Cell lineage-specific mitochondrial resilience during mammalian organogenesis

Mitochondrial activity differs markedly between organs, but it is not known how and when this arises. Here we show that cell lineage-specific expression profiles involving essential mitochondrial genes emerge at an early stage in mouse development, including tissue-specific isoforms present before organ formation. However, the nuclear transcriptional signatures were not independent of organelle function. Genetically disrupting intra-mitochondrial protein synthesis with two different mtDNA mutations induced cell lineage-specific compensatory responses, including molecular pathways not previously implicated in organellar maintenance. We saw downregulation of genes whose expression is known to exacerbate the effects of exogenous mitochondrial toxins, indicating a transcriptional adaptation to mitochondrial dysfunction during embryonic development. The compensatory pathways were both tissue and mutation specific and under the control of transcription factors which promote organelle resilience. These are likely to contribute to the tissue specificity which characterizes human mitochondrial diseases and are potential targets for organ-directed treatments.

POS1044 GUSELKUMAB PROVIDES CONSISTENT AND DURABLE PAIN IMPROVEMENT IN PATIENTS WITH ACTIVE PSORIATIC ARTHRITIS: RESULTS OF 2 PHASE 3, RANDOMIZED, CONTROLLED CLINICAL TRIALS

Background

Guselkumab (GUS), an anti-IL23p19-subunit mAb, demonstrated significant efficacy vs placebo (PBO) in achieving ACR20 response at week (W) 24 in patients (pts) with active PsA in phase 3 trials, DISCOVER-1&2 (D1&2).1,2 Pts with PsA report pain relief as a treatment priority.3

Objectives

To assess GUS treatment effect through 2 years on pt-reported pain across outcome measures.

Methods

Pts with active PsA in D1 (n=381; 31% received 1-2 prior TNFi) and D2 (n=739; biologic-naïve) were randomized (1:1:1) to GUS 100 mg every 4 weeks (Q4W); GUS 100 mg at W0, W4, then Q8W; or PBO with crossover to GUS 100 mg Q4W at W24 (PBO→Q4W). Pts rated pain using visual analog scale (VAS; 0-10; Pt Pain) and reported Bodily Pain intensity over past 4 W via 36-Item Short-Form Health Survey question 21 (0-5). Pts with spondylitis and peripheral arthritis at baseline (BL) rated Spinal and Joint Pain (0-10). Observed mean change, % improvement from BL in tender (TJC; 0-68) and swollen joint counts (SJC; 0-66), and proportion of pts achieving ≥20/≥50% improvement in Pt Pain (nonresponder imputation [NRI]) were evaluated.

Results

In D2, mean BL for Bodily Pain (range: 4.4-4.5), Pt Pain (6.2-6.3), Spinal Pain (6.5-6.7), Joint Pain (6.3-6.8), SJC (11.7-12.9) and TJC (19.8-22.4) indicated moderate pain and disease activity at study outset. GUS-treated pts reported ~2x improvement in Pt Pain, Spinal Pain, Joint Pain, and Bodily Pain intensity at W24 vs PBO, which were maintained or increased at W52 and W100. PBO→Q4W pts had similar improvements. Pt-reported pain appeared more sensitive to treatment effect, with larger differences in % improvement vs PBO than physician-reported TJC/SJC at W24. D1 showed consistent results through 1 year. In 748 GUS-treated pts across D1&2, substantial proportions achieved meaningful improvement in Pt Pain at early time points: 32% (W4) and 48% (W8) achieved ≥20% improvement; 28% (W12) and 33% (W16) achieved ≥50% improvement. At W24, 63%/39% reported ≥20%/≥50% improvement in pain.

Conclusion

GUS provided consistent and durable improvements in pt-reported pain across several outcome measures. Pt-reported pain as an early and sensitive indicator of treatment effect in pts with active PsA and additional factors merits further evaluation.

References

[1]Deodhar A et al. Lancet. 2020;395:1115-25

[2]Mease P et al. Lancet. 2020;395:1126-36

[3]Gudu T et al. Expert Rev Clin Immunol. 2018;14:405-17

Table 1.

Observed Mean (SD) Change from Baseline in Pain Scores, TJC, and SJC at W24, W52, and W100 in DISCOVER-2

