers bureau: AbbVie, Almirall-Hermal, Amgen, Biogen Idec, Biontec, Boehringer-Ingelheim, Celgene, GSK, Eli Lilly, Galderma, Hexal, Janssen, LEO-Pharma, MC2, Medac, Merck Serono, Mitsubishi, MSD, Novartis, Pascoe, Pfizer, Tigercat Pharma, Regeneron, Roche, Sandoz Biopharmaceuticals, Sanofi-Genzyme, Schering-Plough and UCB Pharma, Consultant of: AbbVie, Almirall-Hermal, Amgen, Biogen Idec, Biontec, Boehringer-Ingelheim, Celgene, GSK, Eli Lilly, Galderma, Hexal, Janssen, LEO-Pharma, MC2, Medac, Merck Serono, Mitsubishi, MSD, Novartis, Pascoe, Pfizer, Tigercat Pharma, Regeneron, Roche, Sandoz Biopharmaceuticals, Sanofi-Genzyme, Schering-Plough and UCB Pharma

POS1024 EFFICACY AND SAFETY OF RISANKIZUMAB (RZB) FOR ACTIVE PSORIATIC ARTHRITIS (PsA): 52-WEEK RESULTS FROM KEEPsAKE 1

Background

RZB, a humanized immunoglobulin G1 monoclonal antibody that specifically inhibits the p19 subunit of the human cytokine IL-23, is being investigated as a treatment for PsA.

Objectives

To compare efficacy and safety of RZB vs. placebo (PBO) in patients with PsA who had an inadequate response or intolerance to conventional synthetic disease modifying antirheumatic drug (csDMARD-IR).

Methods

KEEPsAKE 1 (NCT03675308) is an ongoing, phase 3 study that includes a screening period; a 24-week double-blinded, placebo-controlled, parallel-group period (period 1); and an open-label extension period (period 2). Eligible patients aged ≥18 years with active PsA (symptom onset ≥6 months prior to screening, meeting the Classification Criteria for PsA [CASPAR], and ≥5 swollen and ≥5 tender joints) and who had an inadequate response or intolerance to ≥1 csDMARD-IR, were randomized 1:1 to receive RZB 150 mg or placebo (PBO) at weeks 0, 4, and 16. The primary endpoint was the proportion of patients achieving ≥20% improvement in American College of Rheumatology (ACR20) response at week 24. Period 2 started at week 24, and patients were switched to receive open-label RZB 150 mg every 12 weeks through week 208. Mixed-effect model repeated measures and nonresponder imputation methods were used to assess continuous and binary variables, respectively. Efficacy and safety were analyzed in all patients who received ≥1 dose of study drug through week 52. Treatment-emergent adverse events (TEAE) were summarized using exposure-adjusted event rates (EAERs, events/100 patient-years [PY]).

Results

At week 24, a greater proportion of RZB-treated (N=483) vs PBO-treated (N=481) patients achieved ACR20 (55.3% and 32.8%, respectively). At week 52, 70% of patients who were randomized to receive RZB and 63% of patients who were randomized to receive PBO and switch to RZB at week 24 achieved ACR20. In patients with ≥3% of body surface area affected at baseline, 52.7% of RZB-treated patients (N=273) and 9.9% of PBO-treated patients (N=272) achieved ≥90% improvement in Psoriasis Area and Severity Index (PASI 90) at week 24; 67.8% who were randomized to receive RZB and 59.9% who were randomized to receive PBO and switch to RZB at week 24 achieved PASI 90 at week 52. Similar results were observed for other efficacy measures. RZB was well tolerated through 52 weeks of treatment. EAERs of adverse events were stable between weeks 24 and 52. At the week 52 data cut-off (19 April 2021), the total EAER of any TEAE in patients receiving RZB was 143.1/100 PY.

Conclusion

Continuous RZB treatment provided durable efficacy and a consistent safety profile through 52 weeks of treatment in patients with active PsA who were csDMARD-IR.

Acknowledgements

AbbVie, Inc. participated in the study design; study research; collection, analysis, and interpretation of data. AbbVie funded the research for this study. Medical writing assistance, funded by AbbVie, was provided by Jay Parekh, PharmD, of JB Ashtin.

Disclosure of Interests

Lars Erik Kristensen Speakers bureau: AbbVie, Amgen, Biogen, Bristol Myers Squibb, Gilead, Janssen, Lilly, Merck, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Amgen, Biogen, Bristol Myers Squibb, Gilead, Janssen, Lilly, Merck, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Biogen, Gilead, Janssen, Lilly, Novartis, Pfizer, and UCB, MAURO KEISERMAN Speakers bureau: AbbVie, Amgen, Bristol Myers Squibb, Celgene, GlaxoSmithKline, Janssen, Novartis, Pfizer, Roche, and UCB, Consultant of: AbbVie, Amgen, Bristol Myers Squibb, Celgene, GlaxoSmithKline, Janssen, Novartis, Pfizer, Roche, and UCB, Grant/research support from: AbbVie, Amgen, Bristol Myers Squibb, Celgene, GlaxoSmithKline, Janssen, Novartis, Pfizer, Roche, and UCB, Kim Papp Speakers bureau: AbbVie, Amgen, Arcutis, Astellas, Bausch Health, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Dermavant, Dermira, Incyte, Janssen, LEO Pharma, Lilly, Novartis, Pfizer, Sandoz, Sanofi Genzyme, and UCB, Consultant of: AbbVie, Amgen, Arcutis, Astellas, Bausch Health, Baxalta, Baxter, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Coherus, Dermavant, Dermira, EMD Serono, Forward Pharma, Galderma, Genentech, Gilead, Incyte, Janssen, LEO Pharma, Lilly, Meiji Seika Pharma, Merck, Mitsubishi Tanabe Pharma, Novartis, Pfizer, Regeneron, Sandoz, Sanofi Genzyme, Stiefel, Sun Pharma, Takeda, and UCB, Grant/research support from: AbbVie, Amgen, Arcutis, Astellas, Bausch Health, Baxalta, Baxter, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Coherus, Dermavant, Dermira, EMD Serono, Forward Pharma, Galderma, Genentech, Gilead, Incyte, Janssen, LEO Pharma, Lilly, Merck, Novartis, Ortho Dermatologics, Pfizer, Regeneron, Sanofi Genzyme, Sun Pharma, and UCB, Leslie McCasland Consultant of: Lilly, Douglas White Speakers bureau: AbbVie and Novartis, Consultant of: AbbVie and Novartis, Wenjing Lu Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Ahmed M. Soliman Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Ann Eldred Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Lisa Barcomb Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Frank Behrens Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Celgene, Chugai, Galapagos, Genzyme, Gilead, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, and Sanofi, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Celgene, Chugai, Galapagos, Genzyme, Gilead, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, and Sanofi, Grant/research support from: AbbVie, Amgen, Boehringer Ingelheim, Celgene, Chugai, Galapagos, Genzyme, Gilead, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, and Sanofi

POS1042 IMPACT OF RISANKIZUMAB ON IMPROVING HEALTH-RELATED QUALITY OF LIFE, WORK PRODUCTIVITY, AND REDUCING FATIGUE AMONG PATIENTS WITH ACTIVE PSORIATIC ARTHRITIS: A POOLED ANALYSIS OF TWO PHASE 3 CLINICAL TRIALS

Background

Risankizumab (RZB) has been approved in the UK and Europe for the treatment of adults with active PsA. Patient-reported outcomes (PROs) are important tools for understanding a therapy’s efficacy from the patient’s perspective.

Objectives

This study evaluated the impact of RZB versus placebo on health-related quality of life (HRQoL), fatigue, and work productivity in patients with psoriatic arthritis (PsA) and inadequate response to 1 or 2 biologics and/or ≥1 conventional synthetic DMARDs in two Phase 3 trials (KEEPsAKE 1&2).

Methods

Eligible patients with active PsA (n=1402) were randomized (1:1) to receive risankizumab 150 mg (n=706) or placebo (n=696). Patient-reported outcomes assessed were 36-Item Short-Form Health Survey (SF-36), Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT-Fatigue), EQ-5D-5L, and Work Productivity and Activity Impairment–PsA questionnaire. Least squares (LS) mean changes from baseline at Week 24 were compared between risankizumab versus placebo by mixed-effects repeated regression modeling.

Results

At Week 24, risankizumab- versus placebo-treated patients reported greater improvements in LS mean changes with between-group differences (all nominal P<0.001) in SF-36 physical component score (mean difference=3.5, 95% confidence interval [CI] 2.7, 4.2) and mental component score (mean difference=1.8, 95% CI 0.9, 2.6), FACIT-Fatigue (mean difference=2.5, 95% CI 1.5, 3.4), EQ-5D-5L index score (mean=0.07, 95% CI 0.05, 0.09), and EQ-5D-5L visual analogue scale score (mean difference=5.8, 95% CI 3.6, 8.0). In addition, risankizumab- versus placebo-treated patients reported greater reductions with between-group differences (all nominal P<0.001) in overall work impairment (mean difference= −8.9%, 95% CI −13.1, −4.7), activity impairment (mean difference= −7.7%, 95% CI −10.3, −5.2), and presenteeism (mean difference= −9.8%, 95% CI −13.3, −6.3).

Conclusion

Compared to placebo, risankizumab resulted in greater improvements in HRQoL, fatigue, and work productivity among patients with PsA.

Acknowledgements

This work/study was funded by AbbVie Inc. AbbVie participated in the study design, research, data collection, analysis and interpretation of data. No honoraria or payments were made for authorship. Medical writing services provided by Natalie Mitchell of Fishawack Facilitate Ltd, part of Fishawack Health, and funded by AbbVie.

Disclosure of Interests

Lars Erik Kristensen Speakers bureau: AbbVie, Amgen, Biogen, Bristol Myers Squibb, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer, and UCB; and received research grants from AbbVie, Biogen, Eli Lilly, Janssen Pharmaceutical, Novartis, Pfizer, and UCB., Consultant of: AbbVie, Amgen, Biogen, Bristol Myers Squibb, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer, and UCB; and received research grants from AbbVie, Biogen, Eli Lilly, Janssen Pharmaceutical, Novartis, Pfizer, and UCB., Ahmed M. Soliman Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Kim Papp Speakers bureau: AbbVie, Amgen, Astellas, Baxalta, Baxter, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Coherus, Dermira, Eli Lilly, Forward Pharma, Galderma, Genentech, GlaxoSmithKline, Janssen, Kyowa-Hakko Kirin, LEO Pharma, MedImmune, Merck-Serono, Merck Sharp & Dohme, Novartis, Pfizer, Regeneron, Roche, Sanofi-Genzyme, Stiefel, Sun Pharma, Takeda, UCB, and Valeant., Consultant of: AbbVie, Amgen, Astellas, Baxalta, Baxter, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Coherus, Dermira, Eli Lilly, Forward Pharma, Galderma, Genentech, GlaxoSmithKline, Janssen, Kyowa-Hakko Kirin, LEO Pharma, MedImmune, Merck-Serono, Merck Sharp & Dohme, Novartis, Pfizer, Regeneron, Roche, Sanofi-Genzyme, Stiefel, Sun Pharma, Takeda, UCB, and Valeant., Grant/research support from: AbbVie, Amgen, Astellas, Baxalta, Baxter, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Coherus, Dermira, Eli Lilly, Forward Pharma, Galderma, Genentech, GlaxoSmithKline, Janssen, Kyowa-Hakko Kirin, LEO Pharma, MedImmune, Merck-Serono, Merck Sharp & Dohme, Novartis, Pfizer, Regeneron, Roche, Sanofi-Genzyme, Stiefel, Sun Pharma, Takeda, UCB, and Valeant., Lisa Barcomb Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Ann Eldred Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Zailong Wang Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Douglas White Speakers bureau: AbbVie, Novartis, and Roche., Consultant of: AbbVie, Novartis, and Roche., Frank Behrens Speakers bureau: AbbVie, Amgen, BMS, Boehringer, Celgene, Chugai, Genzyme, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, Sandoz, and UCB, Consultant of: AbbVie, Amgen, BMS, Boehringer, Celgene, Chugai, Genzyme, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, Sandoz, and UCB, Grant/research support from: AbbVie, Chugai, Janssen, Pfizer, and Roche

AB0897 Impact of risankizumab on improving symptoms and health-related quality of life and reducing fatigue and pain among psoriatic arthritis patients with moderate-to-severe skin involvement: Evidence from two Phase III trials

Background

Psoriatic arthritis (PsA) greatly affects patient-reported health-related quality of life (HRQoL).

Objectives

To assess the impact of risankizumab (RZB) on patient-reported outcomes (PROs) in patients with high skin burden using integrated efficacy data from two Phase III clinical trials (KEEPsAKE-1 and KEEPsAKE-2).

Methods

Adult patients with PsA with inadequate response or intolerance to disease-modifying antirheumatic drugs were randomized 1:1 to receive RZB (150 mg) or placebo (PBO). Improvement from baseline in PROs (Patient’s Global Assessment of Disease Activity [PtGA] by visual analog scale [VAS], Short-Form 36 Health Questionnaire physical and mental component summary scores [SF-36 PCS and MCS], Health Assessment Questionnaire – Disability Index [HAQ-DI], EQ-5D 5-Level questionnaire [EQ-5D-5L] index and by VAS, Functional Assessment of Chronic Illness Therapy – Fatigue [FACIT-Fatigue], and pain by VAS) were assessed at Week 24 in patients with high skin burden (body surface area involvement ≥3% and Psoriasis Area Severity Index >10). Least squares mean (LSM) difference (95% confidence interval [CI]) between RZB and PBO groups based on mixed-model repeated measures regression is reported.

Results

RZB- vs PBO-treated patients demonstrated greater improvements in PROs with notable LSM differences (95% CI) between groups (P<0.01) in PtGA (-18.7 [-25.1, -12.2]), SF-36 PCS (6.3 [4.2, 8.4]) and MCS (4.4 [2.3, 6.6]), HAQ-DI (-0.4 [-0.5, -0.3]), EQ-5D-5L index (0.1 [0.1, 0.2]) and VAS (8.2 [2.5,13.9]), FACIT-Fatigue (4.9 [2.7, 7.2]), and pain (-18.9 [-25.1, -12.7]).

Conclusion

In patients with PsA with high skin burden, 24 weeks of RZB treatment, as compared with PBO, improved patients’ HRQoL, including fatigue and pain.

Acknowledgements

AbbVie funded the study and participated in interpretation of data, review, and approval of the abstract. No honoraria or payments were made for authorship. Medical writing services were provided by Samantha Francis Stuart (Fishawack Facilitate Ltd) and funded by AbbVie.

Disclosure of Interests

Kim Papp Speakers bureau: AbbVie, Akros, Amgen, Anacor Pharmaceuticals, Arcutis Biotherapeutics, Astellas, Avillion, Bausch Health, Baxalta, Boehringer Ingelheim, Bristol Myers Squibb, Can-Fite Biopharma, Celgene, Coherus BioSciences, Dermavant, Dermira, Dice Pharmaceuticals, Dow Pharma, Eli Lilly, Evelo Biosciences, Galapagos NV, Galderma, Gilead, GlaxoSmithKline, Incyte, Janssen, Kyowa-Hakko Kirin, LEO Pharma, MedImmune, Meiji Seika Pharma, Merck-Serono, Merck Sharp & Dohme, Mitsubishi Pharma, Novartis, Pfizer, PRCL Research, Regeneron, Roche, Sanofi-Genzyme, Sun Pharma, Takeda, UCB, and Xencor., Consultant of: AbbVie, Akros, Amgen, Anacor Pharmaceuticals, Arcutis Biotherapeutics, Astellas, Avillion, Bausch Health, Baxalta, Boehringer Ingelheim, Bristol Myers Squibb, Can-Fite Biopharma, Celgene, Coherus BioSciences, Dermavant, Dermira, Dice Pharmaceuticals, Dow Pharma, Eli Lilly, Evelo Biosciences, Galapagos NV, Galderma, Gilead, GlaxoSmithKline, Incyte, Janssen, Kyowa-Hakko Kirin, LEO Pharma, MedImmune, Meiji Seika Pharma, Merck-Serono, Merck Sharp & Dohme, Mitsubishi Pharma, Novartis, Pfizer, PRCL Research, Regeneron, Roche, Sanofi-Genzyme, Sun Pharma, Takeda, UCB, and Xencor., Grant/research support from: AbbVie, Akros, Amgen, Anacor Pharmaceuticals, Arcutis Biotherapeutics, Astellas, Avillion, Bausch Health, Baxalta, Boehringer Ingelheim, Bristol Myers Squibb, Can-Fite Biopharma, Celgene, Coherus BioSciences, Dermavant, Dermira, Dice Pharmaceuticals, Dow Pharma, Eli Lilly, Evelo Biosciences, Galapagos NV, Galderma, Gilead, GlaxoSmithKline, Incyte, Janssen, Kyowa-Hakko Kirin, LEO Pharma, MedImmune, Meiji Seika Pharma, Merck-Serono, Merck Sharp & Dohme, Mitsubishi Pharma, Novartis, Pfizer, PRCL Research, Regeneron, Roche, Sanofi-Genzyme, Sun Pharma, Takeda, UCB, and Xencor., Ahmed M. Soliman Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Christian Kaufmann Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Lisa Barcomb Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Zailong Wang Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Douglas White Speakers bureau: AbbVie and Novartis., Consultant of: AbbVie and Novartis., Andrew Ostor Speakers bureau: BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Eli Lilly, and Novartis., Consultant of: BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Eli Lilly, and Novartis., Grant/research support from: BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Eli Lilly, and Novartis., Lars Erik Kristensen Speakers bureau: Pfizer, AbbVie, Amgen, Forward Pharma, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen, Consultant of: Pfizer, AbbVie, Amgen, Forward Pharma, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen, Grant/research support from: UCB, Novartis, Pfizer, Eli Lilly, Biogen, AbbVie, and Janssen Pharmaceuticals and UCB.

POS0955 PATIENTS’ PERSPECTIVES ON DISEASE- AND TREATMENT-RELATED ISSUES ARE ESSENTIAL FOR TREATMENT SUCCESS IN PATIENTS WITH SPONDYLOARTHRITIS AND ASSOCIATED DISEASES: A QUALITATIVE CLINICAL CONCEPT MAPPING STUDY

Background

Each patient’s way of living with and relating to their chronic disease is unique. However, patients with chronic diseases may have some mutual concerns and challenges. They must not only handle the disease itself, but also the consequences that the disease has for their everyday and emotional lives1.

Exploring the patient’s perspectives for significant factors of relevance for patients living with a chronic disease is important in order to discover unmet needs and challenges for complying with a comprehensive lifelong treatment strategy and ensuring high-quality lives. Increasing awareness about the possible discrepancy between doctor experienced quality in care and patient experienced quality in care is of high relevance when aiming to ensure optimal disease management.

Objectives

The objective of this study was to explore disease- and treatment-related issues and concerns experienced by adult patients with spondyloarhtritis (SpA) and associated diseases; psoriatic arthritis (PsA), psoriasis (PsO), axial spondyloarthritis (axSpA), and inflammatory bowel disease (IBD; Crohn’s disease (CD) and ulcerative colitis (UC)), and whether these factors were generic or disease dependent.

Methods

Concept Mapping were used to identify and organize disease- and treatment-related issues and concerns2. Concept Mapping is a formal group process with a structured approach to identify ideas on a topic of interest and organize them into cogent domains. Participants were asked to respond to an initial task: ‘Thinking as broadly as you can, please list your thoughts (issues and concerns) related to your disease”, PsA, PsO, axSpA, CD or UC, respectively.

Data were obtained through a nominal group technique and then organized using participants’ themes, multidimensional scaling, cluster analysis, participant validation, and thematic analyses to generate a conceptual model of disease- and treatment related issues and concerns experienced by patients with PsA, PsO, axSpA, CD, and UC.

Results

Seven AxSpA patients, 8 PsA patients, 9 PsO patients, 13 CD patients, and 13 UC patients contributed to generating the conceptual models. Seven AxSpA clusters, 7 PsA clusters, 7 PsO clusters, 10 CD clusters, and 11 UC clusters with each cluster having sub-clusters, emerged from the workshops producing 137 AxSpA statements, 160 PsA statements, 187 PsO statements, 335 CD statements, and 408 UC statements. Some clusters were generic: ‘Concerns about the disease and the future’, ‘Consequences of the disease’, ‘Acceptance of the disease’, ‘Medication and treatment’, and ‘At the doctor’ (Figure 1). Specific clusters were: for AxSpA: ‘Use of public services, for PsA: ‘Difficult to have an invisible disease’, for PsO: ‘Ashamed (about appearance)’, for CD: ‘Speculations and thoughts; life now and in the future - can I expect more surgeries in the future?’, and for UC: ‘The influence and importance of the diet’ and (Figure 1).

Figure 1.

Conclusion

Patients with SpA and associated diseases largely agree on which concepts describe their disease- and treatment-related issues and concerns with a few of them being disease-dependent.

Living a good life with a chronic disease is much more than having clinical control of the disease. This study gives insight to patients’ perspectives on themes that are essential when living with a chronic disease. Considering the patients’ perspectives, it is necessary to promote patient empowerment and adherence to treatment, and thereby optimize disease management and quality of life.

References

[1]Van Houtum L, Rijken M, Groenewegen P. Do everyday problems of people with chronic illness interfere with their disease management? Chronic Disease epidemiology. BMC Public Health [Internet]. 2015;15(1):1–9.

[2]Trochim W, Kane M. Concept mapping: An introduction to structured conceptualization in health care. Int J Qual Heal Care. 2005;17(3):187–91.

Acknowledgements

We would like to thank all the participants who generously shared their experiences and valuable knowledge concerning life with a chronic disease.