W24W52W100GUS Q4WGUS Q8WPBOGUS Q4WGUS Q8WPBO→Q4WGUS Q4WGUS Q8WPBO→Q4WPt Pain (0-10),* N240243243229234231220224215-2.39 (2.35)-2.53 (2.47)-1.08 (2.42)-2.89 (2.68)-3.20 (2.56)-2.75 (2.66)-3.52 (2.62)-3.69 (2.63)-3.41 (2.58)Spinal Pain (0-10), +N806592796488766182-2.26 (2.57)-2.54 (2.70)-1.13 (2.48)-2.74 (2.63)-2.67 (2.71)-2.65 (2.69)-3.11 (2.67)-3.44 (2.71)-3.37 (2.66)Joint Pain (0-10),+N806592796488766182-2.88 (2.17)-2.90 (2.68)-1.40 (2.91)-3.32 (2.27)-3.21 (2.76)-3.42 (2.92)-3.54 (2.35)-3.61 (2.77)-3.80 (2.95)SF-36 (Q21; 0-5), N240243242229234230220224214-0.99 (1.03)-1.03 (1.12)-0.50 (1.11)-1.18 (1.33)-1.29 (1.17)-1.10 (1.16)-1.39 (1.25)-1.47 (1.38)-1.36 (1.27)TJC (0-68), N240243243228234231220224213-11.85(9.88)-10.37(9.49)-7.26(11.15)-15.04(10.51)-13.44(10.03)-14.15(11.39)-16.37(10.70)-15.27(11.10)-16.29(11.27)SJC (0-66), N240243243228234231220224213-8.77(5.46)-8.14(6.07)-6.44(7.20)-10.38(6.17)-9.56(6.28)-10.17(6.79)-10.83(6.66)-10.20(6.88)-10.58(6.15)

*ACR, DAPSA, MDA: VAS 0-10; +BASDAI: VAS 0-10

ACR=American College of Rheumatology; BASDAI=Bath Ankylosing Spondylitis Disease Activity Index; DAPSA=Disease Activity in Psoriatic Arthritis; GUS=guselkumab; MDA=minimal disease activity; PBO=placebo; pt=patient; Q=question; QxW=every x week; SD=standard deviation; SF-36=36-Item Short-Form Survey; SJC=swollen joint count; TJC=tender joint count; VAS=visual analog scale; W=week

Disclosure of Interests

Peter Nash Consultant of: AbbVie, Bristol Myers Squibb, Boehringer, Celgene, Eli Lilly, Gilead, Janssen, Novartis, Pfizer, Roche, Sandoz, and Sun Pharma, Grant/research support from: AbbVie, Bristol Myers Squibb, Boehringer, Celgene, Eli Lilly, Gilead, Janssen, Novartis, Pfizer, Roche, Sandoz, and Sun Pharma, Lai-Shan Tam Consultant of: AbbVie, Boehringer Ingelheim, Eli Lilly, Janssen, Pfizer, and Sanofi, Grant/research support from: Amgen, Boehringer Ingelheim, GSK, Janssen, Novartis, and Pfizer, Wen-Chan Tsai Consultant of: AbbVie, Eli Lilly, Novartis, Pfizer, and Janssen, Ying Ying Leung Consultant of: AbbVie, Eli Lilly, Janssen, and Novartis and on advisory board for Janssen, Daniel Furtner Shareholder of: Johnson & Johnson, Employee of: Janssen, a division of Johnson & Johnson Pte. Ltd, Shihong Sheng Shareholder of: Johnson & Johnson, Employee of: Janssen Research and Development, LLC, Yanli Wang Consultant of: Janssen, Employee of: Cytel, Inc., May Shawi Shareholder of: Johnson & Johnson, Employee of: Janssen Global Services, LLC, Alexa Kollmeier Shareholder of: Johnson & Johnson, Employee of: Janssen Research and Development, LLC, Jonathan Sherlock Shareholder of: Johnson & Johnson, Employee of: Janssen Research and Development, LLC, Daniel Cua Shareholder of: Johnson & Johnson, Employee of: Janssen Research and Development, LLC

POS1029 EFFECTS OF TREATMENT WITH RISANKIZUMAB ON MINIMAL DISEASE ACTIVITY (MDA) AND DISEASE ACTIVITY IN PSORIATIC ARTHRITIS (DAPSA): AN ANALYSIS OF THE KEEPsAKE-1 AND -2 TRIALS

Background

Risankizumab (RZB) is a monoclonal antibody that specifically inhibits interleukin 23.

Objectives

To evaluate the achievement of Minimal Disease Activity (MDA), its components, and achievement of Disease Activity in PsA Low Disease Activity and Remission (DAPSA LDA+REM, [DAPSA score ≤14]) in patients receiving RZB or placebo (PBO) in the KEEPsAKE 1 and 2 clinical trials.

Methods

KEEPsAKE-1 and -2, double-blind, phase 3 trials, evaluated the efficacy of RZB versus PBO for the treatment of adult patients with active psoriatic arthritis (PsA). Patients were randomized (1:1) to receive subcutaneous RZB 150 mg or PBO at weeks 0, 4, and 16. The open label extension began at Week 24 with all patients receiving RZB 150 mg every 12 weeks thereafter. Achievement of MDA, its components, and achievement of DAPSA LDA+REM are reported using non-responder imputation.