Disclosure of Interests

Zara Rebecca Stisen: None declared, Marie Skougaard Grant/research support from: M. Skougaard has received research funding from Eli Lilly and Pfizer that is unrelated to the current abstract., Rebekka L. Hansen: None declared, Katrine Risager Christensen Grant/research support from: K.R. Christensen has participated in advisory board for Gilead Nordic and received unrestricted grants from Pfizer and Gilead Nordics, Lars Erik Kristensen Speakers bureau: Pfizer, AbbVie, Amgen, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen pharmaceuticals, Consultant of: Pfizer, AbbVie, Amgen, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen pharmaceuticals., Tanja Schjødt Jørgensen Speakers bureau: AbbVie, Pfizer, Roche, Novartis, UCB, Biogen and Eli Lilly, Consultant of: AbbVie, Pfizer, Roche, Novartis, UCB, Biogen and Eli Lilly.

POS0182 WHO ARE LIKELY TO BENEFIT FROM THE GOOD LIFE WITH OSTEOARTHRITIS IN DENMARK (GLAD) EXERCISE AND EDUCATION PROGRAM? AN EFFECT MODIFIER ANALYSIS OF A RANDOMISED CONTROLLED TRIAL

Background

EULAR clinical guidelines have identified moderators of knee osteoarthritis (OA) outcomes as an important research priority to optimize individualized treatment. In our recent trial the GLAD exercise and education program was proved equivalent to open-label placebo (OLP) in 206 people with knee OA, which calls for evaluation of factors that may predict differential treatment response to GLAD versus OLP.

Objectives

To identify contextual factors that might modify the treatment effect of the ‘Good Life with osteoArthritis in Denmark’ (GLAD) exercise and education programme on knee osteoarthritis (OA) pain compared to that of open-label placebo (OLP) in individuals with knee OA, i.e. explore who are likely to benefit from participating in exercise and education programs.

Methods

Secondary effect modifier analysis of a randomised controlled trial, in which 206 adults aged ≥ 50 years, with symptomatic and radiographic knee OA were randomised to either an 8-week exercise and education programme (GLAD; n=102) or OLP in the form of 4 intra-articular saline injections over 8 weeks (n=104). Primary outcome was change from baseline to week 9 in the Knee injury and Osteoarthritis Outcome Score questionnaire (KOOS) pain subscale (range 0 (worst) to 100 (best)). Subgroups were created based on baseline information: BMI, swollen study knee, bilateral radiographic knee OA, sports participation as a young adult, sex, median age, a priori treatment preference, regular use of analgesics (NSAIDs or paracetamol), radiographic disease severity, and presence of constant and intermittent pain using the Intermittent and Constant Osteoarthritis Pain questionnaire. Analyses were based on the intention-to-treat principle with simple conservative non-responder imputation of missing outcome data.

Results

Participants who at baseline reported use of analgesics at baseline seem to benefit from the GLAD programme over OLP (subgroup contrast: 10.3 KOOS pain points (95% CI 3.0 to 17.6)). Further, participants with constant pain at baseline also seem to benefit from GLAD over OLP (subgroup contrast: 10.0 KOOS pain points (95%CI 2.8 to 17.2; P=0.007)). Further, a priori preference for GLAD also seemed to predict treatment effect in favour of GLAD. Presence of intermittent pain predicted beneficial effects of OLP, albeit the precision of the estimate was low. See Figure 1.

Figure 1.

Forest plot showing the results of the subgroup analyses based on the intention-to-treat population with missing outcome data at week 9 replaced with the baseline observation (non-responder imputation). The outcome is change from baseline in KOOS pain at week 9 (after 8 weeks of intervention). GLAD: The Good Life with osteoArthritis in Denmark exercise and education programme. OLP: Open-label placebo consisting of 4 intra-articular saline injections. K-L: Kellgren-Lawrence grading of radiographic disease severity.

The full vertical line indicates the overall treatment effect, and the dashed line indicates zero effect. *24 GLAD and 26 OLP had no preference and are not included in the analyses, and 8 GLAD and 5 OLP had missing data; †For study knee.

Conclusion

These results imply that GLAD should not be considered as a one-size-fits-all intervention. For patients who take analgesics for their knee pain or report constant knee pain, GLAD seems to yield clinically relevant benefits when compared to an open-label placebo. The results support a stratified recommendation of GLAD as management of knee OA.

Disclosure of Interests

None declared

POS1018 DRUG SURVIVAL AND TREATMENT RESPONSE RATES IN PSORIATIC ARTHRITIS PATIENTS SWITCHING TO FIRST- OR SECOND-LINE IL-17 INHIBITOR TREATMENT: A DANISH POPULATION-BASED COHORT STUDY

Background

Psoriatic arthritis (PsA) is a seronegative spondyloarthropathy associated with psoriasis [1]. It is defined as a multifaceted chronic inflammatory disease with chronic peripheral and/or axial arthritis, enthesopathy and dactylitis. PsA patients also experience fatigue, decreased physical functions and sleep disturbances, which may result in impaired social activity and decreased work productivity [2, 3]. All of these disease associated symptoms can cause substantial functional and mental impairment and thereby result in decreased quality of life [4-5]. Patient impacting factors are important when trying to further understand the disease and when choosing a treatment option to properly manage the symptoms of PsA [2].

Objectives

The objective of this study was to assess the effectiveness of switching to a first- or second-line IL-17 inhibitor treatment in patients with PsA from 2014 to 2021, using data from the Danish Rheumatology registry (DANBIO) by investigating drug survival and treatment response rates.

Methods

PsA patients recorded in DANBIO who switched to a first- or second-line IL-17 inhibitor treatment from a previous biologic disease-modifying antirheumatic drugs (bDMARD) between 2014 and 2021 were included in this study. Baseline characteristics were analyzed in subgroups: first-line IL-17 inhibitor treatment and second-line IL-17 inhibitor treatment and presented as median and interquartile ranges or number and percentage. Visual analog scale (VAS) fatigue 50% improvement and VAS pain 50% improvement, Disease Activity Scores-28 C-reactive protein (DAS-28-CRP) remission and ΔDAS28 scores at 6- and 12-months follow-up was reported. Drug survival of first- or second-line IL-17 inhibitor treatment was reported as a Kaplan Meier plot.

Results

583 patients were identified and included in the study. Baseline characteristics (Table 1) showed that the age, percentage of females, CRP, HAQ, VAS patient pain, VAS global and DAS28CRP in both first- and second-line IL-17 inhibitor treatment was comparable. First- and second-line IL-17 inhibitor treatment had almost identical drug survival (Figure 1).

Table 1.First-line IL-17 inhibitor n= 434Second-line IL-17 inhibitor n= 97Age, years51.0 (49.6-52.3)51.9 (46.4-54.7)Female, % (n)59.0 (256)53.6 (52)Disease duration, years6.8 (6.1-7.8)8.2 (6.5-12.6)CRP, mg/dl4.0 (4.0-5.2)3.0 (2.9-5.3)HAQ1.1 (1.1-1.3)1.0 (0.9-1.3)VAS pain, 100 mm68 (65-72)73 (66-76)VAS global, 100 mm75 (73-78)80 (75-88)DAS28-CRP4.0 (3.8-4.1)4.2 (3.7-4.6)Previous bDMARD2.0 (1.0-3.0)4.0 (2.0-5.5)

CRP: C-reactive protein, HAQ: Health Assessment Questionnaire, VAS: Visual analog scale, DAS28: 28-joint Disease Activity Score, DMARD: disease-modifying antirheumatic drug.

Figure 1.

Conclusion

PsA patients switching to a first- or second-line IL-17 inhibitor showed comparable baseline characteristics and an almost identical drug survival. Thus, treatment failure of a first-line IL-17 inhibitor treatment, should not block for a second-line IL-17 inhibitor treatment.

References

[1]Ritchlin, C.T., R.A. Colbert, and D.D. Gladman, Psoriatic Arthritis. N Engl J Med, 2017. 376(21): p. 2095-6.

[2]Ogdie, A., L.C. Coates, and D.D. Gladman, Treatment guidelines in psoriatic arthritis. Rheumatology (Oxford), 2020. 59(Suppl 1): p. i37-i46.

[3]Orbai, A.M., et al., International patient and physician consensus on a psoriatic arthritis core outcome set for clinical trials. Ann Rheum Dis, 2017. 76(4): p. 673-680.

[4]Kristensen, L.E., et al., Effectiveness and Feasibility Associated with Switching to a Second or Third TNF Inhibitor in Patients with Psoriatic Arthritis: A Cohort Study from Southern Sweden. J Rheumatol, 2016. 43(1): p. 81-7.

[5]Jørgensen, T.S., et al., Relation Between Fatigue and ACR Response in Patients With Psoriatic Arthritis Treated With Tumor Necrosis Factor Inhibitor Therapy: A Population-based Cohort Study. J Rheumatol, 2020.

Disclosure of Interests

Rebekka L. Hansen: None declared, Tanja Schjødt Jørgensen Speakers bureau: AbbVie, Pfizer, Roche, Novartis, UCB, Biogen and Eli Lilly, Consultant of: AbbVie, Pfizer, Roche, Novartis, UCB, Biogen and Eli Lilly, Alexander Egeberg Speakers bureau: AbbVie, Almirall, Leo Pharma, Samsung Bioepis Co., Ltd., Pfizer, Eli Lilly and Company, Novartis, Galderma, Dermavant, UCB, Mylan, Bristol-Myers Squibb, and Janssen Pharmaceuticals, Consultant of: AbbVie, Almirall, Leo Pharma, Samsung Bioepis Co., Ltd., Pfizer, Eli Lilly and Company, Novartis, Galderma, Dermavant, UCB, Mylan, Bristol-Myers Squibb, and Janssen Pharmaceuticals, Grant/research support from: Pfizer, Eli Lilly, Novartis, AbbVie, Janssen Pharmaceuticals, the Danish National Psoriasis Foundation, the Simon Spies Foundation, and the Kgl Hofbundtmager Aage Bang Foundation, Nana Lippert Rosenoe: None declared, Marie Skougaard Grant/research support from: Eli Lilly and Pfizer, Zara Rebecca Stisen: None declared, Lene Dreyer Speakers bureau: MSD, UCB and Janssen Pharmaceuticals, Consultant of: MSD, UCB and Janssen Pharmaceuticals, Lars Erik Kristensen Speakers bureau: Pfizer, AbbVie, Amgen, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen pharmaceuticals, Consultant of: Pfizer, AbbVie, Amgen, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen pharmaceuticals

POS1470-HPR KNOWING WHAT TO DO WITH THE DATA - A QUALITATIVE STUDY ON CHALLENGES OF USING SMARTPHONE-BASED ePROs IN RHEUMATOID ARTHRITIS

Background

Using patient-reported outcomes (PROs) has a long tradition in rheumatology, and PRO measurement is included in many composite indices evaluating disease progression and treatment response [1]. However, little is known about patients´ and health professionals´ (HPs) perceptions of using digitally collected PROs, the so-called ePROs, with a personal smartphone app.

Objectives

To identify main challenges in utilising ePROs for management and treatment of rheumatoid arthritis from patients’ and HPs’ perspectives.

Methods

We interviewed 25 people with rheumatoid arthritis (RA) and 17 HPs (nurses, rheumatologists, and physiotherapists) from Austria and Denmark. We used the RheumaBuddy app as a practical example to illustrate the digital data collection and the feedback that patients would get from entering their self-reported outcomes. Interviews were recorded and transcribed. We applied a qualitative thematic analysis to identify major themes using a procedure of rigorous coding. Analysis was done by two researchers, and conflicts were solved by consensus. Ethical approval was obtained in both countries.

Results

Three main themes emerged: 1) Being simple yet comprehensive; 2) Resources to interpret, use and act upon the collected data; and 3) Being reminded of the disease. Within the first theme, many valued the intuitiveness and simplicity of ePROs, especially when used as a monitoring tool in between clinical visits. HPs were concerned about not to overwhelm the patients with too many questions. On the other hand, the short ePROs asked in the app were not comprehensive enough to capture psychosocial and lifestyle aspects of the disease which were considered important both by patients and HPs. Within the second theme, patients and HPs expressed that ePROs could be the basis for shared decision making. Nevertheless, some patients had clearer ideas on making use of the feedback they could get from their self-reported data than the others. Participants from Denmark, who experienced a higher level of digital health maturity in official institutions, expressed more proactive use of the data than participants from Austria who were on average younger than their Danish counterparts. One patient in Austria even asserted having no idea what to do with the collected data but believed that the “doctor will make good use of it”. HPs in both countries, however, indicated that they needed more resources, skills, and time to make sense of the ePRO data and act accordingly. Under the third theme, patients considered the collection of ePROs to be very important when pain and disease activity were high. HPs, on the other hand, were more concerned that the regular collection of ePROs might constantly remind patients that they are living with the disease.

Conclusion

The potential adoption of ePROs in practice depends on both patients and HPs’ motivations and ideas to use the feedback they would get from the collected data. This might be influenced by the level of digital health maturity of a country, as well as available resources. In addition, ePROs need to be intuitive and simple, but at the same time comprehensive and reliable enough so that they can be used for shared decision making. Challenges remain for the ePROs to be used as supporting and empowering tools, and not as reminders of the disease and pain.

Table 1.

Demographic data of the participants (N=42)

DemographicAustriaDenmarkTotalDataPatientHPPatientHPPatientHPN14101172517Women (%)10(71)6(60)7(64)5(71)17(68)11(65)Men (%)4(29)4(40)4(36)2(29)8(32)6(35)AgeMean (Range)54(30-76)41(29-63)65(37-77)47(31-59)60(30-77)44(29-63)

References

[1]T Stamm, I Parodis, and P Studenic. Patient-reported outcomes with anifrolumab in patients with systemic lupus erythematosus, Lancet Rheumatol, (2022), in Press.

Acknowledgements

We would like to express our particular thank you to all those who have taken part in the interview study and for their valuable inputs.

Disclosure of Interests

Yuki Seidler: None declared, Tanja Schjødt Jørgensen Speakers bureau: AbbVie, Pfizer, Roche, Novartis, UCB, Biogen and Eli Lilly., Consultant of: AbbVie, Pfizer, Roche, Novartis, UCB, Biogen and Eli Lilly, Paul Studenic: None declared, Helga Radner Speakers bureau: Gilead, Merck Sharp, Pfizer, Abbvie, Consultant of: Gilead, Merck Sharp, Pfizer, Abbvie, Thomas Nygaard: None declared, Nadine Weibrecht: None declared, Nikolas Popper Speakers bureau: Roche, Consultant of: dwh GmbH (as CSO), Lars Erik Kristensen Speakers bureau: Pfizer, AbbVie, Amgen, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen pharmaceuticals, Consultant of: Pfizer, AbbVie, Amgen, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen pharmaceuticals, Grant/research support from: IIT research grants from Novo, UCB, Eli Lilly; Novartis and Abbvie, Tanita-Christina Wilhelmer: None declared, James Rickmann: None declared, Erika Mosor: None declared, Valentin Ritschl: None declared, Tanja Stamm Speakers bureau: AbbVie, Novartis, Roche, Sanofi, and Takeda., Consultant of: AbbVie and Sanofi Genzyme., Grant/research support from: AbbVie and Roche.

POS1099 QUALITY OF LIFE, WORK IMPAIRMENT, AND DAILY ACTIVITY IMPAIRMENT OF PATIENTS WITH PSORIASIS VERSUS PSORIATIC ARTHRITIS: A REAL-WORLD SURVEY IN US AND EUROPE

Background

Psoriasis (PsO) and psoriatic arthritis (PsA) and are chronic immune-mediated diseases characterised by joint inflammation and skin lesions which negatively impact patients’ health-related quality of life (HRQoL). Several previous comparative studies have focused on PsA patients with or without skin involvement. Better understanding of the impact of both PsO and PsA on HRQoL and work / activity impairment will improve understanding of the incremental burden of PsA compared to PsO, and may lead to more personalised treatment options.

Objectives

To compare HRQoL, work impairment, and daily activity impairment of patients with a PsO diagnosis (dx) only, PsO dx with musculoskeletal (MSK) symptoms (sx), PsA dx with active skin sx, and PsA dx without active skin sx.

Methods

Data were drawn from the Adelphi PsO & PsA Disease Specific Programmes™ (DSP), real-world point-in-time surveys of rheumatologists, dermatologists and their consulting patients in the United States and Europe (France, Germany, Italy, Spain and UK); conducted in 2018/19. Patients were grouped according to their symptoms and confirmed diagnoses, comprising four groups:

1. Patients with PsO dx only,

2. Patients with PsO dx and with MSK sx,

3. Patients with PsA dx and with active skin sx,

4. Patients with PsA dx with no active skin sx,

Multivariate linear regression analyses with marginal mean predictions examined differences in patient-reported outcome measures (PROMs) between the four groups. Measures included HRQoL (EuroQol 5-Dimension 5-Level [EQ-5D Utility] and EuroQoL Visual Analogue Scale [EQ-VAS]), work impairment, and daily activity impairment (Work Productivity and Activity Impairment Questionnaire [WPAI]). Analyses controlled for demographics (age, sex, BMI), comorbidities present in >10% of patients and current treatment class (biologics, csDMARDs, steroids & other).

Results

4491 patients were included: Group 1 (n=1833), Group 2 (n=91), Group 3 (n=2451), and Group 4 (n=116). 54% of patients were male, 89% of patients were white, with a mean age of 46.6 years. Demographics were consistent across all patient groups.

The model-predicted EQ-5D-Utility was lower in Groups 2, 3 and 4, compared with Group 1 (p=0.003, p<0.001 and p=0.004 respectively). Similarly, predicted EQ-VAS was lower in Group 3 compared with Group 1 (p=0.006), Table 1.

Table 1.

Predictions of PROMs for PsO-PsA patient groups

PRO toolGroup [n]*Predicted PRO valuePopulation norm (MCID)Regression model p-value (vs. reference group)EQ-5D Utility score (n=1839)1 (ref) [743]0.9220.88 (0.07)2 [32]0.8160.0033 [1023]0.810<0.0014 [41]0.8500.004EQ-VAS (n=1882)1 (ref) [763]78.7878.2 (n/a)2 [36]70.560.0573 [1040]73.890.0064 [43]75.230.248WPAI % overall work impairment (n=1015)1 (ref) [422]15.36n/a (15.0)2 [14]17.860.5603 [558]22.16<0.0014 [21]26.090.014WPAI % work time missed (n=1028)1 (ref) [424]0.91n/a (n/a)2 [14]3.570.4863 [569]4.460.0024 [21]10.430.003WPAI % impairment while working (n=1153)1 (ref) [486]14.90n/a (20.0)2 [18]13.890.8463 [626]19.63<0.0014 [23]17.390.435WPAI % activity impairment (n=1818)1 (ref) [732]18.02n/a (20.0)2 [32]26.250.1223 [1012]26.14<0.0014 [42]25.240.044

*n values provided for reference, but margins are predictions as a result of the model and not for the specific number of patients in each subgroup.

(1) patients with PsO dx only

(2) Patients with PsO dx and MSK sx

(3) Patients with PsA dx and with active skin sx

(4) Patients with PsA dx with no active skin sx

Overall work impairment increased in Groups 3 and 4, compared with Group 1 (p<0.001 and p=0.014 respectively). Furthermore, Groups 3 and 4 missed more work compared with Group 1 (p=0.002 and p=0.003 respectively). Group 3 patients exhibited an increase in presenteeism and activity impairment compared with Group 1 (p<0.001), Table 1.

Conclusion

Patients experiencing PsA dx or MSK sx experienced an additional disease burden compared to patients with PsO sx alone, as measured by worse HRQoL and work impairment.

Disclosure of Interests

Joseph F. Merola Consultant of: Merck Research Laboratories, Abbvie, Dermavant, Eli Lilly and Company, Novartis, Janssen, UCB, Samumed, Celgene, Sanofi Regeneron, GSK, Almirall, Sun Pharma, Biogen, Pfizer, Incyte, Aclaris, and Leo Pharma, Lars Erik Kristensen Speakers bureau: Pfizer, AbbVie, Amgen, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen Pharmaceuticals, Consultant of: Pfizer, AbbVie, Amgen, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen Pharmaceuticals, Grant/research support from: Novo, UCB, Eli Lilly; Novartis and Abbvie, Feifei Yang Employee of: Employee of Janssen Pharmaceuticals, Steve Peterson Employee of: Employee of Janssen Pharmaceuticals, Rachel Teneralli Employee of: Employee of Janssen Pharmaceuticals, Nicola Massey Employee of: Adelphi Real World, Soumya D. Chakravarty Employee of: Employee of Janssen Pharmaceuticals, Megan Hughes Employee of: Adelphi Real World, May Shawi Employee of: Employee of Janssen Pharmaceuticals, Sarah Weatherby Employee of: Adelphi Real World, Christine Contre Employee of: Employee of Janssen Pharmaceuticals, Iris Lin Employee of: Employee of Janssen Pharmaceuticals, Fareen Hassan Employee of: Employee of Janssen Pharmaceuticals, M Elaine Husni Consultant of: Abbvie, Amgen, Eli Lilly, Novartis, Janssen, UCB, Pfizer, Regeneron, and BMS

POS0076 DRUG SURVIVAL OF BIOLOGICS AND NOVEL IMMUNOMODULATORS FOR RHEUMATOID ARTHRITIS, AXIAL SPONDYLOARTHRITIS, PSORIATIC ARTHRITIS, AND PSORIASIS - A NATIONWIDE COHORT STUDY FROM THE DANBIO AND DERMBIO REGISTRIES

Background

Drug survival is an important proxy measure for effectiveness of treatments for inflammatory diseases such as rheumatoid arthritis (RA), axial spondyloarthritis (AxSpA), psoriatic arthritis (PsA), and psoriasis [1-4].

Objectives

The objective of this study was to examine the real-life drug survival of biologics and novel small-molecule therapies across various disease entities such as RA, AxSpA, PsA, and psoriasis.

Methods

We performed a nationwide cohort study using the prospective nationwide registries DANBIO and DERMBIO, comprising all patients treated with biologics or novel small-molecule therapies for RA, AxSpA, PsA, and psoriasis between January 2015 through May 2021 (DANBIO) and November 2009 to November 2019 (DERMBIO). Drug survival was visualized using Kaplan-Meier curves, and Cox proportional hazards models were used to calculate adjusted Hazard Ratios (HRs) with 95% confidence intervals (CIs) for risk of discontinuing therapy.

Results

The study comprised a total of 12,089 patients (17,903 treatment series), including 5,104 RA patients (7,867 series), 2,157 AxSpA patients (3,016 series3), 2,551 PsA patients (3,313 series), and 2,577 psoriasis patients (3,707 series). In confounder-adjusted models drug survival in RA was highest for rituximab followed by baricitinib, etanercept and tocilizumab respectively. For AxSpA drug survival was high for golimumab compared to all other drugs, followed by secukinumab and etanercept and lowest for infliximab. For PsA tofacitinib and infliximab had the lowest drug survival compared to all other drugs. All other drugs performed almost equally well with a tendency of a generally higher drug survival for golimumab, followed by secukinumab and ixekizumab. For psoriasis drug survival was generally highest for guselkumab.

Figure 1.

Conclusion

Differing treatment responses to drugs with various types of action across RA, AxSpA, PsA and psoriasis emphasize that although these diseases have many overlaps in their pathogenesis, there is a need for an individualized treatment approach that considers the underlying disease, patient profile, and treatment history.

References

[1]Egeberg A, Ottosen MB, Gniadecki R, et al. Safety, efficacy and drug survival of biologics and biosimilars for moderate-to-severe plaque psoriasis. Br J Dermatol 2018; 178(2): 509-19.

[2]Gron KL, Glintborg B, Norgaard M, et al. Comparative Effectiveness of Certolizumab Pegol, Abatacept, and Biosimilar Infliximab in Patients With Rheumatoid Arthritis Treated in Routine Care: Observational Data From the Danish DANBIO Registry Emulating a Randomized Trial. Arthritis Rheumatol 2019; 71(12): 1997-2004.

[3]Lindstrom U, Glintborg B, Di Giuseppe D, et al. Comparison of treatment retention and response to secukinumab versus tumour necrosis factor inhibitors in psoriatic arthritis. Rheumatology 2020.

[4]Glintborg B, Lindstrom U, Di Giuseppe D, et al. One-year treatment outcomes of secukinumab versus tumor necrosis factor inhibitors in Spondyloarthritis. Arthritis Care Res (Hoboken) 2020.

Acknowledgements

We acknowledge the substantial contribution of the academic hospitals and private clinics and their physicians that report data to DANBIO and DERMBIO.

Disclosure of Interests

Alexander Egeberg Speakers bureau: AbbVie, Almirall, Leo Pharma, Zuellig Pharma Ltd., Galápagos NV, Sun Pharmaceuticals, Samsung Bioepis Co., Ltd., Pfizer, Eli Lilly and Company, Novartis, Galderma, Dermavant, UCB, Mylan, Bristol-Myers Squibb, and Janssen Pharmaceuticals, Paid instructor for: AbbVie, Almirall, Leo Pharma, Zuellig Pharma Ltd., Galápagos NV, Sun Pharmaceuticals, Samsung Bioepis Co., Ltd., Pfizer, Eli Lilly and Company, Novartis, Galderma, Dermavant, UCB, Mylan, Bristol-Myers Squibb, and Janssen Pharmaceuticals, Consultant of: AbbVie, Almirall, Leo Pharma, Zuellig Pharma Ltd., Galápagos NV, Sun Pharmaceuticals, Samsung Bioepis Co., Ltd., Pfizer, Eli Lilly and Company, Novartis, Galderma, Dermavant, UCB, Mylan, Bristol-Myers Squibb, and Janssen Pharmaceuticals, Grant/research support from: Pfizer, Eli Lilly, Novartis, Bristol-Myers Squibb, AbbVie, Janssen Pharmaceuticals, Nana Lippert Rosenoe: None declared, David Aagaard: None declared, Erik Lørup: None declared, Lea Nymand: None declared, Lars Erik Kristensen Speakers bureau: Dr. LE Kristensen has received fees for speaking and consultancy from Pfizer, AbbVie, Amgen, Forward pharma, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen pharmaceuticals, Paid instructor for: Dr. LE Kristensen has received fees for speaking and consultancy from Pfizer, AbbVie, Amgen, Forward pharma, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen pharmaceuticals, Consultant of: Dr. LE Kristensen has received fees for speaking and consultancy from Pfizer, AbbVie, Amgen, Forward pharma, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen pharmaceuticals, Grant/research support from: Dr. LE Kristensen has received fees for speaking and consultancy from Pfizer, AbbVie, Amgen, Forward pharma, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen pharmaceuticals, Jacob Thyssen Speakers bureau: Dr. Thyssen has attended advisory boards for Almirall, Eli Lilly & Co, Pfizer, LEO Pharma, Asana, Regeneron, AbbVie, Union Therapeutics, and Sanofi-Genzyme and received speaker honorarium from LEO Pharma, Regeneron, Almirall, Abbvie, Eli Lilly & Co, and Sanofi-Genzyme, and been an investigator for AbbVie, Pfizer, Eli Lilly & Co, LEO Pharma and Sanofi-Genzyme., Paid instructor for: Dr. Thyssen has attended advisory boards for Almirall, Eli Lilly & Co, Pfizer, LEO Pharma, Asana, Regeneron, AbbVie, Union Therapeutics, and Sanofi-Genzyme and received speaker honorarium from LEO Pharma, Regeneron, Almirall, Abbvie, Eli Lilly & Co, and Sanofi-Genzyme, and been an investigator for AbbVie, Pfizer, Eli Lilly & Co, LEO Pharma and Sanofi-Genzyme., Consultant of: Dr. Thyssen has attended advisory boards for Almirall, Eli Lilly & Co, Pfizer, LEO Pharma, Asana, Regeneron, AbbVie, Union Therapeutics, and Sanofi-Genzyme and received speaker honorarium from LEO Pharma, Regeneron, Almirall, Abbvie, Eli Lilly & Co, and Sanofi-Genzyme, and been an investigator for AbbVie, Pfizer, Eli Lilly & Co, LEO Pharma and Sanofi-Genzyme., Grant/research support from: Dr. Thyssen has attended advisory boards for Almirall, Eli Lilly & Co, Pfizer, LEO Pharma, Asana, Regeneron, AbbVie, Union Therapeutics, and Sanofi-Genzyme and received speaker honorarium from LEO Pharma, Regeneron, Almirall, Abbvie, Eli Lilly & Co, and Sanofi-Genzyme, and been an investigator for AbbVie, Pfizer, Eli Lilly & Co, LEO Pharma and Sanofi-Genzyme., Simon F. Thomsen Speakers bureau: Dr. Thomsen has been a speaker or has served on advisory boards for Sanofi-Genzyme, AbbVie, LEO Pharma, Pfizer, Eli Lilly and Company, Novartis, UCB Pharma, Almirall, and Janssen Pharmaceuticals; has received research support from Sanofi-Genzyme, AbbVie, LEO Pharma, Novartis, UCB Pharma, and Janssen Pharmaceuticals; and has been an investigator for Sanofi-Genzyme, Regeneron, AbbVie, LEO Pharma, Novartis and Pfizer., Paid instructor for: Dr. Thomsen has been a speaker or has served on advisory boards for Sanofi-Genzyme, AbbVie, LEO Pharma, Pfizer, Eli Lilly and Company, Novartis, UCB Pharma, Almirall, and Janssen Pharmaceuticals; has received research support from Sanofi-Genzyme, AbbVie, LEO Pharma, Novartis, UCB Pharma, and Janssen Pharmaceuticals; and has been an investigator for Sanofi-Genzyme, Regeneron, AbbVie, LEO Pharma, Novartis and Pfizer., Consultant of: Dr. Thomsen has been a speaker or has served on advisory boards for Sanofi-Genzyme, AbbVie, LEO Pharma, Pfizer, Eli Lilly and Company, Novartis, UCB Pharma, Almirall, and Janssen Pharmaceuticals; has received research support from Sanofi-Genzyme, AbbVie, LEO Pharma, Novartis, UCB Pharma, and Janssen Pharmaceuticals; and has been an investigator for Sanofi-Genzyme, Regeneron, AbbVie, LEO Pharma, Novartis and Pfizer., Grant/research support from: Dr. Thomsen has been a speaker or has served on advisory boards for Sanofi-Genzyme, AbbVie, LEO Pharma, Pfizer, Eli Lilly and Company, Novartis, UCB Pharma, Almirall, and Janssen Pharmaceuticals; has received research support from Sanofi-Genzyme, AbbVie, LEO Pharma, Novartis, UCB Pharma, and Janssen Pharmaceuticals; and has been an investigator for Sanofi-Genzyme, Regeneron, AbbVie, LEO Pharma, Novartis and Pfizer., René Lindholm Cordtz: None declared, Nikolai Loft Speakers bureau: speaker for Eli Lilly and Janssen Cilag., Lone Skov Speakers bureau: Dr. Skov has been a paid speaker for AbbVie, Eli Lilly, Novartis, and LEO Pharma, and has been a consultant or has served on Advisory Boards with AbbVie, Janssen Cilag, Novartis, Eli Lilly, LEO Pharma, UCB, Almirall, and Sanofi. She has served as an investigator for AbbVie, Sanofi, Janssen Cilag, Boehringer Ingelheim, AstraZenica, Eli Lilly, Novartis, Regeneron, and LEO Pharma, and has received research and educational grants from Novartis, Sanofi, Janssen Cilag, and LEO Pharma., Paid instructor for: Dr. Skov has been a paid speaker for AbbVie, Eli Lilly, Novartis, and LEO Pharma, and has been a consultant or has served on Advisory Boards with AbbVie, Janssen Cilag, Novartis, Eli Lilly, LEO Pharma, UCB, Almirall, and Sanofi. She has served as an investigator for AbbVie, Sanofi, Janssen Cilag, Boehringer Ingelheim, AstraZenica, Eli Lilly, Novartis, Regeneron, and LEO Pharma, and has received research and educational grants from Novartis, Sanofi, Janssen Cilag, and LEO Pharma., Consultant of: Dr. Skov has been a paid speaker for AbbVie, Eli Lilly, Novartis, and LEO Pharma, and has been a consultant or has served on Advisory Boards with AbbVie, Janssen Cilag, Novartis, Eli Lilly, LEO Pharma, UCB, Almirall, and Sanofi. She has served as an investigator for AbbVie, Sanofi, Janssen Cilag, Boehringer Ingelheim, AstraZenica, Eli Lilly, Novartis, Regeneron, and LEO Pharma, and has received research and educational grants from Novartis, Sanofi, Janssen Cilag, and LEO Pharma., Grant/research support from: Dr. Skov has been a paid speaker for AbbVie, Eli Lilly, Novartis, and LEO Pharma, and has been a consultant or has served on Advisory Boards with AbbVie, Janssen Cilag, Novartis, Eli Lilly, LEO Pharma, UCB, Almirall, and Sanofi. She has served as an investigator for AbbVie, Sanofi, Janssen Cilag, Boehringer Ingelheim, AstraZenica, Eli Lilly, Novartis, Regeneron, and LEO Pharma, and has received research and educational grants from Novartis, Sanofi, Janssen Cilag, and LEO Pharma., Lars Erik Bryld: None declared, Mads Rasmussen Speakers bureau: Dr. Rasmussen has been a paid speaker for AbbVie, Almirall, and LEO Pharma. Consulting, or serving on expert/advisory boards with AbbVie, Almirall, Janssen Cilag, and Eli Lilly. He served as investigator for Janssen Cilag, UCB, and Novartis., Paid instructor for: Dr. Rasmussen has been a paid speaker for AbbVie, Almirall, and LEO Pharma. Consulting, or serving on expert/advisory boards with AbbVie, Almirall, Janssen Cilag, and Eli Lilly. He served as investigator for Janssen Cilag, UCB, and Novartis., Consultant of: Dr. Rasmussen has been a paid speaker for AbbVie, Almirall, and LEO Pharma. Consulting, or serving on expert/advisory boards with AbbVie, Almirall, Janssen Cilag, and Eli Lilly. He served as investigator for Janssen Cilag, UCB, and Novartis., Grant/research support from: Dr. Rasmussen has been a paid speaker for AbbVie, Almirall, and LEO Pharma. Consulting, or serving on expert/advisory boards with AbbVie, Almirall, Janssen Cilag, and Eli Lilly. He served as investigator for Janssen Cilag, UCB, and Novartis., Pil Højgaard: None declared, Salome Kristensen: None declared, Lene Dreyer Speakers bureau: Dr. Dreyer has received research grant/research support from BMS, and speakers bureau from Eli Lilly and Galderma., Paid instructor for: Dr. Dreyer has received research grant/research support from BMS, and speakers bureau from Eli Lilly and Galderma., Consultant of: Dr. Dreyer has received research grant/research support from BMS, and speakers bureau from Eli Lilly and Galderma., Grant/research support from: Dr. Dreyer has received research grant/research support from BMS, and speakers bureau from Eli Lilly and Galderma.

POS1107 CHANGE IN ULTRASOUND-BASED KNEE JOINT INFLAMMATORY MARKERS AFTER WEIGHT LOSS IN PATIENTS WITH OSTEOARTHRITIS: A PROSPECTIVE COHORT STUDY

Background

Pain and impaired function due to knee OA (KOA) can be reduced with weight loss in obese patients. The role of synovitis in symptom improvement after weight loss is not fully understood. MRI and ultrasound (US) can be used in assessment of inflammation in the KOA. Knee joint synovitis assessed by MRI does not seem to change with weight loss, however, the typical MRI score is semiquantitative, which might be less sensitive to change than a quantitative score. US has a higher resolution than MRI and borders between synovium and surrounding tissues might be clearer allowing for a quantitative score. Changes in US-based synovitis following a weight has not been assessed.

Objectives

To assess changes in US synovitis in the knee joint after 8 weeks low-calorie weight loss intervention in overweight persons with KOA.

Methods

prospective cohort study (NCT02931370) including overweight persons (BMI ≥ 27 kg/m2) with KOA. Weight loss was induced by an intensive 8-week diet (1200 kcal/day), participants had symptomatic and radiographically confirmed KOA (KL grade 1-3). At week 0 and 8 all participants filled in the KOOS questionnaire assessing pain, physical function, symptoms, quality of life, and sport/recreation in relation to KOA (0= worst; 100=best). Furthermore, an US examination of the most affected knee was performed assessing the amount of synovial hypertrophy (SH) and effusion in medial and lateral recesses. The US examination was performed in a strictly standardized manner on a high-end US machine. The subsequent image evaluation was done both according to a semiquantitative score from 0 to 3 (0=no SH/effusion and 3=pronounced SH/effusion) and a quantitative scoring system using specific anatomic landmarks to measure the synovial hypertrophy/effusion in millimeter.

Statistical analyses were performed on the per protocol population (participants completing diet intervention).

Results

135 patients with KOA with a mean age of 60y (SD 9.8), a body weight of 106.0 kg (SD18.5) and mean BMI of 36.4 (SD5.4) completed the weight loss intervention. After the diet intervention mean weight change was -12.8 kg (95%CI -13.3 to -12.4) and the reductions in SH were -0.3mm (95%CI -0.5 to -0.1) (medial recess) and -0.4mm (95%CI -0.6 to -0.1) (lateral recess), and -0.03 (-0.13 to 0.07) (medial recess) and -0.07 (-0.20 to 0.05) using the semi-quantitative system. The mean change in the KOOS subscales range from 15.8 (sport/recreation) to 7.4 (QoL). See Table 1.

Table 1.n=135BaselineChangeMean (SD)Mean (95%CI)PAge60.0 (9.8)--Females, n (%)87 (64.4%)--BMI36.4 (5.4)-4.4 (-4.5 to -4.3)<.0001KL-scores; 122 (16.3%)--KL-scores; 256 (41.5%)--KL-scores; 357 (42.2%)--KL-scores; 40 (0%)--Synovial HypertrophyMedial, mm3.8 (1.8)-0.3 (-0.5 to -0.1)0.0198Lateral, mm5.3 (2.3)-0.4 (-0.6 to -0.1)0.0210Medial, 0-31.2 (0.6)-0.03 (-0.13 to 0.07)0.5584Lateral, 0-31.8 (0.8)-0.07 (-0.20 to 0.05)0.2311KOOS, 0-100Pain64.1 (16.0)12 (10.2 to 13.8)<.0001Function68.4 (17.3)14 (12.4 to 15.6)<.0001Symptoms68.9 (16.4)9 (7.2 to 10.8)<.0001Sports/Recreation35.9 (24.0)15.8 (13.2 to 18.3)<.0001QoL43.8 (17.5)7.4 (5.7 to 9.2)<.0001

SD = Standard Deviation; CI = Confidence Interval; BMI = Body Mass Index;

KOOS = Knee injury and Osteoarthritis Outcome Score; QoL = Knee-related Quality of Life

Conclusion

Quantitative measures of SH assessed by US decreased after a significant weight loss over 8-weeks; however, no linear association with weight loss magnitude was seen. A weak correlation between changes in SH in the lateral recess and change in pain was seen. This indicates changes in SH assessed by US examination is associated with a low-calorie diet but seems uncoupled with weight loss magnitude. The weight loss induced changes in synovitis and KOA symptoms seem vaguely related.

Disclosure of Interests

None declared

OP0027 ASSOCIATION BETWEEN BASELINE CARDIOVASCULAR RISK AND INCIDENCE RATES OF MAJOR ADVERSE CARDIOVASCULAR EVENTS AND MALIGNANCIES IN PATIENTS WITH PSORIATIC ARTHRITIS AND PSORIASIS RECEIVING TOFACITINIB

Background

Common comorbidities of psoriatic arthritis (PsA) and psoriasis (PsO) are cardiovascular (CV) disease and metabolic syndrome (MetS).1,2 Risk of CV disease may be associated with increased risk of future malignancies.3 Tofacitinib is a JAK inhibitor for treatment of PsA and has been investigated for treatment of PsO.

Objectives

To examine baseline (BL) CV risk and its association with incidence rates (IRs) of major adverse CV events (MACE) and malignancies in tofacitinib-treated patients (pts) with PsA and PsO.

Methods

Analysis included data from 3 (Phase [P]3/long-term extension [LTE]) trials of pts with PsA and 7 (P2/3/LTE) trials of pts with PsO receiving ≥1 dose of tofacitinib (5 or 10 mg twice daily). IRs (pts with events/100 pt-yrs) for MACE and malignancies (excluding non-melanoma skin cancer) were stratified by: history of coronary artery disease (HxCAD [≥1 of myocardial infarction, coronary heart disease, coronary artery procedure or stable angina pectoris]); BL 10-yr atherosclerotic CV disease (ASCVD) risk (ASCVD-pooled cohort equations calculator [only in pts without HxCAD]); and BL MetS (≥3 of hypertension, raised triglycerides, reduced high-density lipoprotein cholesterol, high waist circumference or high fasting glucose levels).

Results

Of 783 and 3663 pts with PsA and PsO, total tofacitinib exposure was 2038 and 8950 pt-yrs, and median duration of exposure was 3.0 and 2.4 yrs, respectively. In pts with PsA and PsO, 5.0% and 2.5% had HxCAD, respectively; in those without HxCAD, >20% had intermediate/high BL 10-yr ASCVD risk (Figure 1). At BL, 40.9% and 32.7% of pts with PsA and PsO had MetS, respectively. IRs of MACE were greatest in pts with PsA and PsO who had HxCAD/high BL 10-yr ASCVD risk (Table 1). In the PsA cohort, 5/6 pts with MACE had BL MetS. IRs of malignancies in pts with PsA were greatest in those with intermediate/high BL 10-yr ASCVD risk; 8/9 pts with malignancies in these risk categories had BL MetS (Table 1). In the PsO cohort, IR of malignancies was notably greater in those with high vs low/intermediate BL 10-yr ASCVD risk (Table 1).

Table 1.

IRs of MACE and malignancies in pts with PsA and PsO receiving tofacitinib, stratified by HxCAD, BL 10-yr ASCVD risk and BL MetS

MACEMalignanciesPsAPsOPsAPsOn/N[n1]IR (95% CI)n/N[n1]IR (95% CI)n/N[n1]IR (95% CI)n/N[n1]IR (95% CI)HxCADYes1/39[0]0.97 (0.02, 5.38)3/93[0]1.49 (0.31, 4.36)0/39[0]0.00 (0.00, 3.52)0/93[0]0.00 (0.00, 1.83)No5/744[5]0.25 (0.08, 0.59)20/3570[10]0.22 (0.13, 0.34)15/744[10]0.75 (0.42, 1.24)60/3570[26]0.66 (0.51, 0.85)BL 10-yr ASCVD risk categoryHigh risk (≥20%)1/35[1]1.26 (0.03, 7.01)7/179[4]1.67 (0.67, 3.43)1/35[1]1.26 (0.03, 7.03)15/179[10]3.57 (2.00, 5.89)Intermediate risk(≥7.5–<20%)2/121[2]0.62 (0.07, 2.23)9/716[6]0.50 (0.23, 0.95)8/121[7]2.46 (1.06, 4.86)23/716[9]1.28 (0.81, 1.92)Borderline risk(≥5–<7.5%)1/91[1]0.42 (0.01, 2.32)2/400[0]0.19 (0.02, 0.67)2/91[1]0.83 (0.10, 3.01)5/400[1]0.47 (0.15, 1.09)Low risk (<5%)1/487[1]0.08 (0.00, 0.42)2/2241[0]0.03 (0.00, 0.13)4/487[1]0.30 (0.08, 0.77)17/2241[6]0.30 (0.17, 0.47)BL MetSYes5/3200.60 (0.20, 1.40)10/11970.34 (0.16, 0.63)10/3201.20 (0.58, 2.21)26/11970.89 (0.58, 1.31)No1/4630.08 (0.00, 0.44)13/24660.20 (0.11, 0.35)5/4630.40 (0.13, 0.92)34/24660.54 (0.37, 0.75)

Follow-up time calculated up to the day of the first event and subject to risk period of 28 days beyond the last dose of study drug.