Results

MDA achievement at Week 52 in KEEPsAKE-1 was 37.9% for patients originally randomized to RZB and 27.4% for patients originally randomized to PBO. In KEEPsAKE-2, MDA achievement was 27.2% and 33.8% for patients originally randomized to RZB and PBO, respectively. Achievement of MDA and its components are presented in Figure 1. In KEEPsAKE-1, at Week 52 59.2% of patients originally randomized to RZB and 51.4% of patients originally randomized to PBO achieved DAPSA LDA+REM. At Week 52 in KEEPsAKE-2, DAPSA LDA+REM was achieved by 44.6% of patients originally randomized to RZB and 46.6% of patients originally randomized to PBO (Figure 1).

Conclusion

Patients treated with RZB demonstrate achievement of MDA, its components, and DAPSA LDA+REM at Weeks 24 and 52.

Acknowledgements

AbbVie Inc, participated in the study design; study research; collection, analysis and interpretation of data; and writing, reviewing, and approving of this abstract for submission. AbbVie funded the research for this study and provided writing support for this abstract. Medical writing assistance was provided by Trisha Rettig, Ph.D. of AbbVie

Disclosure of Interests

Joseph F. Merola Consultant of: Amgen, Bristol-Myers Squibb, Abbvie, Dermavant, Eli Lilly, Novartis, Janssen, UCB, Sanofi, Regeneron, Sun Pharma, Biogen, Pfizer and Leo Pharma, Iain McInnes Consultant of: AbbVie, Amgen, Astra Zeneca, Compugen, Cabaletta, Evelo, Janssen, Lilly, Novartis, Pfizer, Sanofi, and UCB, Grant/research support from: AbbVie, Amgen, Astra Zeneca, Janssen, Lilly, Novartis, Pfizer, UCB, Arthur Kavanaugh Consultant of: AbbVie Inc., Amgen, Astra-Zeneca, BMS, Celgene, Centocor-Janssen, Pfizer, Roche, and UCB, Grant/research support from: AbbVie Inc., Amgen, Astra-Zeneca, BMS, Celgene, Centocor-Janssen, Pfizer, Roche, and UCB, Peter Nash Speakers bureau: Abbvie, Amgen, Janssen, Lilly, Novartis, Pfizer, UCB, BMS, Rocje, Sanofi, Gilead/Galapagos, MSD, Samsung, Celgene, Amgen, Boehringer, Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, Pfizer, UCB, BMS, Rocje, Sanofi, Gilead/Galapagos, MSD, Samsung, Celgene, Amgen, Boehringer, Grant/research support from: Abbvie, Amgen, Janssen, Lilly, Novartis, Pfizer, UCB, BMS, Rocje, Sanofi, Gilead/Galapagos, MSD, Samsung, Celgene, Amgen, Boehringer, Zhenyi Xue Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Vassilis Stakias Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Ann Eldred Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Sandra Ciecinski Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Kevin Douglas Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Laura Coates Speakers bureau: AbbVie, Amgen, Biogen, Celgene, Eli Lilly, Galapagos, Gilead, Janssen, Medac, Novartis, Pfizer and UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly, Gilead, Galapagos, Janssen, Novartis, Pfizer and UCB, Grant/research support from: AbbVie, Amgen, Celgene, Eli Lilly, Janssen, Novartis and Pfizer

POS1017 GUSELKUMAB PROVIDES CONTINUED IMPROVEMENT IN KEY DOMAINS OF PSORIATIC ARTHRITIS THROUGH 2 YEARS

Background

Recent guidelines from the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) recommend that psoriatic arthritis (PsA) therapy achieve lowest possible disease activity across 6 key domains and related conditions. 1 In the DISCOVER-1&2 trials, guselkumab (GUS) significantly improved signs and symptoms of PsA at Week (W) 24.

Objectives

Evaluate GUS efficacy through W100 of DISCOVER-2 by GRAPPA-recommended PsA domains (peripheral arthritis, skin, dactylitis, enthesitis, axial disease [nails not evaluated]) and related conditions of inflammatory bowel disease (IBD) and uveitis.

Methods

Enrolled adults had active PsA, were naïve to biologics/JAK inhibitors, and had ≥5 swollen and ≥5 tender joints and CRP ≥0.6 mg/dL. Randomized (1:1:1) patients (pts) received GUS 100 mg every 4 weeks (Q4W); GUS 100 mg at W0, W4, then every 8 weeks (Q8W); or placebo (PBO) with crossover to GUS 100 mg Q4W at W24. Outcomes selected aligned with GRAPPA-recommended domains/conditions: overall disease activity (Psoriatic Arthritis Disease Activity Score [PASDAS], Minimal Disease Activity [MDA]), peripheral arthritis (changes in Disease Activity Index for Psoriatic Arthritis [DAPSA] and clinical DAPSA [cDAPSA]), skin (Psoriasis Area and Severity Index [PASI], Investigator’s Global Assessment of psoriasis [IGA]), dactylitis (Dactylitis Severity Score [DSS]), enthesitis (Leeds Enthesitis Index [LEI]), axial disease (spinal pain) and IBD/uveitis (adverse events [AEs]). Among 493 GUS-randomized pts, change from baseline (BL) through W100 in continuous outcomes were analyzed by Repeated Measures Generalized Linear Mixed Effects Models adjusting for respective BL score and GUS regimen. Achievement of therapeutic endpoints was summarized by descriptive statistics using nonresponder imputation (NRI) for missing categorical data.