CI, confidence interval; N, total pts; n, pts with MACE/malignancies; n1, pts with MACE/malignancies and BL MetS.

Conclusion

In tofacitinib-treated pts with PsA and PsO, raised CV risk and MetS at BL were potentially associated with higher IRs of MACE and malignancies. Our findings support assessing CV risk in pts with PsA and PsO and enhanced monitoring for malignancies in those with raised CV risk.

References

[1]Karmacharya et al. Ther Adv Musculoskel Dis 2021; 13: 1-15.

[2]Garshick et al. J Am Coll Cardiol 2021; 77: 1670-1680.

[3]Lau et al. JACC CardioOncol 2021; 3: 48-58.

Acknowledgements

Study sponsored by Pfizer Inc. Medical writing support was provided by Emma Mitchell, CMC Connect, and funded by Pfizer Inc.

Disclosure of Interests

Lars Erik Kristensen Speakers bureau: AbbVie, Amgen, Biogen, Bristol-Myers Squibb, Eli Lilly, Janssen, MSD, Novartis, Pfizer Inc and UCB, Grant/research support from: Biogen, Janssen, Novartis and UCB, Bruce Strober Speakers bureau: AbbVie, Amgen, Eli Lilly, Janssen and Ortho Dermatologics, Consultant of: AbbVie, Almirall, Amgen, Arcutis, Arena, Aristea, Boehringer Ingelheim, Bristol-Myers Squibb, Cara, Celgene, Dermavant, Dermira, Eli Lilly, GlaxoSmithKline, Janssen, Leo, Meiji Seika Pharma, Novartis, Ortho Dermatologics, Pfizer Inc, Regeneron, Sanofi-Genzyme, Sun Pharma and UCB, Denis Poddubnyy Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer Inc and UCB, Consultant of: AbbVie, BIOCAD, Gilead Sciences, GlaxoSmithKline, Eli Lilly, MSD, Novartis, Pfizer Inc, Samsung Bioepis and UCB, Grant/research support from: AbbVie, MSD, Novartis and Pfizer, Ying Ying Leung Consultant of: AbbVie, Eli Lilly, Janssen and Novartis, Hyejin Jo Consultant of: Pfizer Inc, Employee of: Syneos Health, Kenneth Kwok Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Ivana Vranic Shareholder of: Pfizer Inc, Employee of: Pfizer Ltd, Dona Fleishaker Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Lara Fallon Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Arne Yndestad Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Dafna D Gladman Consultant of: AbbVie, Amgen, Celgene, Eli Lilly, Galapagos, Gilead Sciences, Janssen, Novartis, Pfizer Inc and UCB.

OP0103 GENE EXPRESSION PROFILES RETRIEVED FROM SINGLE CELL RNA SEQUENCING REVEAL PHENOTYPIC TRAITS IN PATIENTS WITH PSORIATIC ARTHRITIS INITIATING TUMOUR NECROSIS FACTOR ALPHA INHIBITOR AND INTERLEUKIN-17 INHIBITOR

Background

Patients with Psoriatic Arthritis (PsA) suffer from heterogenous debilitating symptoms caused by immune-mediated inflammation. However, great diversity in clinical response to available medical therapies targeting the immune response in PsA complicates treatment decision-making.

Objectives

The primary objective of the study was to evaluate gene expression profiles at baseline in responders versus non-responders of Tumour Necrosis Factors alpha inhibitor (TNFi) and Interleukin-17 inhibitor (IL-17i), respectively, to examine the foundation for future improved PsA patient stratification.

Methods

Single cell RNA sequencing (scRNAseq) was included to evaluate the transcriptome in responders versus non-responders of Tumour Necrosis Factor alpha inhibitor (TNFi) and Interleukin-17 inhibitor (IL-17i). Peripheral blood mononuclear cells (PBMCs) was isolated for scRNAseq and Disease Activity Score in PsA (DAPSA) retrieved in 40 PsA patients; 20 initiating TNFi and 20 initiating IL-17i. Responders and non-responders were stratified based on 50% improvement after 4-months (DAPSA50). The BD Rhapsody Whole Transcriptome Approach [1] was applied to prepare cDNA libraries sequenced to a depth of approximately 50.000 reads pr. cells on the Illumina NovaSeq 6000. The Seurat pipeline [2] was implemented for the analysis of gene expression on single cell level.

Results

A total of 273.515 cells were retrieved after initial quality control. Comparing patient demographics and characteristics at baseline revealed no difference between groups (Table 1). Dimensionality reduction with principal component analysis and additional clustering analysis indicated different phenotypic traits of responders and non-responders to TNFi and IL-17i (Figure 1). The results were limited by the DAPSA50 stratification only requiring 50% improvement at 4-month. Nevertheless, it is believed that scRNAseq can be included to improve PsA patient stratification.

Table 1.

Patient characteristics

All (n=40)TNFi responders (n=12)TNFi non-responders (n=8)IL-17i responders (n=8)IL-17i non-responders (n=12)p-valueSex, female23 (57.5)7 (58.3)4 (50.0)4 (50.0)8 (66.7)0.853Age51.9 ±12.148.4 ±10.954.7 ±11.649.6 (17.5)52.7 ±9.90.766Disease duration8.1 ±7.46.7 ±6.810.1 ±10.110.4 ±7.913.7 ±6.40.903DAPSA36.5 ±18.534.4 ±23.234.1 ±13.850.5 ±17.338.5 ±17.90.176

Patient characteristics were presented as number with corresponding percentage or mean with corresponding standard deviations. P-value < 0.05 was considered statically significant. TNFi; Tumour Necrosis Factor alpha inhibitor, IL-17i; Interleukin-17 inhibitor, DAPSA; Disease Activity in Psoriatic Arthritis.

Figure 1.

Gene expression profiles of DAPSA50 responders and non-responders to IL-17i Heat maps revealing differential gene expression of DAPSA50 responders and non-responders to IL-17i implying the possibility of improved stratification of PsA patients

Conclusion

High-dimensional data, retrieved from scRNAseq combined with bioinformatical data modelling and clinical knowledge, is important and should possibly be implemented to explore PsA disease heterogeneity and for better stratification of PsA patients prior to initiating available medical therapies.

References

[1]Shum EY, Walczak EM, Chang C FH. Quantitation of mRNA Transcripts and Proteins Using the BD RhapsodyTM Single-Cell Analysis System. Adv Exp Med Biol 2019;1129:63–79.

[2]Satija R, Farrell JA, Gennert D, et al. Spatial reconstruction of single-cell gene expression data. Nat Biotechnol 2015;33:495–502. doi:10.1038/nbt.3192

Acknowledgements

We wish to acknowledge all patients participating in this study, our patient research partner Dorte Kongshøj Marcussen for valuable talks during the project and data manager Christian Cato Holm. Additionally, we wish to thank the parties providing funding to complete the study; Eli Lilly, The Danish Rheumatism Association, Elisabeth and Karl Ejnar Nis-Hanssens Mindelegat and Minister Erna Hamiltons Legat for Videnskab og Kunst.

Disclosure of Interests

Marie Skougaard Speakers bureau: has received speaking fees from Janssen, Grant/research support from: has received research funding from Eli Lilly, Pfizer, The Danish Rheumatism Association and the Danish Psoriasis Association., Clara Drachmann: None declared, Zara Rebecca Stisen: None declared, Sisse B. Ditlev: None declared, Leon Eyrich Jessen: None declared, Lars Erik Kristensen Speakers bureau: from Pfizer, AbbVie, Amgen, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen pharmaceuticals, Consultant of: from Pfizer, AbbVie, Amgen, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen pharmaceuticals, Grant/research support from: Novo, UCB, Eli Lilly; Novartis and Abbvie

Increased prevalence of sleep disturbance in psoriatic arthritis is associated with inflammatory and non-inflammatory measures

OBJECTIVES

To examine the prevalence of sleep disturbances, quantified by the Pittsburgh Sleep Quality Index (PSQI), in patients with psoriatic arthritis (PsA), psoriasis (PsO) and healthy controls (HCs), explore associations between PSQI and clinical and patient-reported outcomes, and evaluate the effect of treatment on PSQI.

METHOD

Patients were included from the Parker Institute's PsA patient cohort to evaluate the prevalence of sleep disturbances. Univariate and multivariate regression analyses were used to explore associations between sleep disturbance and outcome measures. Treatment effect in PsA patients was assessed with a mixed-effect model for repeated measures.

RESULTS

In total, 109 PsA patients, 20 PsO patients, and 20 HCs were included. Sleep disturbances were reported by 66.1% of PsA patients, 45.0% of PsO patients, and 15.0% of HCs. Univariate regression analyses revealed statistically significant associations (p < 0.001) between PSQI and Disease Activity Score (DAS28CRP), tender points, visual analogue scale (VAS) patient global and pain, Psoriatic Arthritis Impact of Disease fatigue, Health Assessment Questionnaire (HAQ), and painDETECT score. Multivariate regression analysis demonstrated VAS patient global, VAS pain, and tender points as being independently associated with PSQI. The mixed-effect model revealed no effect of treatment.

CONCLUSION

More PsA patients than PsO patients and HCs reported sleep disturbances. Sleep disturbances were associated with inflammatory and non-inflammatory measures possibly explaining the limited effect of treatment. This demonstrates the need for interdisciplinary approaches to improve the management of sleep disturbance in PsA.Trial registration: ClinicalTrials.gov (NCT02572700).

Agreement between self-reported and observed functioning in patients with rheumatoid arthritis, osteoarthritis, and fibromyalgia, and the influence of pain and fatigue: a cross-sectional study

Objective: To evaluate the relationship between self-reported and performance-based measures of functioning in rheumatoid arthritis (RA), knee osteoarthritis (OA), and fibromyalgia (FM), and the influence of pain and fatigue.Method: Self-reported functioning was assessed by the Stanford Health Assessment Questionnaire, Fibromyalgia Impact Questionnaire, and Knee injury and Osteoarthritis Outcome Score. Performance-based measures of task-related physical activity included grip strength and Six-Minute Walk Test (6MWT). Assessment of Motor and Process Skills (AMPS) was used to obtain performance-based measures of activities of daily living (ADL) ability. Pain and fatigue were assessed by 100 mm visual analogue scales. Spearman's rho correlation and regression modelling were applied.Results: Correlations between self-reported functioning and performance-based measures of ADL ability were weak to moderate, and strongest in OA (r = 0.57, p = 0.002), and AMPS ADL ability measures did not enter regression models as explanatory factors for self-reported functioning. Correlations between AMPS ADL ability measures and measures of task-related physical activity were weak, except for a strong correlation between AMPS ADL motor ability and 6MWT in OA (r = 0.63, p = 0.000). The 6MWT was the only performance-based test explaining variance in AMPS motor ability (OA = 42%; FM = 11%). Pain explained variance in self-reported ability and contributed to variance in AMPS ADL motor ability measures in OA.Conclusion: Self-reported and observed measures of functioning assess partly different aspects of functioning, and both approaches may therefore be relevant in a structured assessment of patients with musculoskeletal disorders.

AB0559 EFFICACY AND SAFETY OF RISANKIZUMAB IN PATIENTS WITH ACTIVE PSORIATIC ARTHRITIS AFTER INADEQUATE RESPONSE OR INTOLERANCE TO DMARDs: 24-WEEK RESULTS FROM THE PHASE 3, RANDOMIZED, DOUBLE-BLIND KEEPsAKE 1 TRIAL

Background:

Risankizumab (RZB) is a humanized immunoglobulin G1 monoclonal antibody that specifically inhibits interleukin 23 by binding to its p19 subunit. RZB is being investigated as a treatment for adults with psoriatic arthritis (PsA).

Objectives:

To compare the efficacy and safety of RZB vs placebo (PBO) for the treatment of active PsA in patients who have had inadequate response or intolerance to ≥ 1 conventional synthetic disease modifying antirheumatic drug (csDMARD-IR).

Methods:

In KEEPsAKE 1 (NCT03675308), eligible adults (csDMARD-IR with ≥ 5 swollen joints [SJC] and ≥ 5 tender joints [TJC]) were randomized (1:1) to receive blinded subcutaneous RZB 150 mg or PBO at weeks 0, 4, and 16. The primary endpoint was the proportion of patients achieving 20% improvement in American College of Rheumatology score (ACR20) at week 24. Ranked secondary and other secondary endpoints are shown in the Table 1. Safety was assessed throughout the study. Results reported here are from the 24-week double-blind period; the open-label period with all patients receiving RZB is ongoing.

Results:

964 patients (RZB, N = 483; PBO, N = 481) were evaluated at week 24. Demographics and baseline characteristics were generally balanced between treatment groups (mean duration of PsA: 7.12 years; mean SJC: 12.2; mean TJC: 20.6; mean body surface area involved with psoriasis [BSA] in patients with BSA ≥ 3%: 16.7%). A significantly greater proportion of RZB- vs PBO-treated patients (57.3% and 33.5%, respectively) achieved the primary endpoint of ACR20 at week 24 (P < .001; Table 1). Significant differences were also observed for RZB vs PBO for the first 8 ranked secondary endpoints (P < .001 for all; Table 1). Serious adverse events were reported for 2.5% and 3.7% of RZB- and PBO-treated patients, respectively; serious infections were reported for 1.0% and 1.2%. There was 1 death in the RZB group.

Conclusion:

RZB resulted in significantly greater improvements in signs and symptoms of PsA compared with PBO and was well tolerated in patients who were csDMARD-IR.

Disclosure of Interests:

Lars Erik Kristensen Speakers bureau: LK has received honoraria or fees for serving as a speaker or consultant from AbbVie, Amgen, Biogen, Bristol-Myers Squibb, Gilead, Janssen, Lilly, Merck, Novartis, Pfizer, and UCB., Consultant of: LK has received honoraria or fees for serving as a speaker or consultant from AbbVie, Amgen, Biogen, Bristol-Myers Squibb, Gilead, Janssen, Lilly, Merck, Novartis, Pfizer, and UCB., MAURO KEISERMAN Speakers bureau: MK has received honoraria or fees for serving on advisory boards, as a speaker or as a consultant, and grants as a principal investigator from AbbVie, Amgen, Bristol-Myers Squibb, Celgene, GlaxoSmithKline, Janssen, Novartis, Pfizer, Roche, and UCB., Consultant of: MK has received honoraria or fees for serving on advisory boards, as a speaker or as a consultant, and grants as a principal investigator from AbbVie, Amgen, Bristol-Myers Squibb, Celgene, GlaxoSmithKline, Janssen, Novartis, Pfizer, Roche, and UCB., Grant/research support from: MK has received honoraria or fees for serving on advisory boards, as a speaker or as a consultant, and grants as a principal investigator from AbbVie, Amgen, Bristol-Myers Squibb, Celgene, GlaxoSmithKline, Janssen, Novartis, Pfizer, Roche, and UCB., Kim Papp Speakers bureau: KP has received honoraria or fees for serving on advisory boards, as a speaker, and as a consultant, as well as grants as principal investigator from AbbVie, Amgen, Astellas, Bausch Health (Valeant), Baxalta, Baxter, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Coherus, Dermira, EMD Serono, Forward Pharma, Galderma, Genentech, GlaxoSmithKline, Janssen, Kyowa Kirin, LEO Pharma, Lilly, MedImmune, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi Genzyme, Stiefel, Sun Pharma, Takeda, and UCB., Consultant of: KP has received honoraria or fees for serving on advisory boards, as a speaker, and as a consultant, as well as grants as principal investigator from AbbVie, Amgen, Astellas, Bausch Health (Valeant), Baxalta, Baxter, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Coherus, Dermira, EMD Serono, Forward Pharma, Galderma, Genentech, GlaxoSmithKline, Janssen, Kyowa Kirin, LEO Pharma, Lilly, MedImmune, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi Genzyme, Stiefel, Sun Pharma, Takeda, and UCB., Grant/research support from: KP has received honoraria or fees for serving on advisory boards, as a speaker, and as a consultant, as well as grants as principal investigator from AbbVie, Amgen, Astellas, Bausch Health (Valeant), Baxalta, Baxter, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Coherus, Dermira, EMD Serono, Forward Pharma, Galderma, Genentech, GlaxoSmithKline, Janssen, Kyowa Kirin, LEO Pharma, Lilly, MedImmune, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi Genzyme, Stiefel, Sun Pharma, Takeda, and UCB., Leslie McCasland Speakers bureau: LM has received fees for serving on an advisory board from Lilly., Douglas White Speakers bureau: DW has received honoraria or fees for serving on advisory boards, as a speaker, and as a consultant from AbbVie, Merck, Novartis, and Roche., Consultant of: DW has received honoraria or fees for serving on advisory boards, as a speaker, and as a consultant from AbbVie, Merck, Novartis, and Roche., Lisa Barcomb Shareholder of: LB is a full-time employee of AbbVie, and may hold AbbVie stock or stock options., Employee of: LB is a full-time employee of AbbVie, and may hold AbbVie stock or stock options., Wenjing Lu Shareholder of: WL is a full-time employee of AbbVie, and may hold AbbVie stock or stock options., Employee of: WL is a full-time employee of AbbVie, and may hold AbbVie stock or stock options., Zailong Wang Shareholder of: ZE is a full-time employee of AbbVie, and may hold AbbVie stock or stock options., Employee of: ZE is a full-time employee of AbbVie, and may hold AbbVie stock or stock options., Ahmed M. Soliman Shareholder of: AMS is a full-time employee of AbbVie, and may hold AbbVie stock or stock options., Employee of: AMS is a full-time employee of AbbVie, and may hold AbbVie stock or stock options., Ann Eldred Shareholder of: AE is a full-time employee of AbbVie, and may hold AbbVie stock or stock options., Employee of: AE is a full-time employee of AbbVie, and may hold AbbVie stock or stock options., Frank Behrens Speakers bureau: FB has received research grants, honoraria, or fees for serving as a consultant or speaker from AbbVie, Amgen, Boehringer Ingelheim, Celgene, Chugai, Galapagos, Genzyme, Gilead, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, and Sanofi., Consultant of: FB has received research grants, honoraria, or fees for serving as a consultant or speaker from AbbVie, Amgen, Boehringer Ingelheim, Celgene, Chugai, Galapagos, Genzyme, Gilead, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, and Sanofi., Grant/research support from: FB has received research grants, honoraria, or fees for serving as a consultant or speaker from AbbVie, Amgen, Boehringer Ingelheim, Celgene, Chugai, Galapagos, Genzyme, Gilead, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, and Sanofi.

POS0237 GUT DYSBIOSIS LINKED TO WORSE DISEASE STATUS IN AXIAL SPONDYLOARTHRITIS

Background:

Based on clinical and genetic associations, axial spondyloarthritis (axSpA) and inflammatory bowel disease (IBD) are suspected to have a linked pathogenesis. Gut dysbiosis, intrinsic to IBD, has also been observed in axSpA. It is, however, not established to what degree gut dysbiosis is associated with axSpA disease severity.

Objectives:

To compare presence and degree of gut dysbiosis between axSpA patients and controls, and to explore whether gut dysbiosis is associated with axSpA disease activity, function and pain.

Methods:

The GA-map Dysbiosis Test (Genetic Analysis, Oslo, Norway) was used to identify and grade gut dysbiosis based on faecal samples from 44 non-radiographic axSpA (nr-axSpA; ASAS criteria) and 88 ankylosing spondylitis (AS; modified New York criteria) patients without IBD, consecutively enrolled in a population-based cohort study, and from 46 controls without rheumatic disease or IBD (frequency-matched to the patients for age/sex). The GA-map Dysbiosis Test is a validated method grading microbiota aberration on a 1-5 scale (Dysbiosis Index, DI), where ≥3 denotes dysbiosis. Analysis of covariance (ANCOVA) was used to compare DI between axSpA patients (nr-axSpA and AS combined) and controls, adjusted for age, sex, body mass index (BMI) and smoking. Within the axSpA group, disease activity (ASDAS-CRP; BASDAI), function (BASFI) and pain (VAS pain) were compared between patients with various DI levels by One-way analysis of variance (ANOVA) or Kruskal-Wallis test, as appropriate. Finally, axSpA patients were subdivided by presence of dysbiosis (DI ≥3 vs. <3) followed by comparison of ASDAS-CRP, BASDAI, BASFI, VAS pain and Evaluator´s global assessment of disease activity (EvalGlobal; 0-4: remission-maximal) by ANCOVA. Analyses were conducted unadjusted and adjusted for age, sex, BMI, smoking, axSpA subtype, gut inflammation (faecal calprotectin ≥50 mg/kg), irritable bowel syndrome symptoms (ROME III criteria), ASAS 3-month NSAID score and cs/bDMARD treatment.