Results

~90% of GUS-randomized pts completed treatment at W100. For continuous outcomes, improvements over time in key PsA domains extended through W100 of GUS (Figure 1). Therapeutic endpoint response rates also increased incrementally through W100 (Table 1). Mean improvements and response rates were consistent across key domains with no significant difference between GUS regimens. For related conditions, 1 GUS pt had IBD and 4 had uveitis at BL and none had AE of exacerbation through W100. No pt developed IBD through W100 (vs 1 PBO pt through W24); 1 GUS pt had AE of iridocyclitis through W100 (vs 1 PBO pt through W24).

Table 1.

Number (%) of GUS-randomized Pts (N=493) Achieving Therapeutic Endpoints Over Time (NRI)*

WeekQ4WQ8W81624521008162452100MDA*8 (3)33 (14)47 (19)83 (34)93 (38)9 (4)42 (17)63 (25)77 (31)100 (40)DAPSA43 (18)61 (25)88 (36)125 (51)151 (62)43 (17)79 (32)97 (39)130 (52)147 (59) ≤14’; ≤45 (2)12 (5)21 (9)39 (16)52 (21)3 (1)15 (6)23 (9)46 (19)60 (24)cDAPSA41 (17)58 (24)89 (36)125 (51)150 (61)44 (18)75 (30)95 (38)131 (53)147 (60) ≤13* ≤35 (2)13 (5)29 (12)44 (18)59 (24)4 (2)19 (8)25 (10)53 (21)65 (26)PASDAS ≤3.225 (10)44 (18)58 (24)105 (43)126 (51)28 (11)56 (23)76 (31)106 (43)122 (49) ≤1.94 (2)11 (4)22 (9)36 (15)51 (21)2 (1)16 (6)23 (9)52 (21)58 (23)Skin PASI75†-137 (74)146 (79)160 (87)152 (83)-129 (73)139 (79)151 (86)144 (82) PASI90†-100 (54)114 (62)142 (77)136 (74)-97 (55)121 (69)131 (74)123 (70) PASI100†-62 (34)83 (45)106 (58)109 (59)-48 (27)80 (46)93 (53)94 (53) IGA 0/1 Response‡-122 (66)127 (69)147 (80)140 (76)-110 (62)124 (70)131 (74)126 (72)Enthesitis resolution§45 (27)66 (40)71 (43)93 (56)102 (61)50 (32)75 (48)87 (55)97 (62)110 (70)Dactylitis resolution§39 (32)64 (53)80 (66)90 (74)87 (72)34 (31)51 (46)66 (60)86 (77)92 (83)

*Repeated Measures Generalized Linear Mixed Effects Models; excludes pts who achieved endpoint at BL.

†Pts with BL IGA≥2 and BSA≥3%.

‡IGA skin response = score of 0 or 1 and ≥2 grade improvement from BL.

§Among pts with domain at BL.

Conclusion

In DISCOVER-2 bio-naïve PsA pts, both GUS regimens provided continued improvements in key GRAPPA-recommended domains of PsA through up to 2 years of treatment.

References

[1]Coates et al. Ann Rheum Dis 2021;80(suppl 1):139

Disclosure of Interests

Laura Coates Speakers bureau: AbbVie, Amgen, Biogen, Celgene, Eli Lilly, Galapagos, Gilead, Janssen, Medac, Novartis, Pfizer and UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly, Gilead, Galapagos, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Amgen, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, and UCB, Laure Gossec Consultant of: AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GSK, Janssen, Novartis, Pfizer, Samsung Bioepis, Sanofi-Aventis, and UCB, Grant/research support from: Amgen, Eli Lilly, Galapagos, Pfizer, and Sandoz, Christine CONTRE Shareholder of: Johnson & Johnson, Employee of: Janssen Cilag, May Shawi Shareholder of: Johnson & Johnson, Employee of: Janssen Pharmaceutical Companies of Johnson & Johnson, Emmanouil Rampakakis Consultant of: Janssen, Employee of: JSS Medical Research, Natalie Shiff Shareholder of: Johnson & Johnson, Employee of: Janssen Scientific Affairs, LLC, Alexa Kollmeier Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Xie L Xu Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Peter Nash Grant/research support from: Janssen, Abbvie, Pfizer, Novartis, Lilly, Gilead, Roche, Sandoz, Celgene, Sun, Boehringer, and Bristol Myers Squibb, Philip J Mease Speakers bureau: AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer, Sun Pharma, and UCB, Consultant of: AbbVie, Aclaris, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GSK, Inmagene, Janssen, Novartis, Pfizer, Sun Pharma, and UCB, Grant/research support from: AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, Janssen, Novartis, Pfizer, Sun Pharma, and UCB, Philip Helliwell Paid instructor for: Abbvie, Amgen, Novartis, Janssen, Consultant of: Eli Lilly

POS1030 PAIN RESPONSE IN PSORIATIC ARTHRITIS PATIENTS TREATED WITH GUSELKUMAB IS DRIVEN PREDOMINANTLY BY INFLAMMATION-INDEPENDENT EFFECTS

Background

Although reducing inflammation has been associated with pain improvement, the two do not always correlate. Recent studies have suggested that, in addition to its role in inflammation pathogenesis, IL-23 may be involved in pain regulation in a lymphocyte-independent manner1. Guselkumab (GUS), a fully human monoclonal antibody that selectively inhibits IL-23, has demonstrated safety and efficacy in treating multiple domains of active PsA in the DISCOVER-1&2 (D1&D2) trials2,3.

Objectives

To quantify the role of reducing inflammation on the observed relationship between GUS and pain response in PsA patients (pts) using mediation modelling.

Methods

Pooled data from the D1&D2 studies were analyzed. Pts in D1 had ≥3 swollen and ≥3 tender joints (SJC/TJC) and C-reactive protein (CRP)≥0.3 mg/dL; in D2, pts had ≥5 SJC and ≥5 TJC and CRP≥0.6 mg/dL. 31% of D1 pts received 1-2 prior tumor necrosis factor inhibitors (TNFi); D2 pts were bio-naïve. Pts were randomized 1:1:1 to GUS 100 mg every 4 weeks (Q4W); GUS 100 mg at W0, W4, then every 8 weeks (Q8W); or placebo (PBO); PBO pts crossed over to GUS 100 mg Q4W at W24. Pts with history of fibromyalgia were excluded from the analysis. Least square mean changes in pt-reported pain (0-100 VAS) through W52 were estimated with a repeated measures linear mixed model adjusting for known pain determinants. Mediation modelling was performed separately for Q4W & Q8W, W4 & W24, and TNFi-naïve & -experienced (exp) pts. In each model, change in pt-reported pain was the dependent variable; treatment regimen was the independent variable; inflammation, measured by change in SJC or CRP, was the designated mediator; covariates were: age; sex; and baseline (BL) pain score, BMI, SF-36 MCS score, and NSAID use.

Results

Mean (SD) BL pain levels in the GUS Q4W, GUS Q8W, and PBO groups were 60.4 (19.8), 62.0 (20.2), and 61.1 (19.6), respectively. Treatment with GUS was associated with significantly greater pain improvement compared with PBO as early as W4 (ΔQ4W-PBO [95%CI]: -4.9 [-7.6, -2.2]; ΔQ8W-PBO [95%CI]: -5.2 [-7.9, -2.5] (Figure 1). These between-group differences were further enhanced by W24 (ΔQ4W-PBO [95%CI]: -14.6 [-17.6, -11.5]; ΔQ8W-PBO [95%CI]: -14.3 [-17.3, -11.2]); by W52, GUS-randomized pts exhibited an approximate 30-point (̴50%) decrease in pain. Similar results were observed for TNFi-naïve and TNFi-exp pts.

Figure 1.

Mediation analyses demonstrated that the majority of GUS effect on pain at W4 was not attributable to SJC (direct effect), specifically ≤6% was mediated by inflammation as assessed by changes in SJC (indirect effect; Table 1). Similarly, at W24, the indirect effect via SJC improvement represented ≤10% of the GUS treatment effect. No differences were observed between TNFi-naïve and -exp pts at either timepoint.

Consistent results were obtained when using CRP as the mediator variable instead of SJC, whereby ≤2-9%% of GUS effect on pan was mediated by inflammation and 91-98% was direct (Table 1).

Table 1.

Direct (D) Treatment Effect vs. Indirect (IND) Effect via Inflammation Markers on Pain Improvement

MediatorWeekPt GroupEffectGUS Q4WGUS Q8WSJC4AllD96.7%*97.0%*IND†3.3%3%TNFi-NaiveD93.7%*98.5%*IND†6.3%1.5%TNFi-ExpD100%*100%*IND†0%0%24AllD94.8%*92.0%*IND†5.2%*8.0%*TNFi-NaiveD89.6%*90.1%*IND†10.4%*9.9%*TNFi-ExpD99.8%*95.7%*IND†0.2%4.3%CRP4AllD97.6%*95.0%*IND‡2.4%5.0%TNFi-NaiveD98.2%*95.4%*IND‡1.8%4.6%TNFi-ExpD97.6%*95.3%*IND‡2.4%4.7%24AllD97.2%*94.2%*IND‡2.8%5.8%*TNFi-NaiveD98.1%*95.9%*IND‡1.9%4.1%TNFi-ExpD96.5%*91.4%*IND‡3.5%8.6%

*p<0.05; †via SJC; ‡via CRP

Conclusion

GUS induced significant improvement in pt-reported pain as early as W4 of treatment, which was continuously enhanced through W52. While the known mediation effect of SJC and CRP, as markers of inflammation, on pain was confirmed, the majority of GUS’s effect on pain reduction was independent of its effect on these markers, regardless of dosing regimen or prior TNFi experience.