Results:

Characteristics of the patients/controls are shown in the Table 1. Gut dysbiosis (DI≥3) was observed in 33% of axSpA patients and 17% of controls. DI was significantly higher among the patients (β-estimate [bootstrapped 95%CI] for the between-group difference: 0.34 [0.04-0.65]; p=0.027). In the axSpA group, higher DI was associated with worse scores in all assessed outcomes (Figure 1, panel A). Moreover, presence of dysbiosis (DI≥3) was associated with worse ASDAS-CRP, BASDAI, BASFI, VAS pain and EvalGlobal (Figure 1, panel B; EvalGlobal not shown in the Figure: unadjusted β [bootstrapped 95%CI]: 0.32 [0.09-0.55], adjusted: 0.28 [0.03-0.52] for patients with DI ≥3 vs. <3), with between-group differences remaining significant after adjustment, except for ASDAS-CRP (p=0.079) and VAS pain (p=0.064).

Table 1.All patients n=132Nr-axSpAn=44ASn=88Controlsn=46Male sex, n (%)72 (55)17 (39)55 (63)23 (50)Age, y53 (13)48 (12)55 (13)51 (14)Symptom duration, y26 (14)21 (11)28 (14)Body mass index, kg/m227 (4.3)27 (4.2)27 (4.3)25 (3.3)Smoking ever, n (%)43 (33)9 (20)34 (39)13 (28)CRP, mg/L3.7 (5.3)2.3 (2.4)4.3 (6.1)F-Calprotectin ≥50 mg/kg, n (%)46 (35)12 (27)34 (39)Evaluator´s global, 0-4, median (IQR)1 (0-1)1 (0-1)1 (0-1)ASDAS-CRP1.8 (0.9)1.9 (0.9)1.8 (0.9)BASDAI3.1 (2.2)3.3 (1.9)3.0 (2.4)BASFI2.0 (2.1)2.0 (1.7)2.1 (2.2)VAS pain, cm3.3 (2.5)3.4 (2.2)3.2 (2.7)IBS symptoms, n (%)43 (33)15 (34)28 (32)ASAS 3-month NSAID score37 (44)36 (44)37 (44)Ongoing csDMARD, n (%)24 (18)9 (20)15 (17)Ongoing bDMARD, n (%)56 (42)19 (43)37 (42)

Mean (SD) unless otherwise specified. y, years; IBS, irritable bowel syndrome

Conclusion:

Gut dysbiosis, present to a higher degree in axSpA patients than controls, is associated with worse axSpA disease activity and function. These associations appear independent of gut inflammation and both NSAID and immunomodulatory treatment. This provides further evidence for an important link between disturbances in gastrointestinal homeostasis and axSpA manifestations, and implies that gut dysbiosis may be a novel biomarker for severe disease.

Disclosure of Interests:

Jonas Sagard: None declared, Tor Olofsson Consultant of: Eli Lilly, Merck Sharp & Dohme, Elisabeth Mogard: None declared, Jan Marsal Consultant of: AbbVie, Bristol-Myers Squibb, EuroDiagnostica, Ferring, Hospira, Janssen-Cilag, Merck, Sharp & Dohme (MSD), Otsuka, Pfizer, Sandoz, Takeda, Tillotts, UCB Pharma, Grant/research support from: AbbVie, Ferring, and Pfizer, Kristofer Andréasson: None declared, Mats Geijer Speakers bureau: UCB Pharma, AbbVie, Novartis, Pfizer, Lars Erik Kristensen Speakers bureau: Pfizer, AbbVie, Amgen, UCB, Celegene, BMS, MSD, Novartis, Eli Lilly, Janssen pharmaceuticals, Consultant of: Pfizer, AbbVie, Amgen, UCB, Celegene, BMS, MSD, Novartis, Eli Lilly, Janssen pharmaceuticals, Elisabet Lindqvist: None declared, Johan K Wallman Consultant of: Celgene, Eli Lilly, Novartis

POS0144 NOVEL APPLICATION OF OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY AND NAILFOLD CAPILLAROSCOPY IN PSORIATIC ARTHRITIS - DIAGNOSTIC AND PROGNOSTIC ACCURACY IN RELATION TO PSORIASIS AND HAND OSTEOARTHRITIS

Background:

Nailfold video capillaroscopy (NVC) and angiographic optical coherence tomography (OCTA) have potential in diagnosing psoriatic arthritis (PsA) and differentiating it from psoriasis vulgaris (PsO) and hand osteoarthritis (OA).

Objectives:

To assess the diagnostic properties of NVC and OCTA in patients with PsA compared to patients with PsO and hand OA based on nailfold capillary patterns.

Methods:

Patients with distal interphalangeal-joint PsA and nail involvement (n=50), PsO with nail involvement (n=12); and OA (n=13) were included in this cross-sectional study. Capillaries were evaluated semi-quantitatively and qualitatively. Differences in capillary findings between groups were assessed using mixed linear models. Binary logistic regression analyses were performed to determine the probability for PsA diagnosis based on capillaroscopy findings.

Results:

Reduced capillary density and reduced nailfold blood flow in OCTA images distinguished PsA from both PsO (p=0.004 and p=0.052) and OA (p=0.024 and p<0.001). Qualitative analysis revealed that glomerular capillaries were found in only 3% of PsA patients but in 13% of PsO patients (P=0.003). Furthermore, coiled vessels were only seen in 55% of PsA patients and 71% in PsO patients (P=0.043). NVC microhaemorrhage was dominant in PsA patients (13 % and 17 %) and significantly different to OA patients (p=0.05). No capillary pattern was associated with an increased probability of the PsA diagnosis.

Conclusion:

A pathognomic pattern for PsA diagnosis was not identified, however we demonstrated characteristics significant capillaroscopy findings for PsA such as decreased capillary density, reduced blood flow, and less coiled vessels in OCTA and presence of NVC microhemorrhages.

Table 1.NVC-ratingPsA (n=188)PsO (n=42)OA (n=48)PsA vs PsOPsA vs OANVC ad modum CutoloReduced capillary density51 %31 %51 %P=0.1070.770Irregularly enlarged capillaries22 %33 %25 %P=0.082P=0.988Giant capillary2 %00P=0.400P=0.375Microhaemorrhages13 %7 %2 %P=0.327P=0.05Capillary ramifications14 %24 %29 %P=0.054P=0.307Capillary disorganisation45 %57 %48 %P=0.170P=0.685OCTA-ratingPsA n=193PsO n=48OA n=52PsA vs PsOPsA vs OAOCTA ad modum CutoloReduced capillary density53 %21 %33 %P=0.004P=0.024Irregularly enlarged capillaries34 %56 %19 %p=0.015P=0.178Giant capillary000--Microhaemorrhages000--Capillary ramifications000--Capillary disorganisation55 %46 %49 %P=0.2090.723OCTNail thickness*, mm., mean (SD)0.62 (0.13)0.73 (0.39)0.59 (0.08)p=0.876P=0.020OCTA blood flow percentage, mean (SD)6.00 (2.94)6.94 (3.08)7.88 (3.30)P=0.052P<0.001Capillary morphologyPsA n=192PsO n=48OA n=52PsA vs PsOPsA vs OAQualitative evaluation of NVC morphologyTortuous/Coiled capillaries55 %71 %56 %P=0.043P=0.890Enlarged capillary diameter17 %21 %17 %P=0.557P=0.984Ramified capillaries13 %15 %19 %P=0.701P=0.215Microhaemorrhages17 %6 %8 %P=0.068P=0.106Elongated capillaries6 %4 %4 %P=0.669P=0.592Different capillary shapes, glomerular3 %13 %2 %P=0.003P=0.779

The distribution of NVC and OCTA capillary morphology between PsA, PsO and OA, and qualitative evaluation of NVC morphology. Data are presented as percentage of capillary findings within the group. Differences between PsA and the other groups are presented as p-values. PsA: psoriatic arthritis, PsO: psoriasis vulgaris, OA: hand osteoarthritis, NVC nailfold video capillaroscopy, OCTA: angiographic optical coherence tomography. *: 1 patient (PsO group) was excluded from the analysis because of nail thickness>2.0 mm exceeding the maximum penetration depth of the OCT laser, representing an outlier.

Figure 1.

Optical coherence tomography angiography of the nail and nailbed blood vessels in patients with psoriatic arthritis, psoriasis, and hand osteoarthritis. *: nail plate. ¤: cuticle. #: proximal nailfold. §: one-millimetre field.

Acknowledgements:

The data-analysis of blood flow in angiographic OCT images was kindly performed as a batch analysis by CEO Jon Holmes, Michelson Diagnostics Ltd., Kent.

Disclosure of Interests:

Jørgen Guldberg-Møller Speakers bureau: AbbVie, NOVARTIS, Eli-Lilly and BK Ultrasound outside the present work., Tanja Schjødt Jørgensen Speakers bureau: AbbVie, Pfizer, Roche, Novartis, UCB, Biogen and Eli Lilly., Consultant of: AbbVie, Pfizer, Roche, Novartis, UCB, Biogen and Eli Lilly., Marius Henriksen Consultant of: Advisory Board member of Thuasne Group, France, Karen Ellegaard: None declared, Mette Mogensen: None declared, Lars Erik Kristensen Speakers bureau: Pfizer, AbbVie, Amgen, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen pharmaceuticals., Consultant of: Pfizer, AbbVie, Amgen, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen pharmaceuticals.

AB0554 SLEEP QUALITY IN PATIENTS WITH PSORIATIC ARTHRITIS

Background:

Psoriatic arthritis (PsA) is a chronic immune-mediated inflammatory disease. It has a heterogeneous clinical presentation with main features being joint swelling and pain, skin and nail psoriasis, enthesitis, and dactylitis. Self-reported outcomes such as quality of sleep and fatigue are often neglected topics although having great impact on patients’ everyday lives.

Objectives:

The primary objective was to analyze the prevalence of PsA patients suffering from poor quality of sleep, defined by Pittsburgh Sleep Quality Index (PSQI) score ≥ 5, and to study the association between being a good or poor sleeper and clinical- and patient-reported outcomes.

Secondary, the effects on outcomes after initiation of treatment.

Methods:

Patient characteristics, disease activity and self-reported outcomes were obtained from the PIPA cohort. To evaluate the primary objective, a cross-sectional analysis was conducted including PSQI score at baseline and corresponding data. Patients were divided into two groups, defined as good or poor sleepers (Table 1).

Data from initiation of treatment (baseline) and 4 months follow-up were included when assessing the effect of treatment. Transition of good and poor sleepers from baseline to 4 months follow-up was depicted by a chi-squared test.

A crosstab analysis was performed with baseline PSQI and whether they had widespread pain to investigate a possible link, additionally a Mann-Whitney U test.

Results:

From January 2018-November 2020 a total of 109 patients were included. The prevalence of PsA patients suffering from poor quality of sleep at baseline were 66.1% whereas the remaining 33.9% were deemed good sleepers.

There was no statistically significant difference in patient demographics when comparing good and poor sleepers at baseline. There was a statistically significant difference in patient-reported outcomes such as Visual Analogue Scale (VAS) pain, VAS global, Health Assessment Questionnaire (HAQ) score and Disease Activity Score (DAS28-CRP), with poor sleepers scoring higher.

57 patients had complete data at 4 months follow-up. At baseline 71.9% of them were classified as poor sleepers (Figure 1). A chi-squared test presented the transition at 4 months follow-up. 47.4% of the patients were now classified as poor sleepers.

While 27 poor sleepers became good sleepers, 13 good sleepers became poor sleepers, with data being statistically significant (p 0.001).

The crosstab analysis exposed 75 patients without widespread pain (mean 7.13±3.79) and 31 patients with widespread pain (mean 9.52±4.93).

Baseline PSQI and whether the patients had widespread pain was statistically significant (p 0.018).

Conclusion:

Overall, PsA patients with poor quality of sleep have higher levels in terms of self-reported pain and disease activity.

The amount of good sleepers after 4 months increased, but there was a negative transition of patients going from good to poor sleepers. This could indicate that more factors are important for quality of sleep, e.g. sociopsychological aspects like anxiety, depression, ability to work.

Table 1.

Patient characteristics

Totaln = 109Good sleepersPSQI ≤ 5n = 37Poor sleepersPSQI > 5n = 72nnpFemale, n (%)65 (59.4%)19 (51.4%)3746 (63.9%)720.206Age, yrs53.9 (45.4-62.25)60.4 (45.5-65.2)3751.5 (44.7-59.95)720.144Disease duration, yrs3.86 (1.0-11.0)4.5 (1.04-11.06)342.91 (1.0-10.75)680.352csDMARD, n (%)71 (65.1%)26 (70.2%)3745 (62.5%)720.420bDMARD, n (%)70 (64.2%)24 (64.8%)3746 (63.9%)720.920Patient pain assessment0-100 mm VAS50.0 (21.0-74.5)27.0 (9.0-60.5)3763.5 (32.25-78.0)72<0.001Patient global assessment0-100 mm VAS61.0 (27.5-78.5)35.0 (17.5-59.0)3769.5 (50.0-85.75)72<0.001PsAID fatigue6.0 (3.0-8.0)4.0 (2.5-7.0)376.5 (4.0-8.0)720.488HAQ score, 0-30.75 (0.38-1.25)0.38 (0.25-0.81)370.88 (0.63-1.38)72<0.001PASI1.7 (0.0-9.75)2.0 (0.0-7.3)351.2 (0.0-11.5)650.940DAS28-CRP3.77 (3.02-4.58)3.44 (2.65-3.94)374.07 (3.28-4.93)720.001

Disclosure of Interests:

Peter Benzin: None declared., Zara Rebecca Stisen: None declared., Marie Skougaard: None declared., Tanja Schjødt Jørgensen Speakers bureau: Received consulting fees and/or speaking fees from AbbVie, Pfizer, Roche, Novartis, UCB, Biogen and Eli Lilly, Consultant of: Received consulting fees and/or speaking fees from AbbVie, Pfizer, Roche, Novartis, UCB, Biogen and Eli Lilly, Rebekka L. Hansen: None declared., Lourdes M. Perez-Chada: None declared., Mette Mogensen: None declared., Joseph F. Merola Consultant of: Consultant and/or investigator for Merck, Bristol-Myers Squibb, AbbVie, Dermavant, Eli Lilly, Novartis, Janssen, UCB, Sanofi, Regeneron, Arena, Sun Pharma, Biogen, Pfizer, EMD Sorono, Avotres and Leo Pharma., Lars Erik Kristensen Speakers bureau: Received fees for speaking and consultancy from Pfizer, AbbVie, Amgen, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen pharmaceuticals., Consultant of: Received fees for speaking and consultancy from Pfizer, AbbVie, Amgen, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen pharmaceuticals.

Inflammatory hallmarks of lesser prominence in psoriatic arthritis patients starting biologics: a Nordic population-based cohort study

OBJECTIVES

To assess secular trends in baseline characteristics of PsA patients initiating their first or subsequent biologic DMARD (bDMARD) therapy and to explore prescription patterns and treatment rates of bDMARDs from 2006 to 2017 in the Nordic countries.

METHODS

PsA patients registered in the Nordic rheumatology registries initiating any treatment with bDMARDs were identified. The bDMARDs were grouped as original TNF inhibitor [TNFi; adalimumab (ADA), etanercept (ETN) and infliximab (IFX)]; certolizumab pegol (CZP) and golimumab (GOL); biosimilars and ustekinumab, based on the date of release. Baseline characteristics were compared for the five countries, supplemented by secular trends with R2 calculations and point prevalence of bDMARD treatment.

RESULTS

A total of 18 089 patients were identified (Denmark, 4361; Iceland, 449; Norway, 1948; Finland, 1069; Sweden, 10 262). A total of 54% of the patients were female, 34.3% of patients initiated an original TNFi, 8% CZP and GOL, 7.5% biosimilars and 0.3% ustekinumab as a first-line bDMARD. Subsequent bDMARDs were 25.2% original TNFi, 9% CZP and GOL, 12% biosimilars and 2.1% ustekinumab. From 2015 through 2017 there was a rapid uptake of biosimilars. The total of first-line bDMARD initiators with lower disease activity increased from 2006 to 2017, where an R2 close to 1 showed a strong association.

CONCLUSION

Across the Nordic countries, the number of prescribed bDMARDs increased from 2006 to 2017, indicating a previously unmet need for bDMARDs in the PsA population. In recent years, PsA patients have initiated bDMARDs with lower disease activity compared with previous years, suggesting that bDMARDs are initiated in patients with a less active inflammatory phenotype.

FRI0345 HEAD-TO-HEAD STUDY EVALUATING THE COMBINED ACR50/PASI100 TREATMENT RESPONSE OF IXEKIZUMAB VERSUS ADALIMUMAB: INDIVIDUAL PATIENT DATA FROM A RANDOMIZED, OPEN-LABEL STUDY IN BIOLOGIC-NAÏVE PATIENTS WITH PSORIATIC ARTHRITIS THROUGH WEEK 52

Background:

Multiple biologic DMARDs (bDMARDs) are available for the treatment of psoriatic arthritis (PsA), but there are few direct comparisons of their efficacy and safety. In SPIRIT-H2H study, ixekizumab (IXE), a high-affinity monoclonal antibody selectively targeting IL-17A, was superior to adalimumab (ADA) at Week 24 for simultaneous achievement of ACR50 and 100% improvement from baseline in the Psoriasis Area and Severity Index (PASI 100) in patients (pts) with active PsA. Efficacy on other PsA domains was shown.1

Objectives:

To provide individual patient data demonstrating the simultaneous improvement in musculoskeletal and skin symptoms as assessed by American College of Rheumatology (ACR) response criteria and Psoriasis Area and Severity Index (PASI) percent improvement, respectively.

Methods:

Pts with active PsA fulfilling Classification for Psoriatic Arthritis (CASPAR) criteria, ≥3/66 tender and ≥3/68 swollen joints, ≥3% psoriasis body surface area (BSA) involvement, no prior treatment with bDMARDs, and prior inadequate response to ≥1 conventional synthetic DMARD (csDMARD), were randomized 1:1 to open-label IXE or ADA (label dosing according to presence/absence of moderate-to-severe psoriasis [baseline BSA≥10%, PASI≥12, and static Physician’s Global Assessment≥3]) in Study I1F-MC-RHCF (NCT03151551). In this analysis, max ACRx was defined as the maximum ACRx response a patient can achieve where ACRx derivation follows the typical ACR response criteria: ≥x% improvement in both tender joint count (TJC) and swollen joint count (SJC) and ≥x% improvement in ≥3 of the 5 remaining components, Health Assessment Questionnaire-Disability Index total score (HAQ-DI), C-reactive protein (CRP), Patient Global Assessment (PatGA), Physician Global Assessment (PhyGA), and patient assessment of joint pain (patJP). Missing data were imputed using the last observation carried forward (LOCF) method.

Results:

At baseline, demographic and disease characteristics were similar across treatment groups. Mean baseline values for the ACR core data set were 20.2 (TJC), 10.4 (SJC), 63.8 (PatGA), 10.2 (CRP), 59.2 (PhyGA), 1.2 (HAQ-DI), and 61.0 (patJP). Mean PASI total score was 7.8. Figures 1 and 2 show the maximum ACR response by PASI percent improvement at Weeks 24 and 52, respectively. Independent of joint improvement, more ixekizumab-treated patients compared to adalimumab-treated patients achieved ≥PASI 90 (76.6% vs. 57.5% at week 24 and 83.0% vs. 59.6% at Week 52). Evaluation of patient-level data shows that while very few patients had joint improvement but little skin improvement (max ACRx≥50 and PASI<50; Figures 1 and 2) in both treatment arms (IXE: 1.8%; ADA: 1.4%), fewer patients treated with IXE had no to little improvement in both joint and skin symptoms (PASI<50 and max ACRx<50) than those treated with ADA at Week 24 (IXE: 3.6%; ADA: 13.3%). A similar pattern was observed at Week 52 (Figure 2).

Conclusion:

Ixekizumab treatment was superior to adalimumab when evaluating the combination of musculoskeletal and skin symptoms of PsA as measured by ACR response and PASI response.

References:

[1]Mease PJ, Smolen JS, Behrens F et al., Ann Rheum Dis 2019; 79(1):123-131.

Disclosure of Interests:

Arthur Kavanaugh Grant/research support from: AbbVie, Amgen, Eli Lilly, Novartis, Janssen, Pfizer, Gilead, UCB, Consultant of: AbbVie, Amgen, Eli Lilly, Novartis, Janssen, Pfizer, Gilead, UCB, Ennio Lubrano: None declared, Talia Muram Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Chen-Yen Lin Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Soyi Liu Leage Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, 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, Lars Erik Kristensen Consultant of: UCB Pharma (Advisory Board), Sannofi (Advisory Board), Abbvie (Advisory Board), Biogen (Advisory Board), Speakers bureau: AbbVie, Amgen, Biogen, Bristol-Myers Squibb,Celgene, Eli Lilly, Gilead, Forward Pharma, Janssen Pharmaceuticals, MSD, Novartis, Pfizer, and UCB Pharma

PARE0024 AWARENESS ABOUT FAMILY PLANNING AND PREGNANCY EXPECTATION AMONG PATIENTS WITH CHRONIC INFLAMMATORY DISEASE OF THE SKIN OR JOINTS

Background:

Patients affected by chronic inflammatory diseases of the skin or joints (CIDs; including psoriasis [PSO], rheumatoid arthritis [RA], juvenile idiopathic arthritis [JIA], psoriatic arthritis [PsA], non-radiographic axial spondyloarthritis [nr-axSpA; reported in the survey as ‘axSpA’], or ankylosing spondylitis [AS]) may be challenged in their attempts to have children. A multinational survey conducted in Europe and the US, including 969 patients, revealed that most patients’ concerns regarding family planning and pregnancy (FPP) were inadequately or inconsistently addressed.1

Objectives:

To investigate the general level of information on FPP and the potential concerns among Danish patients with CIDs.