References

[1]Arthritis Res Ther. 2020;22:123

[2]Lancet. 2020;395:1115

[3]Lancet. 2020;395:1126

Disclosure of Interests

Philip J Mease Speakers bureau: AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer, Sun Pharma, and UCB, Consultant of: AbbVie, Aclaris, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Inmagene, Janssen, Novartis, Pfizer, Sun Pharma, and UCB, Grant/research support from: AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, Janssen, Novartis, Pfizer, Sun Pharma, and UCB, Enrique Soriano Speakers bureau: AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Janssen, Novartis, Pfizer, Roche, and UCB, Consultant of: AbbVie, Janssen, Novartis, and Roche, Grant/research support from: AbbVie, Janssen, Novartis, Pfizer, Roche, and UCB, Soumya D Chakravarty Shareholder of: Johnson & Johnson, Employee of: Janssen Scientific Affairs, LLC and Drexel University College of Medicine, Emmanouil Rampakakis Consultant of: Janssen, Employee of: JSS Medical Research, May Shawi Shareholder of: Johnson & Johnson, Employee of: Janssen Pharmaceutical Companies of Johnson & Johnson, Peter Nash Speakers bureau: Janssen, Abbvie, Pfizer, Novartis, Lilly, Gilead, Roche, Sandoz, Celgene, Sun, Boehringer, and Bristol Myers Squibb, Consultant of: Janssen, Abbvie, Pfizer, Novartis, Lilly, Gilead, Roche, Sandoz, Celgene, Sun, Boehringer, and Bristol Myers Squibb, Grant/research support from: Janssen, Abbvie, Pfizer, Novartis, Lilly, Gilead, Roche, Sandoz, Celgene, Sun, Boehringer, and Bristol Myers Squibb, Proton Rahman Speakers bureau: Janssen, Consultant of: AbbVie, Amgen, Bristol Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, and UCB, Grant/research support from: Janssen and Novartis

POS1070 BASELINE DETERMINANTS OF PAIN RESPONSE IN PATIENTS WITH PSORIATIC ARTHRITIS RECEIVING GUSELKUMAB

Background

Pain in patients (pts) with psoriatic arthritis (PsA) has multifaceted origins; sustained improvement is difficult to achieve.1 Guselkumab (GUS), a fully human monoclonal antibody that selectively inhibits IL-23, is effective in treating multiple domains of PsA including joint, skin, and entheseal symptoms, and also elicits long-lasting improvements in pt-reported pain in the DISCOVER-1&2 trials of pts with active PsA.2

Objectives

These post hoc analyses were conducted to identify determinants of changes in pt-reported pain in PsA pts using pooled data through 1 year of DISCOVER-1&2.

Methods

Enrolled adult pts had active PsA despite standard therapies. DISCOVER-1 pts had ≥3 swollen and ≥3 tender joints and C-reactive protein (CRP) ≥0.3 mg/dL; DISCOVER-2 pts had ≥5 swollen and ≥5 tender joints and CRP ≥0.6 mg/dL. 31% of DISCOVER-1 pts received 1-2 prior tumor necrosis factor inhibitors; DISCOVER-2 pts were biologic-naïve. Pts were randomized 1:1:1 to GUS 100 mg every 4 weeks (wks) (Q4W); GUS 100 mg at W0, W4, then every 8 wks (Q8W); or placebo (PBO); PBO pts crossed over to GUS 100 mg Q4W at W24. Determinants with a statistically important effect (p<0.15) on pain (0-100 mm Visual Analogue Scale) in univariate Repeated Measures Generalized Linear Mixed Effects Models were included in a multivariate model employing backward stepwise selection (Pout=0.1) to identify independent determinants of pain improvement over 24 wks; the model was then tested separately in pts treated with PBO (through W24) and with GUS (through W24 and through W52).

Results

GUS was associated with significantly greater improvement in pain compared to PBO as early as 2 wks post-treatment; there was a significant interaction between treatment group and time, with effect of GUS on pain continuously enhanced through W24. Higher baseline (BL) pain score, worse mental health (assessed with the Short-Form-36 Mental Component Summary [SF-36 MCS] score), and lower fatigue level and lower tender joint count [TJC] were also associated with significantly greater pain improvements at W24, while background use of NSAIDs was a negative predictor of pain improvement (Table 1). Treatment effect on pain was independent of PsA duration, gender, PsA subtype, prior TNFi exposure, BL skin disease, and BL swollen joint count (SJC). Continuous significant improvement from BL in pain with GUS extended through W52 even after adjustment for the identified determinants of pain improvement through W24 (Figure 1). At W52, predictors of change in pain remained significant with the exception of SF-36 MCS score (Table 1). Results did not exclude a small number of enrolled pts with fibromyalgia (FM: nGUS=8; nPBO=4). According to these exploratory findings, medical history of FM was associated with lower pain improvement through W24 (p=0.066); in the models run separately in pts with GUS and PBO, pts with FM treated with GUS had a mean (95% CI) pain improvement (-9.1 [-19.5, 1.2]) while pts treated with PBO had a mean worsening (0.7 [-12.5, 13.9]). Pain improvement through 52 wks was significant regardless of FM: pts with FM had a mean (95% CI) improvement of -14.7

Table 1.

Significant Predictors of Change in Pain (W24 and W52)

BL DeterminantW24W52Estimate (95% CL)Estimate (95% CL)Pain score-0.62 (-0.69:-0.55) ‡-0.75 (-0.83:-0.67) ‡Fatigue-0.38 (-0.50:-0.27) ‡-0.37 (-0.53:-0.22) ‡SF-36 MCS0.20 (0.11:0.30)‡0.11 (-0.02:0.24)TJC0.13 (0.06:0.19) †0.12 (0.04:0.21) †NSAID use (Y vs N)2.29 (0.62:3.96) †2.76 (0.55:4.98) *

* p <0.05; †p <0.01; ‡p ≤0.0001

(-25.9, -3.6) comparable to non-FM pts at W24, while pain improvement in pts with no FM was -22.2 (-24.0, -20.4).

Conclusion

Early significant effects of GUS on pain were enhanced through 1 year. Significant predictors of change in pain were consistent at W24 and W52, with the exception of mental health measures. The impact of mental status on pt-reported pain and the potential for GUS to improve pain in pts with FM warrant further consideration.

References

[1]Gudu T et al. Expert Rev Clin Immunol 2018;14(5):405-17.

[2]Nash P et al. ACR Convergence 2021;Nov 5-9 (Poster 21-1368).

Disclosure of Interests

Peter Nash Grant/research support from: Janssen, Abbvie, Pfizer, Novartis, Lilly, Gilead, Roche, Sandoz, Celgene, Sun, Boehringer, and Bristol Myers Squibb, Christopher T. Ritchlin Consultant of: UCB Pharma, Amgen, AbbVie, Lilly, Pfizer, Novartis, Gilead, Janssen, Grant/research support from: UCB Pharma, AbbVie, Amgen, Proton Rahman Consultant of: AbbVie, Amgen, Bristol Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, and UCB, Grant/research support from: Janssen and Novartis, May Shawi Shareholder of: Johnson & Johnson, Employee of: Janssen Pharmaceutical Companies of Johnson & Johnson, Emmanouil Rampakakis Consultant of: Janssen, Employee of: JSS Medical Research, YoungJa Lee Shareholder of: Johnson & Johnson, Employee of: Janssen Asia Pacific, Alexa Kollmeier Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Xie L Xu Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Jonathan Sherlock Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Daniel Cua Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Saakshi Khattri Speakers bureau: AbbVie, Eli Lilly, Glenmark, Ichnos Sciences, Janssen, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Eli Lilly, Glenmark, Ichnos Sciences, Janssen, Novartis, Pfizer, and UCB, Enrique Soriano Speakers bureau: AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Janssen, Novartis, Pfizer, Roche, and UCB, Consultant of: AbbVie, Janssen, Novartis, and Roche, Grant/research support from: AbbVie, Janssen, Novartis, Pfizer, Roche, and UCB, Dennis McGonagle Grant/research support from: AbbVie, Amgen, Bristol Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, Novartis, Pfizer, and UCB

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

Background

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

Objectives

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

Methods

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

Results

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

Conclusion

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

References

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

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

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

Acknowledgements

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

Disclosure of Interests

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

POS1026 PREDICTORS FOR ACHIEVEMENT OF LOW DISEASE ACTIVITY AT WEEK 56 IN PATIENTS WITH PSORIATIC ARTHRITIS WHO RECEIVED UPADACITINIB 15 MG ONCE DAILY: POOLED ANALYSIS OF TWO PHASE 3 STUDIES

Background

Upadacitinib (UPA) 15 mg once daily (QD) has demonstrated efficacy and safety in patients with psoriatic arthritis (PsA) for up to 56 weeks in the Phase 3 SELECT-PsA 1 and 2 trials.1,2

Objectives

This post hoc analysis of these studies explored the association of baseline characteristics and short-term responses with achievement of minimal disease activity (MDA) and Disease Activity Index for Psoriatic Arthritis (DAPSA) low disease activity (LDA).

Methods

Data were pooled from patients with prior inadequate response or intolerance to ≥1 non-biologic (b) DMARDs (SELECT-PsA 1) or ≥1 bDMARDs (SELECT-PsA 2) originally randomized to UPA 15 mg QD. Logistic regression models were used to assess the association between baseline characteristics and short-term (Week 12) responses with achieving MDA or DAPSA LDA at 56 weeks, sustained MDA (MDA at Weeks 36 and 56), or sustained DAPSA LDA (DAPSA LDA at Weeks 36, 44, and 56). Each predictor was evaluated separately in an initial model that included effects for study and concurrent non-bDMARD use. Odds ratios and concordance (c-)statistics were used to determine the predictive accuracy. Statistically significant predictors were then evaluated simultaneously using stepwise logistic regression with the Akaike Information Criterion for model-building.