Methods:

An online survey to identify FPP issues was designed, and CID patients aged 18–50 years (yrs) were included. Respondents were recruited through patient organisations providing their members with a link to the questionnaire. In addition to demographics, information relating to time of diagnosis, treatments received, pregnancies, and course of disease were collected along with access to and concerns regarding FPP. Descriptive statistics were applied.

Results:

Eligible patients included 368 with rheumatological diagnoses (RA, PsA, JIA, nr-axSpA, or AS; 304 [83%] female, mean age: 40 yrs; 64 [17%] male, mean age: 42 yrs) and 95 with dermatological diagnoses (PSO or PsA; 64 [67%] female, mean age: 37 yrs; 31 [33%] male, mean age: 42 yrs). Among the rheumatic patients, 43% of females and 53% of males were currently receiving systemic treatment and 37% of females and 22% of males had received >3 different systemic treatments (other than painkillers and non-steroidal anti-inflammatory drugs [NSAIDs]). Lack of access to FPP information was consistent across age groups, but higher in those with dermatological diagnoses (Table).

In total, 68% of patients with rheumatological and 73% with dermatological diagnoses had biological children and among these 18% and 23% of patients, respectively, indicated their disease had affected how many children they had or planned to have. The most frequent concerns among patients with rheumatological diagnoses were the potential physical impact of a pregnancy, disease worsening, heredity and being able to take care of the child (19, 16, 16 and 13%, respectively), whilst disease worsening and heredity (12 and 16%, respectively) were the most frequent concerns in those with dermatological diagnoses. Many patients experienced disease worsening during or after pregnancy (rheumatologic diagnoses: 16% and 34%; dermatologic: 20% and 59%, respectively).

Conclusion:

Danish CID patients of reproductive age have concerns related both to their disease and to FPP, which affect their decisions around family planning. The majority of patients responding to this survey reported limited access to information about FPP, pointing to a need for healthcare professionals to provide standardised family planning information.

References:

[1] Chakravarty E. BMJ Open 2014;4:e004081.

Table.

Thematic analysis and quotes

ThemeDescriptionQuoteOral-RA linksRA medications caused dry mouthThe medications, really, really are awful on your mouth, in particular prednisone. I get very raw gums… it [was] painful to brush my teeth.We don’t have saliva to wash things away. We have a different mouth floraComplicated oral careTime-demanding oral care routines.Multiple oral health care tools and adaptations used depending on current oral health, and RA activity.The severe pain made it very hard to open my mouth to brush my teeth. The joint damage [makes it] really hard to handle a toothbrush.We have to have toothbrushes with a wide handle… and different attachments when we need them.Even with those [special] products, the pain sometimes was just overwhelming. I’m dedicated about brushing my teeth, but boy, it was a struggle. It took me a long time to brush my teeth.Access to professional oral careLack of dental insurance and costs of careLogistical access: multiple dental visits.Physical access: attending appointments; prolonged sitting in a dental chair.I have a hygienist, and a dentist, and a gum dentist and a bunch of dentists with fancy names. I see them every 3 months.Dental offices have dental hygienists. And some of them are an A+, and some of them are C-…it’s important that hygienists are trained, that they really understand the tools.When I go back in the [dental] chair, it was uncomfortable [when first diagnosed]. I struggled. I couldn’t keep my mouth open.Shame due to oral healthShame relating to poor oral health.Seeking oral care possibly considered unusual for their age.I would feel ashamed. Something’s wrong. Everyone around me has these beautiful teeth. I don’t, and something is wrong.I’m getting braces. At my age, I’m getting braces.Table.

Proportion of patients with rheumatological or dermatological diagnoses who reported having little or no access to FPP information, stratified by age

AgeRheumatological diagnosisN (%)Dermatological diagnosisN (%)18–29 yrs19 (49)14 (74)30–39 yrs61 (58)16 (73)40–50 yrs134 (60)34 (63)

Acknowledgments:

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

Disclosure of Interests:

Karen Schreiber Consultant of: UCB Pharma (Advisory Board), Caecilie Johansen Consultant of: UCB Pharma (Advisory Board), Ulla-Fie Jensen Consultant of: UCB Pharma (Advisory Board), Employee of: UCB Pharma, Alexander Egeberg Grant/research support from: Pfizer, Eli Lilly, Novartis, AbbVie, Janssen Pharmaceuticals, the Danish National Psoriasis Foundation and the Kgl Hofbundtmager Aage Bang Foundation, Consultant of: UCB Pharma (Advisory Board), Speakers bureau: AbbVie, Almirall, Leo Pharma, Samsung Bioepis Co. Ltd., Pfizer, Eli Lilly, Novartis, Galderma, Dermavant, UCB Pharma, Mylan, Bristol-Myers Squibb and Janssen Pharmaceuticals, Simon F. Thomsen Grant/research support from: UCB Pharma, AbbVie, Novartis, Sanofi, Leo Pharma, and Janssen Pharmaceuticals, Consultant of: UCB Pharma (Advisory Board), AbbVie, Novartis, Sanofi, Eli Lilly, Roche, Janssen Pharmaceuticals, Pfizer, Celgene, Leo Pharma, Almirall, Speakers bureau: UCB Pharma, AbbVie, Novartis, Sanofi, Eli Lilly and Leo Pharma, Asbjorn L Hansen Consultant of: UCB Pharma (Advisory Board), Employee of: UCB Pharma, Trine Bay Laurberg Consultant of: UCB Pharma (Advisory Board), Lone Skov Grant/research support from: Pfizer, AbbVie, Novartis, Sanofi, Janssen Pharmaceuticals, and LEO Pharma, Consultant of: UCB Pharma (Advisory Board), AbbVie, Janssen Pharmaceuticals, Novartis, Eli Lilly, LEO Pharma, Almirall, and Sanofi, Speakers bureau: AbbVie, Eli Lilly, Novartis, and LEO Pharma. Investigator for AbbVie, Janssen Pharmaceuticals, Boehringer Ingelheim, AstraZeneca, Eli Lilly, Novartis, Regeneron, and LEO Pharma, Lars Erik Kristensen Consultant of: UCB Pharma (Advisory Board), Sannofi (Advisory Board), Abbvie (Advisory Board), Biogen (Advisory Board), Speakers bureau: AbbVie, Amgen, Biogen, Bristol-Myers Squibb,Celgene, Eli Lilly, Gilead, Forward Pharma, Janssen Pharmaceuticals, MSD, Novartis, Pfizer, and UCB Pharma

OP0172 EFFECT OF WEIGHT LOSS AND LIRAGLUTIDE ON SERUM URATE LEVELS AMONG OBESE KNEE OSTEOARTHRITIS PATIENTS: SECONDARY ANALYSIS OF A RANDOMISED CONTROLLED TRIAL

Background:

There is a strong association between gout and obesity. Lowering urate is the cornerstone of gout management [1] and urate levels correlate strongly with central obesity. Previous studies suggest that weight loss has a positive effect on serum urate, however, the studies are sparse and small [2].

Objectives:

To assess the impact of an initial low-calorie diet-induced weight loss and subsequent randomisation to the body weight-lowering drug liraglutide (a glucagon-like peptide 1 receptor agonist) or placebo on serum urate levels.

Methods:

In the LOSE-IT trial (NCT02905864), a randomised, double-blinded, placebo-controlled, parallel group, single-centre trial [3], 156 obese individuals with knee osteoarthritis, but without gout, were offered an initial 8-week intensive diet intervention (week -8 to 0) on Cambridge Weight Plan (800-1000 kcal/day) followed by a weight loss maintenance period in which participants were randomised to either liraglutide 3 mg/day or placebo for 52 weeks. We conducted a secondary analysis of blood samples collected at week -8, 0 and 52. The primary outcome measure was change in serum urate. We used paired t-test for the change from week -8 to 0, and for change from week 0 to 52 we used an ANCOVA model adjusted for stratification factors (sex, age category and obesity class), and the level of the outcome at baseline. Data were analysed as observed (i.e. no imputation of missing data).

Results:

156 individuals were randomised and 155 had blood samples taken at baseline. In the initial intensive diet intervention period (week -8 to 0) they lost a mean of 12.5 kg (95% CI -13.1 to -11.9, n 156). In the following 52 weeks, the liraglutide group lost an additional 4.1 kg (SE 1.2, n 71) whereas the control group was almost unchanged with a weight loss of 0.2 kg (SE 1.2, n 66). Looking at the main outcome of serum urate levels change, the initial intensive diet resulted in a mean decrease of 0.21 mg/dL (95% CI 0.35 to 0.07, n 155) for the entire cohort. In the following year (week 0 to 52) the liraglutide group exhibited a further mean decrease in serum urate of 0.48 mg/dL (SE 0.11, n 69), whereas the placebo group exhibited a slight decrease in mean serum urate of 0.07 mg/dL (SE 0.12, n 65) resulting in a significant between-group difference of -0.40 mg/dL (95% CI -0.69 to -0.12, n 134) – see Figure 1. Four participants in each group experienced serious adverse events; no deaths were observed.

Conclusion:

This secondary analysis of the LOSE-IT trial suggests that liraglutide provides a potential novel serum urate lowering drug mechanism in obese patient populations, with potential implication for gout treatment.

References:

[1]Richette P et al. 2016.Ann Rheum Dis2017;76:29–42.

[2]Nielsen SM et al.Ann Rheum Dis2017 76(11):1870-1882.

[3]Gudbergsen H et al.BMJ2019. 71–2.

Disclosure of Interests:

Kristian Zobbe: None declared, Sabrina Mai Nielsen: None declared, Robin Christensen: None declared, Anders Overgaard: None declared, henrik gudbergsen Speakers bureau: Pfizer 2016, Marius Henriksen: None declared, Henning Bliddal Grant/research support from: received research grant fra NOVO Nordic, Consultant of: consultant fee fra NOVO Nordic, Lene Dreyer: None declared, Lisa Stamp: None declared, Filip Krag Knop Shareholder of: Minority shareholder in Antag Therapeutics Aps, Grant/research support from: AstraZeneca, Gubra, Novo Nordisk, Sanofi and Zealand Pharma, Consultant of: Amgen, AstraZeneca, Boehringer Ingelheim, Carmot Therapeutics, Eli Lilly, MSD/Merck, Mundipharma, Novo Nordisk, Sanofi and Zealand Pharma., Speakers bureau: AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, MedImmune, MSD/Merck, Mundipharma, Norgine, Novo Nordisk, Sanofi and Zealand Pharma., Lars Erik Kristensen Consultant of: UCB Pharma (Advisory Board), Sannofi (Advisory Board), Abbvie (Advisory Board), Biogen (Advisory Board), Speakers bureau: AbbVie, Amgen, Biogen, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Forward Pharma, Janssen Pharmaceuticals, MSD, Novartis, Pfizer, and UCB Pharma

FRI0275 ONE-YEAR TREATMENT RETENTION OF SECUKINUMAB VERSUS TUMOR NECROSIS FACTOR INHIBITORS IN SPONDYLOARTHRITIS. RESULTS FROM FIVE NORDIC BIOLOGIC REGISTRIES

Background:

Tumor necrosis factor inhibitors (TNFi) have been available for more than a decade for treatment of spondyloarthrtitis (SpA). Secukinumab (SEC) represents a new mode of action, but few studies have compared outcomes in patients(pts) treated with SEC vs TNFi – and the optimal treatment strategy in routine care remains to be established. Comparative studies between SEC and adalimumab (ADA) are ongoing.

Objectives:

To describe baseline characteristics and compare 1-yr treatment retention of SEC vs TNFi (ADA/certolizumab pegol(CLZ)/etanercept(ETN)/golimumab(GOL)/infliximab(IFX)) in SpA-pts from 5 Nordic countries.

Methods:

Observational, prospective cohort study. Pts with SpA (ankylosing spondylitis/non-radiographic axial SpA/undifferentiated SpA) starting SEC or any TNFi during 2015-2018 were identified in clinical rheumatology registries of the Nordic countries. Baseline characteristics were retrieved. Country-specific data were pooled. 1-yr treatment retention of SEC vs TNFi was assessed through crude survival probability curves, retention rates and adjusted Cox regression analyses (ADA reference). Analyses were stratified by line of bDMARD and TNFi type.

Results:

In total, 10692 treatment courses (834 SEC, 9858 TNFi) in 7952 patients were included. SEC was rarely used as 1stbDMARD (Table 1), whereas it was the drug most frequently used as 3rd+ line (Table 2). Baseline characteristics were numerically similar for SEC vs TNFi (Table 1).

Table 1.

Patient characteristics at treatment start

1stline2ndline3rd+ lineSECTNFiSECTNFiSECTNFiN70518615626056082067Male, %535544534546Age, yrs45 (14)41 (14)45 (12)44 (13)47 (12)46 (13)BASDAI, mm45 (28)53 (22)52 (22)52 (24)63 (22)58 (24)Concomitant csDMARD, %182723232726

Means (SD) unless otherwise stated

Table 2.

Table 2. 1-yr treatment retention (Kaplan Meier, Cox Regression)

DrugRetentions rates, 1 yr % (95% CI)Adjusted* HR (95% CI) for discontinuation1stlineADA76 (73-79)1CLZ68 (63-72)1.4 (1.1-1.8)ETN74 (71-76)1.1 (0.9-1.3)GOL80 (77-84)0.8 (0.6-1.0)IFX65 (62-67)1.5 (1.3-1.8)SEC76 (62-85)0.9 (0.5-1.6)2ndlineADA72 (68-75)1CLZ58 (51-64)1.5 (1.2-1.9)ETN65 (61-68)1.2 (1.0-1.5)GOL73 (67-77)0.9 (0.7-1.2)IFX67 (63-71)1.2 (0.9-1.5)SEC67 (58-74)1.1 (0.8-1.5)3rd+ lineADA73 (68-77)1CLZ52 (46-57)2.0 (1.6-2.6)ETN65 (61-70)1.3 (1.0-1.6)GOL65 (60-70)1.3 (1.0-1.7)IFX61 (56-66)1.5 (1.2-1.9)SEC61 (57-65)1.4 (1.1-1.8)

* by sex, baseline age, BASDAI, concomitant csDMARD (y/n/missing). Pts with missing baseline BASDAI (41-60%) excluded

1-yr treatment retention varied between the TNFi (Figure,Table 2), with SEC showing retention rates comparable to ADA when used as 1stor 2ndline therapy. However, SEC retention was poorer than ADA when used as 3rd+ therapy, but comparable to retention of other TNFi.

In adjusted Cox regression analyses, confidence intervals were wide and included 1 for SEC vs ADA (1st, 2ndline), whereas there was slightly poorer retention of SEC versus ADA when used as 3rd+ bDMARD (Table 2).

Conclusion:

These observational data in >10.000 biological treatment courses in SpA, showed that SEC was mainly used in bDMARD experienced pts. Baseline characteristics were similar in pts treated with SEC vs TNFi. The 1-yr retention for SEC was similar to that of the TNFi when used as 1stor 2ndline, but poorer than ADA regarding 3rd+ courses. Further analyses are planned to explore confounding by indication and channeling towards treatment.

Acknowledgments:

Glintborg/Lindström shared 1st author, Kristensten/Jacobsson shared last.

Partly funded by NordForsk and FOREUM

Disclosure of Interests:

Bente Glintborg Grant/research support from: Grants from Pfizer, Biogen and Abbvie, Ulf Lindström: None declared, Daniela Di Giuseppe: None declared, Sella Aarrestad Provan Consultant of: Novartis, Björn Gudbjornsson Speakers bureau: Novartis and Amgen, Merete L. Hetland Grant/research support from: BMS, MSD, AbbVie, Roche, Novartis, Biogen and Pfizer, Consultant of: Eli Lilly, Speakers bureau: Orion Pharma, Biogen, Pfizer, CellTrion, Merck and Samsung Bioepis, Brigitte Michelsen Grant/research support from: Research support from Novartis, Consultant of: Consulting fees Novartis, Johan K Wallman Consultant of: AbbVie, Celgene, Eli Lilly, Novartis and UCB Pharma, Kalle Aaltonen: None declared, Anna-Mari Hokkanen Grant/research support from: MSD, Tanja Schjødt Jørgensen Speakers bureau: Abbvie, Pfizer, Roche, Novartis, UCB, Biogen, and Eli Lilly

, Rebekka L. Hansen: None declared, Arni Jon Geirsson: None declared, Kathrine L. Grøn Grant/research support from: BMS, Niels Steen Krogh: None declared, Johan Askling Grant/research support from: JA acts or has acted as PI for agreements between Karolinska Institutet and the following entities, mainly in the context of the ARTIS national safety monitoring programme of immunomodulators in rheumatology: Abbvie, BMS, Eli Lilly, Merck, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi, and UCB Pharma, Lars Erik Kristensen Consultant of: UCB Pharma (Advisory Board), Sannofi (Advisory Board), Abbvie (Advisory Board), Biogen (Advisory Board), Speakers bureau: AbbVie, Amgen, Biogen, Bristol-Myers Squibb,Celgene, Eli Lilly, Gilead, Forward Pharma, Janssen Pharmaceuticals, MSD, Novartis, Pfizer, and UCB Pharma, Lennart T.H. Jacobsson Consultant of: AbbVie, Eli Lilly, Janssen, Novartis and Pfizer

THU0619-HPR PREVALENCE OF DISTAL INTERPHALANGEAL JOINT ULTRASONOGRAPHY FEATURES IN PSORIATIC ARTHRITIS, SKIN PSORIASIS, OSTEOARTHRITIS AND HEALTHY INDIVIDUALS: A CROSS-SECTIONAL STUDY

Background:

Distal interphalangeal (DIP) joint involvement is a feature of both psoriatic arthritis (PsA) and hand osteoarthritis (OA), and nail-changes are features seen both in PsA and nail psoriasis patients without joint involvement (PsO). In both PsA and OA, ultrasonography (US) is used to quantify DIP joint inflammation.

Objectives:

To explore disease-specific US-detected characteristics in the DIP-joints and extensor tendon entheses in patients with DIP-joint OA, PsA, PsO with nail involvement, and healthy controls (HC).

Methods:

In PsA, PsO, OA and HC US examination of DIP joints 2-5 and the extensor tendon were performed. The US images were scored for DIP joint grey-scale synovitis, DIP joint Doppler, osteophytes and erosions (grade 0-3) and presence/absence of enthesitis and peritendonitis of the extensor tendon according to OMERACT standards. Prevalences were calculated on all included fingers (i.e. four fingers per participant), and differences in prevalences were tested using Chi-square statistics.

Results:

Fifty PsA patients (44% females; mean age: 55y), 13 PsO patients (38% females; mean age 54y), 12 OA patients (100% females, mean age 71y), and 29 HC (52% females, mean age 48y) participated. The prevalences across the diagnosis groups are shown in figure 1, and the distribution of US outcomes was significantly different (highest Chi-square P-value: 0.0127). The PsA group had the largest prevalence of extensor tendon enthesitis (45.5%), peritendonitis (15%), and DIP joint erosions (11%), but also exhibited a considerable prevalence of osteophytes (46%). In the PsO group, the most marked findings were synovitis (33%) and enthesitis (35%). The OA group had the largest prevalence of DIP joint synovitis (67%) and osteophytes (88%) but also 25% prevalence of enthesitis. 24% of the HC group had a grade 1 synovitis.

Conclusion:

This cross-sectional study found significant patterns of US findings distributed dependent on the underlying condition. PsA patients were mainly differentiated by the presence of extensor tendon enthesitis and peritendonitis. A high prevalence of enthesitis and synovitis was seen in patients with DIP joint OA. The high prevalence of enthesitis in PsO is consistent with a preclinical phase of PsA in this group.

Disclosure of Interests:

Jørgen Guldberg-Møller Speakers bureau: Novartis, Ely Lilly, AbbVie, BK Ultrasound, Marius Henriksen: None declared, Mikael Boesen Speakers bureau: Image Analysis Group, AbbVie, AstraZeneca, Eli Lilly, Esaote, Glenmark, Novartis, Pfizer, UCB, Lene Dreyer: None declared, Karen Ellegaard: None declared, Marie Skougaard: None declared, Christine Ballegaard: None declared, Ai Lyn Tan: None declared, Richard Wakefield Speakers bureau: Novartis, Janssen, GE, Lars Erik Kristensen Consultant of: UCB Pharma (Advisory Board), Sannofi (Advisory Board), Abbvie (Advisory Board), Biogen (Advisory Board), Speakers bureau: AbbVie, Amgen, Biogen, Bristol-Myers Squibb,Celgene, Eli Lilly, Gilead, Forward Pharma, Janssen Pharmaceuticals, MSD, Novartis, Pfizer, and UCB Pharma

THU0394 COMPARISON OF TREATMENT RETENTION OF SECUKINUMAB AND TNF-INHIBITORS IN PSORIATIC ARTHRITIS. OBSERVATIONAL DATA FROM A NORDIC COLLABORATION

Background:

A head-to-head trial (EXCEED) has indicated similar effectiveness of secukinumab (SEC) and the tumor necrosis factor inhibitor (TNFi) adalimumab (ADA) in psoriatic arthritis (PsA). In the clinical setting, treatment retention serves as a combined measure of overall effectiveness and tolerability.

Objectives:

To explore baseline patient characteristics, and compare treatment retention rates for SEC and each of etanercept (ETN), infliximab (IFX), golimumab (GOL), certolizimab (CZP) and ADA in PsA.

Methods:

Patients starting SEC or any TNFi in 2015-2018, in the 5 Nordic countries, were identified in clinical rheumatology registers. Data were pooled for analysis and stratified by 1st, 2ndand ≥3rdline of treatment. One year treatment retention was compared by crude Kaplan-Meier curves and a proportional hazard model for risk of discontinuation, censored at 1 year and adjusted for sex, age, country and baseline CRP, patient global and use of csDMARD, with ADA as reference.

Results:

In total, 6062 patients with PsA were included, contributing 8172 treatment starts (table 1). SEC was mainly used as 2ndor ≥3rdline treatment. The survival curves and 1-year treatment retention rates, stratified by line of treatment, were similar for SEC compared to the TNFis, with some differences between the different TNFi (fig 1, table 2). Adjusted hazard ratios (HR) also indicated similar risk of SEC withdrawal compared to ADA (table 2).

Table 1.

Patient characteristics at treatment start

1stline2ndline≥3rdlineSECN=164TNFiN=3808SECN=273TNFiN=1767SECN=767TNFiN=1393Females48%47%44%42%36%39%Age, years52 (13)49 (13)50 (12)50 (13)52 (12)51 (12)Disease duration, years12 (10)10 (10)13 (10)13 (10)16 (10)16 (10)Swollen joint count 283 (4)2 (3)2 (3)2 (3)3 (4)2 (3)CRP, mg/L10 (18)10 (17)7 (11)9 (17)13 (22)11 (20)Patient global score57 (24)58 (24)60 (25)59 (26)68 (23)65 (24)Concomitant therapycsDMARD30%60%41%57%49%53% Methotrexate24%49%31%48%40%44% Sulphasalazine2%9%5%5%4%6%

Numbers are mean (SD) unless noted otherwise

Table 2.

One year treatment retention and hazard of discontinuation for SEC and TNFi

Line of treatmentDrugN1 year treatment retention % (95% CI)Adjusted HR (95% CI) for discontinuation1stlineADA56973 (69-76)RefCZP27366 (60-72)1.2 (0.9-1.6)ETN174773 (71-75)0.9 (0.7-1.1)GOL21267 (60-73)1.2 (0.9-1.7)IFX100762 (59-65)1.4 (1.1-1.7)SEC16472 (63-78)1.0 (0.7-1.4)2ndlineADA41569 (63-73)RefCZP17651 (43-58)1.6 (1.2-2.2)ETN70163 (59-66)1.2 (0.9-1.5)GOL15169 (61-76)0.9 (0.6-1.2)IFX32465 (59-70)1.0 (0.8-1.4)SEC27369 (62-74)0.9 (0.7-1.2)≥3rdlineADA34667 (62-72)RefCZP22149 (42-56)1.5 (1.2-2.0)ETN37262 (57-67)1.1 (0.9-1.5)GOL20656 (49-63)1.3 (1.0-1.8)IFX24857 (50-63)1.3 (1.0-1.8)SEC76763 (59-67)1.0 (0.8-1.3)

Conclusion:

In this large study of bDMARD treatment of PsA in clinical practice, SEC was most often used as 2ndor ≥3rdline treatment, and the treatment retention of SEC was comparable with that of TNFi. Further analyses, taking into account other comorbidities, channeling and effectiveness will be presented.

Acknowledgments:

UL and BG are shared first, and LJ and LEK shared last authors.

Partly funded by Nordforsk and FOREUM.

Disclosure of Interests:

Ulf Lindström: None declared, Bente Glintborg Grant/research support from: Grants from Pfizer, Biogen and Abbvie, Daniela Di Giuseppe: None declared, Tanja Schjødt Jørgensen Speakers bureau: Abbvie, Pfizer, Roche, Novartis, UCB, Biogen, and Eli Lilly

, Björn Gudbjornsson Speakers bureau: Novartis and Amgen, Kathrine L. Grøn Grant/research support from: BMS, Sella Aarrestad Provan Consultant of: Novartis, Brigitte Michelsen: None declared, Merete L. Hetland Grant/research support from: BMS, MSD, AbbVie, Roche, Novartis, Biogen and Pfizer, Consultant of: Eli Lilly, Speakers bureau: Orion Pharma, Biogen, Pfizer, CellTrion, Merck and Samsung Bioepis, Johan K Wallman Consultant of: AbbVie, Celgene, Eli Lilly, Novartis and UCB Pharma, Dan Nordström Consultant of: Abbvie, Celgene, Lilly, Novartis, Pfizer, Roche and UCB., Speakers bureau: Abbvie, Celgene, Lilly, Novartis, Pfizer, Roche and UCB., Nina Trokovic: None declared, Thorvardur Love: None declared, Niels Steen Krogh: None declared, Johan Askling Grant/research support from: JA acts or has acted as PI for agreements between Karolinska Institutet and the following entities, mainly in the context of the ARTIS national safety monitoring programme of immunomodulators in rheumatology: Abbvie, BMS, Eli Lilly, Merck, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi, and UCB Pharma, Lennart T.H. Jacobsson Consultant of: AbbVie, Eli Lilly, Janssen, Novartis and Pfizer, Lars Erik Kristensen Consultant of: UCB Pharma (Advisory Board), Sannofi (Advisory Board), Abbvie (Advisory Board), Biogen (Advisory Board), Speakers bureau: AbbVie, Amgen, Biogen, Bristol-Myers Squibb,Celgene, Eli Lilly, Gilead, Forward Pharma, Janssen Pharmaceuticals, MSD, Novartis, Pfizer, and UCB Pharma

FRI0592 IMPACT OF INDIVIDUAL SYMPTOMS OF PSORIATIC ARTHRITIS ON PHYSICAL COMPONENT SCORE AND MENTAL COMPONENT SCORE OF SF-36 AS A MEASURE OF HEALTH RELATED QUALITY OF LIFE (QOL): AN OBSERVATIONAL COHORT STUDY

Background:

Patients with Psoriatic Arthritis (PsA) experience diverse symptoms including skin and nail psoriasis, swollen and tender joints, enthesitis, and fatigue that have shown to impair health related quality of life (QoL). We hypothesized that different elements of disease influence SF-36 physical (PCS) and mental (MCS) component summary scores differently.

Objectives:

The objective of the study was to assess the interaction between change in disease activity (DAS28CRP), PsA symptoms (psoriasis [PsO], nail PsO, enthesitis, fatigue, pain, and physical function) with changes in PCS and MCS scores in a PsA patient cohort exploring effect of treatment on clinical manifestations and patient-reported outcome (PRO).

Methods:

Data were obtained from the PIPA cohort (1) at baseline and after 4 months of treatment. Patients’ characteristics were described as medians with interquartile ranges (IQRs) and numbers with percentages. Data were presented as changes between baseline and follow-up with delta (Δ) values on xyz-plots. Associations between PCS and MCS scores, DAS28CRP, and PsA symptoms were described with fitted linear regression plane models. PCS and MCS were derived from 8 domains of SF-36 and ranged from 0-100 with lower values reflecting more impaired QoL.

Results:

71 PsA patients were included in the study. 40 (56%) patients were female with a mean age of 50 (IQR 41-60) years and disease duration of 2.15 (IQR 0.2-9) years. Figure 1 shows associations between PsA symptoms, DAS28CRP, and PCS (green regression plane) and MCS (blue regression plane). For all PROs; pain, fatigue and physical function, improvements in both ΔPCS and Δ MCS scores were associated with improvements in either Δpain, ΔPsAID fatigue, and/or ΔHAQ, and to a larger extent than improvements in ΔDAS28CRP. Improvements in Δnail PsO (regression coefficient (RC): -0.22) and ΔPASI (RC: -0.31) positively impacts ΔMCS, without a clear association in PCS scores (RC: 0.13 and 0.38 for Δnail PsO and ΔPASI, respectively). Improvement in inflammatory features SPARCC enthesitis and DAS28CRP showed improvement in both ΔPCS and ΔMCS.

Figure 1.

Association between disease activity, individual symptoms and PCS/MCS PCS; physical component summary (green regression plane), MCS; mental component summary (blue regression plane). Arrows indicate the positive improvement vector. SF-36: short form-36, CI: Confidence Interval, DAS28CRP: disease activity score with 28 joints and c-reactive protein, PASI: Psoriasis Area Severity Index, SPARCC: Spondyloarthritis Research Consortium of Canada enthesitis index, VAS: visual analogue scale, PsAID: Psoriatic Arthritis Impact of Disease, HAQ: Health Assessment Questionnaire

Conclusion:

Pain and fatigue are well-known factors to impair QoL in PsA patient. Here we show that diminishing these factors, pain and fatigue, improved both PCS and MCS scores more than changes in DAS28CRP. Improvements in skin and nail manifestations impacted MCS scores and are as important as changes in joint manifestations which affect PCS and MCS scores equally.

References:

[1] Hojgaard P et al. Pain mechanisms and ultrasonic inflammatory activity as prognostic factors in patients with psoriatic arthritis (…) BMJ Open. 20

Disclosure of Interests:

Marie Skougaard: None declared, Tanja Schjødt Jørgensen Speakers bureau: Abbvie, Pfizer, Roche, Novartis, UCB, Biogen, and Eli Lilly, Mia Joranger Jensen: None declared, Christine Ballegaard: None declared, Jørgen Guldberg-Møller Speakers bureau: Novartis, Ely Lilly, AbbVie, BK Ultrasound, Alexander Egeberg Grant/research support from: Pfizer, Eli Lilly, Novartis, AbbVie, Janssen Pharmaceuticals, the Danish National Psoriasis Foundation and the Kgl Hofbundtmager Aage Bang Foundation, Consultant of: UCB Pharma (Advisory Board), Speakers bureau: AbbVie, Almirall, Leo Pharma, Samsung Bioepis Co. Ltd., Pfizer, Eli Lilly, Novartis, Galderma, Dermavant, UCB Pharma, Mylan, Bristol-Myers Squibb and Janssen Pharmaceuticals, Robin Christensen: None declared, Joseph F. Merola Consultant of: Merck, AbbVie, Dermavant, Eli Lilly, Novartis, Janssen, UCB Pharma, Celgene, Sanofi, Regeneron, Arena, Sun Pharma, Biogen, Pfizer, EMD Sorono, Avotres and LEO Pharma, Laura C Coates: None declared, Vibeke Strand Consultant of: AbbVie, Amgen, Biogen, Celltrion, Consortium of Rheumatology Researchers of North America, Crescendo Bioscience, Eli Lilly, Genentech/Roche, GlaxoSmithKline, Hospira, Janssen, Merck, Novartis, Pfizer, Regeneron Pharmaceuticals, Inc., Sanofi, UCB, Philip J Mease Grant/research support from: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – grant/research support, Consultant of: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – consultant, Speakers bureau: Abbott, Amgen, Biogen Idec, BMS, Eli Lilly, Genentech, Janssen, Pfizer, UCB – speakers bureau, Lars Erik Kristensen Consultant of: UCB Pharma (Advisory Board), Sannofi (Advisory Board), Abbvie (Advisory Board), Biogen (Advisory Board), Speakers bureau: AbbVie, Amgen, Biogen, Bristol-Myers Squibb,Celgene, Eli Lilly, Gilead, Forward Pharma, Janssen Pharmaceuticals, MSD, Novartis, Pfizer, and UCB Pharma

THU0614-HPR ASSESSING THE EFFECT OF INTERVENTIONS FOR AXIAL SPONDYLOARTHRITIS ACCORDING TO THE ENDORSED ASAS/OMERACT CORE OUTCOME SET: A META-RESEARCH STUDY OF TRIALS INCLUDED IN COCHRANE REVIEWS

Background:

The Assessment of SpondyloArthritis international Society (ASAS) has defined separate core sets for: i) symptom-modifying anti-rheumatic drugs (SM-ARD), ii) clinical record keeping, and iii) disease-controlling anti-rheumatic therapy (DC-ART). These all include the following domains: ‘physical function’, ‘pain’, ‘spinal mobility’, ‘spinal stiffness’ and ‘patient global assessment’ (PGA). The core set for clinical record keeping further includes the domains ‘peripheral joints’ and ‘acute phase reactants’, and the core set for DC-ART further includes the domains ‘fatigue’, ‘spine/hip radiographs’.

Objectives:

To assess the effect of interventions for each of the 9 axSpA core domains.

Methods:

We investigated the efficacy across all interventions included in Cochrane reviews according to the core outcome set for axSpA, as reported in these eligible axSpA trials. We combined data using the standardized mean difference (SMD) to meta-analyze outcomes involving similar constructs. By meta-regression analysis, we examined the effect for each of the nine separate SMD measures on the primary endpoint across all trials.

Results:

Among 85 articles screened, we included 43 trials with 63 randomized comparisons. Mean (SD) number of core outcomes domains measured for SM-ARD trials was 4.2 (1.7). 6 trials assessed all 5 proposed domains. Mean (SD) for number of core outcome domains for DC-ART trials was 5.8 (1.7). Unfortunately, no trials assessed all 9 domains. 8 trials were judged to have high risk of selective outcome reporting. The most responsible core domains for achieving success in meeting the primary objective per trial were pain; OR (95% CI) 5.19 (2.28, 11.77) and PGA; OR (95% CI) 1.87 (1.14, 3.07).

Conclusion:

Overall outcome reporting was good for SM-ARD trials, and poor for DC-ART trials. None of the DC-ART trials assessed all 9 domains. Outcome-reporting bias and ‘missing data’ should be reduced by implementing the endorsed ASAS/OMERACT outcome domains in all clinical trials. Our findings suggest that PGA and pain likely provide a holistic assessment of disease beyond “objective measures” of spinal inflammation.

Disclosure of Interests:

Rikke Asmussen Andreasen: None declared, Lars Erik Kristensen Consultant of: UCB Pharma (Advisory Board), Sannofi (Advisory Board), Abbvie (Advisory Board), Biogen (Advisory Board), Speakers bureau: AbbVie, Amgen, Biogen, Bristol-Myers Squibb,Celgene, Eli Lilly, Gilead, Forward Pharma, Janssen Pharmaceuticals, MSD, 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, Vibeke Strand Consultant of: AbbVie, Amgen, Biogen, Celltrion, Consortium of Rheumatology Researchers of North America, Crescendo Bioscience, Eli Lilly, Genentech/Roche, GlaxoSmithKline, Hospira, Janssen, Merck, Novartis, Pfizer, Regeneron Pharmaceuticals, Inc., Sanofi, UCB, Philip J Mease Grant/research support from: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – grant/research support, Consultant of: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – consultant, Speakers bureau: Abbott, Amgen, Biogen Idec, BMS, Eli Lilly, Genentech, Janssen, Pfizer, UCB – speakers bureau, Maarten de Wit Grant/research support from: Dr. de Wit reports personal fees from Ely Lilly, 2019, personal fees from Celgene, 2019, personal fees from Pfizer, 2019, personal fees from Janssen-Cilag, 2017, outside the submitted work., Consultant of: Dr. de Wit reports personal fees from Ely Lilly, 2019, personal fees from Celgene, 2019, personal fees from Pfizer, 2019, personal fees from Janssen-Cilag, 2017, outside the submitted work., Speakers bureau: Dr. de Wit reports personal fees from Ely Lilly, 2019, personal fees from Celgene, 2019, personal fees from Pfizer, 2019, personal fees from Janssen-Cilag, 2017, outside the submitted work., Torkell Ellingsen: None declared, Inger Marie Jensen Hansen: None declared, Jamie Kirkham: None declared, George Wells: None declared, Peter Tugwell: None declared, Lara Maxwell: None declared, Maarten Boers: None declared, Kenneth Egstrup: None declared, Robin Christensen Grant/research support from: Dr. Christensen reports non-financial support from Board membership, grants from Consultancy (AbbVie, Amgen, Axellus A/S, Biogen, Bristol-Myers Squibb, Cambridge Weight Plan, Celgene, Eli Lilly, Hospira, MSD, Norpharma, Novartis, Orkla Health, Pfizer, Roche, Sobi, Takeda), personal fees from Employment (Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark), non-financial support from Expert testimony, grants from Grants/grants pending (Axellus A/S, AbbVie, Cambridge Weight Plan, Janssen, MSD, Mundipharma, Novartis, and Roche), grants from Payment for lectures including service on speakers bureaus (Abbott, Amgen, Axellus, Bayer HealthCare Pharmaceuticals, Biogen Idec, Bristol-Myers Squibb, Cambridge Weight Plan, Ipsen, Janssen, Laboratoires Expanscience, MSD, Mundipharma, Norpharma, Novartis, Pfizer, Roche, Rottapharm-Madaus, Sobi, and Wyeth), grants from Payment for manuscript preparation (Axellus, Bristol-Myers Squibb, and Cambridge Weight Plan, Aleris-Hamlet (via Norpharma)), non-financial support from Patents (planned, pending or issued), non-financial support from Royalties, grants from Payment for development of educational presentations (Bristol-Myers Squibb, MSD, Pfizer), non-financial support from Stock/stock options, grants from Travel/accommodations/meeting expenses unrelated to activities listed (Abbott, AbbVie, Axellus, Biogen, Bristol-Myers Squibb, Cambridge Weight Plan, Celgene, Laboratoires Expanscience, Norpharma, Novartis, Pfizer, Roche, Rottapharm-Madaus, and Wyeth), non-financial support from Other (err on the side of full disclosure), outside the submitted work; and I am involved in many health-care initiatives and research that could benefit from wide uptake of this publication (including Cochrane, OMERACT, IDEOM, RADS, and the GRADE Working Group).

Musculoskeletal Statistics Unit, The Parker Institute is grateful for the financial support received from public and private foundations, companies and private individuals over the years. The Parker Institute is supported by a core grant from the Oak Foundation; The Oak Foundation is a group of philanthropic organizations that, since its establishment in 1983, has given grants to not-for-profit organizations around the world.., Consultant of: Dr. Christensen reports non-financial support from Board membership, grants from Consultancy (AbbVie, Amgen, Axellus A/S, Biogen, Bristol-Myers Squibb, Cambridge Weight Plan, Celgene, Eli Lilly, Hospira, MSD, Norpharma, Novartis, Orkla Health, Pfizer, Roche, Sobi, Takeda), personal fees from Employment (Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark), non-financial support from Expert testimony, grants from Grants/grants pending (Axellus A/S, AbbVie, Cambridge Weight Plan, Janssen, MSD, Mundipharma, Novartis, and Roche), grants from Payment for lectures including service on speakers bureaus (Abbott, Amgen, Axellus, Bayer HealthCare Pharmaceuticals, Biogen Idec, Bristol-Myers Squibb, Cambridge Weight Plan, Ipsen, Janssen, Laboratoires Expanscience, MSD, Mundipharma, Norpharma, Novartis, Pfizer, Roche, Rottapharm-Madaus, Sobi, and Wyeth), grants from Payment for manuscript preparation (Axellus, Bristol-Myers Squibb, and Cambridge Weight Plan, Aleris-Hamlet (via Norpharma)), non-financial support from Patents (planned, pending or issued), non-financial support from Royalties, grants from Payment for development of educational presentations (Bristol-Myers Squibb, MSD, Pfizer), non-financial support from Stock/stock options, grants from Travel/accommodations/meeting expenses unrelated to activities listed (Abbott, AbbVie, Axellus, Biogen, Bristol-Myers Squibb, Cambridge Weight Plan, Celgene, Laboratoires Expanscience, Norpharma, Novartis, Pfizer, Roche, Rottapharm-Madaus, and Wyeth), non-financial support from Other (err on the side of full disclosure), outside the submitted work; and I am involved in many health-care initiatives and research that could benefit from wide uptake of this publication (including Cochrane, OMERACT, IDEOM, RADS, and the GRADE Working Group).

Musculoskeletal Statistics Unit, The Parker Institute is grateful for the financial support received from public and private foundations, companies and private individuals over the years. The Parker Institute is supported by a core grant from the Oak Foundation; The Oak Foundation is a group of philanthropic organizations that, since its establishment in 1983, has given grants to not-for-profit organizations around the world.., Speakers bureau: Dr. Christensen reports non-financial support from Board membership, grants from Consultancy (AbbVie, Amgen, Axellus A/S, Biogen, Bristol-Myers Squibb, Cambridge Weight Plan, Celgene, Eli Lilly, Hospira, MSD, Norpharma, Novartis, Orkla Health, Pfizer, Roche, Sobi, Takeda), personal fees from Employment (Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark), non-financial support from Expert testimony, grants from Grants/grants pending (Axellus A/S, AbbVie, Cambridge Weight Plan, Janssen, MSD, Mundipharma, Novartis, and Roche), grants from Payment for lectures including service on speakers bureaus (Abbott, Amgen, Axellus, Bayer HealthCare Pharmaceuticals, Biogen Idec, Bristol-Myers Squibb, Cambridge Weight Plan, Ipsen, Janssen, Laboratoires Expanscience, MSD, Mundipharma, Norpharma, Novartis, Pfizer, Roche, Rottapharm-Madaus, Sobi, and Wyeth), grants from Payment for manuscript preparation (Axellus, Bristol-Myers Squibb, and Cambridge Weight Plan, Aleris-Hamlet (via Norpharma)), non-financial support from Patents (planned, pending or issued), non-financial support from Royalties, grants from Payment for development of educational presentations (Bristol-Myers Squibb, MSD, Pfizer), non-financial support from Stock/stock options, grants from Travel/accommodations/meeting expenses unrelated to activities listed (Abbott, AbbVie, Axellus, Biogen, Bristol-Myers Squibb, Cambridge Weight Plan, Celgene, Laboratoires Expanscience, Norpharma, Novartis, Pfizer, Roche, Rottapharm-Madaus, and Wyeth), non-financial support from Other (err on the side of full disclosure), outside the submitted work; and I am involved in many health-care initiatives and research that could benefit from wide uptake of this publication (including Cochrane, OMERACT, IDEOM, RADS, and the GRADE Working Group).

Musculoskeletal Statistics Unit, The Parker Institute is grateful for the financial support received from public and private foundations, companies and private individuals over the years. The Parker Institute is supported by a core grant from the Oak Foundation; The Oak Foundation is a group of philanthropic organizations that, since its establishment in 1983, has given grants to not-for-profit organizations around the world.

AB0321 EFFECT ON RETENTION RATES OF A NOVEL AUTOINJECTOR E-DEVICE IMPLEMENTED IN CLINICAL PRACTICE IN PATIENTS WITH CHRONIC ARTHRITIS TREATED WITH CERTOLIZUMAB PEGOL; A MULTI-CENTRE STUDY

Background:

Anti-tumour necrosis factor (anti-TNF) adherence is suboptimal and impacted by multiple psychological, practical and physical barriers, such as patient needle phobia, lack of confidence in self-administration skills and forgetting injection dates (1,2). ava®, a reusable electro-mechanical self-injection device (e-Device) developed for certolizumab pegol (CZP) administration, aims to overcome some of these barriers.

Objectives:

The objective of this study was to explore the clinical retention rate of an e-Device aimed at empowering chronic arthritis patients using CZP.

Methods:

Patients treated with CZP were recruited from the Netherlands, Denmark and Sweden through rheumatology clinics to evaluate patient experience with the e-Device. Patients were adults (aged between 18 and 85 years) with RA, axSpA or PsA. After being trained on how to use the e-Device, patients administered 3 consecutive self-injections on their own. Descriptive statistics for baseline characteristics, retention rates and reasons for withdrawal were assessed. Data on physical function (HAQ) are reported for Denmark and Sweden only due to lack of data from Holland.

Results:

59 patients participated in the study (Netherlands: 25; Denmark: 15; Sweden: 19). Most patients were women (71%), with a mean age of 55 years [16.2] and an average disease duration of 12 years [8.8]. A total of 42% and 39% had previously been treated with csDMARD(s) or were currently on csDMARD(s), respectively. 12% of the patients were bio-naive. Only 6 (10%) patients started CZP de novo. The remaining switched device. The most used administration form prior to entering the study was pre-filled syringe (78%). At the time of inclusion, patients were mildly disabled with an average HAQ score of 0.5 [0.6] and a moderate VAS-pain score of 32 [25.1] (data not shown).

The overall retention rate was 42% after 52 weeks, declining to 38% after 104 weeks (Figure 1). A sharp decline is seen at week 8 which coincides with the end of the project phase. Between week 32 and 112 only 4 patients withdrew from the study (Figure 1). The primary reason for withdrawal was patient’s request (Figure 1). Dropout rates due to lack of efficacy or adverse events were as expected compared to other cohorts of biologic therapies. When stratified by country the analysis showed no significant differences between countries (data not shown).

Figure 1.

Overall retention rate and reasons for withdrawal

Conclusion:

An initial large drop-out was evident within the first 8 weeks, whereas almost no drop-out was seen in the extension phase (after week 8). The reasons for withdrawal was primarily patient request. Thus, the injection experience must be tailored carefully when selecting patients for new autoinjector e-Devices to enhance retention on device and patient satisfaction. Not one device fits all.

References:

[1]Maniadakis N, Toth E, Schiff M, et al. A Targeted Literature Review Examining Biologic Therapy Compliance and Persistence in Chronic Inflammatory Diseases to Identify the Associated Unmet Needs, Driving Factors, and Consequences. Adv Ther 2018;35:1333-1335.

[2]Lopez-Gonzalez R, Leon L, Loza E, et al. Adherence to biologic therapies and associated factors in rheumatoid arthritis, spondyloarthritis and psoriatic arthritis: a systematic literature review. Clin Exp Rheumatol 2015;33:559-69.

Acknowledgments:

This study was funded by UCB

Disclosure of Interests:

Tanja Schjødt Jørgensen Speakers bureau: Abbvie, Pfizer, Roche, Novartis, UCB, Biogen, and Eli Lilly, Rebekka L. Hansen: None declared, Bart Pouls: None declared, Bart van den Bemt Grant/research support from: UCB, Pfizer and Abbvie, Consultant of: Delivered consultancy work for UCB, Novartis and Pfizer, Speakers bureau: Pfizer, AbbVie, UCB, Biogen and Sandoz., Christopher Sjowall: None declared, Lars Erik Kristensen Consultant of: UCB Pharma (Advisory Board), Sannofi (Advisory Board), Abbvie (Advisory Board), Biogen (Advisory Board), Speakers bureau: AbbVie, Amgen, Biogen, Bristol-Myers Squibb,Celgene, Eli Lilly, Gilead, Forward Pharma, Janssen Pharmaceuticals, MSD, Novartis, Pfizer, and UCB Pharma

Cause-specific mortality in patients with psoriasis and psoriatic arthritis

BACKGROUND

There are limited data regarding causes of mortality in patients with psoriasis or psoriatic arthritis (PsA).

OBJECTIVES

This retrospective cohort study evaluated the risk and leading causes of mortality in patients with psoriasis or PsA.

METHODS

Individuals with a hospital-based diagnosis of PsA or psoriasis were identified using the Danish National Patient Registry. Matched control individuals were identified from the general population. The main outcome measures were risk of death and cause-specific mortality in patients with psoriasis or PsA.

RESULTS

Death rates per 1000 patient-years (with 95% confidence intervals) vs. controls were 22·3 (19·7-24·9) vs. 13·9 (11·8-16·0) for patients with psoriasis and 10·8 (8·9-12·8) vs. 11·6 (9·6-13·6) for patients with PsA. Survival, according to stratified hazard ratios (HRs), was significantly lower in patients with psoriasis than in controls (HR 1·74, P < 0·001), but not in patients with PsA (HR 1·06, P = 0·19). Significantly increased risk of death was observed in patients with psoriasis vs. controls due to a number of causes; the highest risks were observed for diseases of the digestive system; endocrine, nutritional and metabolic diseases; and certain infectious and parasitic diseases (HRs 3·61, 3·02 and 2·71, respectively). In patients with PsA, increased mortality was observed only for certain infectious and parasitic diseases (HR 2·80) and diseases of the respiratory system (HR 1·46). Patients with psoriasis died at a younger age than controls (mean age 71·0 vs. 74·5 years, P < 0·001).

CONCLUSIONS

Patients with severe psoriasis have increased mortality risk compared with matched controls, due to a number of causes. Evidence to support an increased risk for patients with PsA was less convincing.

Pain and pain mechanisms in patients with inflammatory arthritis: A Danish nationwide cross-sectional DANBIO registry survey

Background

Central pain mechanisms may be prominent in subsets of patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and other spondyloarthritis (SpA). The painDETECT questionnaire (PDQ) identifies neuropathic pain features, which may act as a proxy for centrally mediated pain.

The objectives were to quantify and characterize pain phenotypes (non-neuropathic vs. neuropathic features) among Danish arthritis patients using the PDQ, and to assess the association with on-going inflammation.

Methods

The PDQ was included onto the DANBIO touch screens at 22 departments of Rheumatology in Denmark for six months. Clinical data and patient reported outcomes were obtained from DANBIO. A PDQ-score >18 indicated neuropathic pain features, 13–18 unclear pain mechanism and <13 non-neuropathic pain.

Results

Pain data (visual analogue scale, VAS) was available for 15,978 patients. 7,054 patients completed the PDQ (RA: 3,826, PsA: 1,180, SpA: 1,093). 52% of all patients and 63% of PDQ-completers had VAS pain score ≥ 30 mm. The distribution of the PDQ classification-groups (<13/ 13-18/ >18) were; RA: 56%/24%/20%. PsA: 45%/ 27%/ 28%. SpA: 55% / 24%/ 21%. More patients with PsA had PDQ score >18 compared to RA and SpA (p<0.001). For PDQ > 18 significantly higher scores were found for all patient reported outcomes and disease activity scores. No clinical difference in CRP or swollen joint count was found. Logistic regression showed increased odds for having VAS pain ≥39 mm (the median) for a PDQ-score >18 compared to <13 (OR = 10.4; 95%CI 8.6–12.5).

Conclusions

More than 50% of the Danish arthritis patients reported clinically significant pain. More than 20% of the PDQ-completers had indication of neuropathic pain features, which was related to a high pain-level. PDQ-score was associated with DAS28-CRP and VAS pain but not with indicators of peripheral inflammation (CRP and SJC). Thus, pain classification by PDQ may assist in mechanism-based pain treatment.

Safety of Etoricoxib, Celecoxib, and Nonselective Nonsteroidal Antiinflammatory Drugs in Ankylosing Spondylitis and Other Spondyloarthritis Patients: A Swedish National Population-Based Cohort Study

OBJECTIVE

Safety data regarding the use of etoricoxib and other nonsteroidal antiinflammatory drugs (NSAIDs) in ankylosing spondylitis (AS) and other spondyloarthritis (SpA) patients are rather limited. Our objective was to estimate and compare rates of gastrointestinal, renovascular, and cardiovascular adverse events in patients exposed to etoricoxib, celecoxib, or nonselective NSAIDs or totally unexposed to NSAIDs.

METHODS

We performed a national register-based cohort study on patients with AS or SpA (n = 21,872) identified in the Swedish national patient register from 1987-2009. Treatment exposure was assessed time dependently based on the prescription drug register from 2006-2009, adjusting for sociodemographics and comorbidities derived from national population-based registers.

RESULTS

Exposure to etoricoxib, celecoxib, and nonselective NSAIDs was 7.6%, 3.9%, and 71.2%, respectively. No major risk differences for serious cardiovascular, gastrointestinal, or renal adverse events were seen among the 3 exposure groups. Patients unexposed to NSAIDs had more baseline comorbidities and an increased relative risk for congestive heart failure events during the study period (2.0, 95% confidence interval [95% CI] 1.3-3.2). The relative risk for atherosclerotic events was nonsignificant when compared to the nonselective NSAID group (1.0, 95% CI 0.7-1.5), while the relative risk for gastrointestinal events was lower for unexposed patients (0.5, 95% CI 0.4-0.7).

CONCLUSION

Overall, serious adverse events related to nonselective NSAIDs, etoricoxib, and celecoxib were similar and in the range of what would be expected in a group of SpA patients. Patients unexposed to NSAIDs had considerably more baseline comorbidities and increased risk for congestive heart failure, reflecting a selection of patients being prescribed NSAIDs in clinical practice.

Surgical interventions for nephrolithiasis in ankylosing spondylitis and the general population

OBJECTIVE

The aim of this study was to estimate rates and type of definitive surgical interventions for nephrolithiasis in Swedish patients with ankylosing spondylitis (AS) compared to the general population.

MATERIALS AND METHODS

This national prospective cohort study linked data from Swedish population and healthcare registries. Incidence rates and interventions for nephrolithiasis during follow-up in patients with AS were compared to general population comparator (GPC) subjects.

RESULTS

In total, 8572 AS patients were followed for 49,959 person-years and 39,639 matched GPCs were followed for 225,221 person-years. Mean age at study entry was 46 years [interquartile range (IQR) 36-56 years] and 65% were male. In AS patients with a diagnosis of nephrolithiasis during the study period, 29% (72/250) underwent similar intervention for nephrolithiasis compared to 24% (114/466) GPCs (p = 0.21). The incidence rate ratio (RR) in overall AS patients was 2.9 [95% confidence interval (CI) 2.1-3.8] during a median follow-up of 6.2 years (IQR 3.2-8.6 years). With prior diagnosis of nephrolithiasis, the RR for AS patients compared to GPCs was 3.7 (95% CI 1.8-7.7); without prior nephrolithiasis the RR was 2.1 (95% CI 1.5-3.0). Increasing age [odds ratio (OR) 1.02, 95% CI 1.01-1.03], prior nephrolithiasis diagnosis (OR 3.3, 95% CI 1.97-5.62) and atherosclerotic cardiac disease (OR 2.0, 95% CI 1.03-3.91) were identified as predictors of intervention for nephrolithiasis.

CONCLUSIONS

Patients with AS have an almost three-fold increased risk of surgical intervention for kidney stones, with similar management, compared to the general population.

Hypoglycaemia and QT interval prolongation in type 1 diabetes--bridging the gap between clamp studies and spontaneous episodes

AIMS

We propose a study design with controlled hypoglycaemia induced by subcutaneous injection of insulin and matched control episodes to bridge the gap between clamp studies and studies of spontaneous hypoglycaemia. The observed prolongation of the heart rate corrected QT interval (QTc) during hypoglycaemia varies greatly between studies.

METHODS

We studied ten adults with type 1 diabetes (age 41±15years) without cardiovascular disease or neuropathy. Single-blinded hypoglycaemia was induced by a subcutaneous insulin bolus followed by a control episode on two occasions separated by 4weeks. QT intervals were measured using the semi-automatic tangent approach, and QTc was derived by Bazett's (QTcB) and Fridericia's (QTcF) formulas.

RESULTS

QTcB increased from baseline to hypoglycaemia (403±20 vs. 433±39ms, p<0.001). On the euglycaemia day, QTcB also increased (398±20 vs. 410±27ms, p<0.01), but the increase was less than during hypoglycaemia (p<0.001). The same pattern was seen for QTcF. Plasma adrenaline levels increased significantly during hypoglycaemia compared to euglycaemia (p<0.01). Serum potassium levels decreased similarly after insulin injection during both hypoglycaemia and euglycaemia.

CONCLUSIONS

Hypoglycaemia as experienced after a subcutaneous injection of insulin may cause QTc prolongation in type 1 diabetes. However, the magnitude of prolongation is less than typically reported during glucose clamp studies, possible because of the study design with focus on minimizing unwanted study effects.

Efficacy and drug survival of anti-tumour necrosis factor-alpha therapies in patients with non-radiographic axial spondyloarthritis: an observational cohort study from Southern Sweden

OBJECTIVES

To evaluate the efficacy and drug survival of anti-tumour necrosis factor (anti-TNF) therapy in non-radiographic axial spondyloarthritis (nr-axSpA) patients treated in clinical practice in Southern Sweden.

METHOD

In this cohort study we prospectively included 112 patients with nr-axSpA and high disease activity as well as inadequate response or intolerance to non-steroidal anti-inflammatory drugs (NSAIDs) receiving their first course of anti-TNF therapy. Patients fulfilling modified New York criteria for ankylosing spondylitis (AS) were excluded. The Assessment of SpondyloArthritis International Society (ASAS) criteria for axial SpA were fulfilled by 77% (n = 86) of the included patients.

RESULTS

At baseline, the median age of the cohort was 38 years, 59% were males, 79% of the patients had imaging suggestive of sacroiliitis (primarily inflammation on magnetic resonance imaging, MRI), 71% were HLA-B27 positive, and the median disease duration was 6 years and 10 months. At 6 months of follow-up, the median Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) decreased from 5.6 to 3.2 (p = 0.002), the Bath Ankylosing Spondylitis Functional Index (BASFI) decreased from 3.9 to 1.8 (p = 0.005), and C-reactive protein (CRP) level decreased from 4.4 to 1.7 mg/L (p = 0.001). After 1 year of treatment the Kaplan-Meier estimated drug survival was 76%, and at 2 years of follow-up this value decreased to 65%. Patients with inflammatory MRI findings at baseline had significantly better drug survival [hazard ratio (HR) 0.24, 95% confidence interval (CI) 0.10-0.55, p = 0.001]. Male sex was also associated with higher drug survival (HR 0.45, 95% CI 0.24-0.85, p = 0.011). CRP level at baseline was not associated with drug survival.

CONCLUSIONS

Anti-TNF treatment of patients with nr-axSpA in clinical practice resulted in reduced BASDAI and BASFI scores and good drug survival. The results from this study suggest that male gender and positive imaging at baseline are associated with a favourable treatment course.

Drug survival on TNF inhibitors in patients with rheumatoid arthritis comparison of adalimumab, etanercept and infliximab

Objective

To compare drug survival on adalimumab, etanercept and infliximab in patients with rheumatoid arthritis (RA).

Methods

Patients with RA (n=9139; 76% women; mean age 56 years) starting their first tumour necrosis factor (TNF) inhibitor between 2003 and 2011 were identified in the Swedish Biologics Register (ARTIS). Data were collected through 31 December 2011. Drug survival over up to 5 years of follow-up was compared overall and by period of treatment start (2003–2005/2006–2009; n=3168/4184) with adjustment for age, sex, education, period, health assessment questionnaire (HAQ), disease duration, concomitant disease modifying antirheumatic drug (DMARD) treatment and general frailty (using hospitalisation history as proxy).

Results

During 20 198 person-years (mean/median 2.2/1.7 years) of follow-up, 3782 patients discontinued their first biological (19/100 person-years; 51% due to inefficacy, 36% due to adverse events). Compared with etanercept, infliximab (adjusted HR 1.63, 95% CI 1.51 to 1.77) and adalimumab initiators had higher discontinuation rates (1.26, 95% CI 1.16 to 1.37), and infliximab had a higher discontinuation rate than adalimumab (1.28, 95% CI 1.18 to 1.40). These findings were consistent across periods, but were modified by time for adalimumab versus etanercept (p<0.001; between-drug difference highest the 1st year in both periods). The discontinuation rate was higher for starters in 2006–2009 than 2003–2005 (adjusted HR 1.12, 95% CI 1.04 to 1.20). The composition of 1-year discontinuations also changed from 2003–2005 vs 2006–2009: adverse events decreased from 45% to 35%, while inefficacy increased from 43% to 53% (p<0.001).

Conclusions

Discontinuation rates were higher for infliximab compared with adalimumab and etanercept initiators, and for adalimumab versus etanercept during the 1st year. Discontinuation rates increased with calendar period, as did the percentage discontinuations due to inefficacy.

Presence of peripheral arthritis and male sex predicting continuation of anti-tumor necrosis factor therapy in ankylosing spondylitis: an observational prospective cohort study from the South Swedish Arthritis Treatment Group Register

OBJECTIVE

To examine clinical characteristics as possible predictors of long-term treatment continuation with adalimumab, etanercept, and infliximab in ankylosing spondylitis (AS) patients who had never taken biologics treated in clinical practice.

METHODS

Patients in southern Sweden with active AS starting biologic therapy for the first time between October 1999 and December 2008 (n = 243, 75% men) were included in a structured clinical followup over 2 years. Patients with clinical spondylitis had not responded to at least 2 nonsteroidal antiinflammatory drugs, whereas patients who also had peripheral arthritis (n = 121) had additionally failed at least 1 conventional disease-modifying antirheumatic drug (DMARD) treatment course. The mean ± SD age at inclusion was 43 ± 12 years, with a mean ± SD disease duration prior to treatment of 16 ± 12 years.

RESULTS

The 2-year drug continuation rate was 74%. Male sex (hazard ratio [HR] of premature discontinuation 0.36 [95% confidence interval (95% CI) 0.19-0.68]) and the presence of peripheral arthritis (HR 0.49 [95% CI 0.27-0.88]) were found to be significant predictors of better drug survival. Furthermore, a trend was seen for more favorable drug continuation on treatment with etanercept as compared with infliximab (HR 0.50 [95% CI 0.25-1.04], P = 0.062), whereas no differences were found comparing the 3 anti-tumor necrosis factor agents in other ways. Higher baseline C-reactive protein level (HR 0.99 [95% CI 0.97-1.00], P = 0.12) and concomitant treatment with nonbiologic DMARDs (HR 0.61 [95% CI 0.34-1.10], P = 0.10) also showed trends to entail better drug adherence.

CONCLUSION

AS patients in this study have an excellent 2-year drug survival rate of 74%. Significant predictors for treatment continuation in this study were male sex and the presence of peripheral arthritis.

The number needed to treat for second-generation biologics when treating established rheumatoid arthritis: a systematic quantitative review of randomized controlled trials

OBJECTIVE

To evaluate the number needed to treat (NNT) and the number needed to harm (NNH) of the second-generation biologics abatacept, certolizumab, golimumab, rituximab, and tocilizumab in patients with established rheumatoid arthritis (RA) taking concomitant methotrexate (MTX).

METHODS

A systematic literature search of MEDLINE, EMBASE, Web of Science, and the Cochrane Register of Controlled Trials was conducted up to 1 November 2009. We selected any published randomized, double-blind, MTX-controlled study including RA patients with a mean disease duration of at least 5 years before entering a pivotal trial on second-generation biological therapy. Studies eligible for inclusion involved patients, who had previously shown inadequate response to conventional disease-modifying anti-rheumatic drug (DMARD) therapy. Pre-specified binary outcomes were extracted with a preference for 1-year data (6-month data were used if no data were available for 1 year). Two reviewers independently extracted the data necessary to estimate the absolute measures in a non-responder intention-to-treat (ITT) analysis.

RESULTS

Five randomized controlled trials, one for each of the drugs, were selected and data extracted according to published data at endpoint for American College of Rheumatology 50% (ACR50)-responding patients, and withdrawals due to adverse events. NNT ranged from four to six treated patients to achieve one ACR50 response, while withdrawals due to adverse events were few and non-significant compared to the placebo group, except for rituximab administered as 1000 mg.

CONCLUSION

Comparable efficacy was shown by the five biological agents studied, with few adverse events. However, for rituximab, tocilizumab, and golimumab, only 6-month data were available, hampering the external validity with regard to long-term efficacy and tolerability. A low dose (500 mg) of rituximab may be as effective as the recommended dose of 1000 mg.