Results

Of 640 patients included in the analysis, 40% and 47% achieved MDA and DAPSA LDA, respectively, at 56 weeks. Evaluated separately, younger age, sex (male), geographic region, lower weight, lower body mass index, the presence of dactylitis or enthesitis, and lower scores of Patient’s Assessment of Pain (Pt-Pain), Patient’s Global Assessment (PtGA), tender joint count in 68 joints, and Health Assessment Questionnaire-Disability Index (HAQ-DI) were significant baseline predictors for achieving MDA and DAPSA LDA at Week 56. Lower Pt-Pain (Weeks 12–24) and PtGA (Weeks 16–24) scores were strongly predictive (c-statistics >0.8) of achieving MDA at Week 56, and both measures (from Week 8) were moderately predictive (c-statistics >0.7) of achieving DAPSA LDA. Evaluated simultaneously with several baseline characteristics, lower Pt-Pain and HAQ-DI scores at Week 12 were included in models strongly predictive of achieving MDA (c-statistic=0.850; Figure 1) and DAPSA LDA (c-statistic=0.840; Figure 2) at Week 56. For each 1-point increase in Pt-Pain or HAQ-DI scores at Week 12 (after adjusting for other effects in the model), patients were less likely to achieve MDA (by 32% or 56%, respectively) or DAPSA LDA (by 23% or 31%, respectively) at Week 56. Predictors for achieving sustained MDA and sustained DAPSA LDA were generally similar to those identified for achieving MDA and DAPSA LDA, respectively.

Conclusion

In patients with PsA receiving UPA 15 mg, baseline characteristics and early responses strongly predicted achievement of MDA or DAPSA LDA at Week 56. This may guide considerations of treatment targets in clinical trials and encourage physicians to further optimize treatment of their patients in clinical practice.

References

[1]McInnes IB, et al. Ann Rheum Dis 2020;79:16–7.

[2]Mease PJ, et al. Rheumatol Ther 2021 [Epub ahead of print].

Acknowledgements

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

Disclosure of Interests

Daniel Aletaha Consultant of: AbbVie, Grünenthal, Janssen, Medac, Merck, Mitsubishi/Tanabe, Pfizer, Roche, and UCB, Grant/research support from: AbbVie, Grünenthal, Janssen, Medac, Merck, Mitsubishi/Tanabe, Pfizer, Roche, and UCB, Philip J Mease Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Galapagos, Genentech, Gilead, and Janssen, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Galapagos, Genentech, Gilead, and Janssen, Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, and Janssen, Ralph Lippe Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Frank Behrens Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Celgene, Chugai, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, and UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Celgene, Chugai, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, and UCB, Grant/research support from: Chugai, GlaxoSmithKline, Janssen, Pfizer, and Roche, Derek Haaland Speakers bureau: AbbVie, Amgen, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, Takeda, and UCB, Consultant of: AbbVie, Amgen, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, Takeda, and UCB, Grant/research support from: AbbVie, Adiga Life Sciences, Amgen, Bristol-Myers Squibb, Can-Fite BioPharma, Celgene, Eli Lilly, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, Regeneron, Sanofi, and UCB, Penelope Palominos Speakers bureau: AbbVie, Janssen, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Janssen, Novartis, Pfizer, and UCB, Apinya Lertratanakul Shareholder of: formerly of AbbVie, Employee of: former employee of AbbVie, Michael Lane Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Kevin Douglas Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Peter Nash Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, and UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, and UCB, Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, and UCB, Arthur Kavanaugh Speakers bureau: AbbVie, Amgen, Janssen, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Amgen, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Amgen, Janssen, Novartis, Pfizer, and UCB

AB0547 ASSOCIATION BETWEEN ACHIEVEMENT OF LOW DISEASE ACTIVITY OR REMISSION WITH IMPROVEMENT IN QUALITY OF LIFE IN UPADACITINIB-TREATED PATIENTS IN THE PHASE 3 SELECT-PsA 1 AND 2 STUDIES

Background:

The efficacy and safety of upadacitinib (UPA) in patients (pts) with active psoriatic arthritis (PsA) was demonstrated in the phase 3 SELECT-PsA 1 and SELECT-PsA 2 clinical trials.1,2

Objectives:

To explore the relationship between achievement of low disease activity (LDA) or remission (REM) and pt-reported outcomes (PROs) in SELECT-PsA 1 and 2.

Methods:

The SELECT-PsA program enrolled pts with prior inadequate response or intolerance to ≥1 non-biologic disease-modifying antirheumatic drug (DMARD; SELECT-PsA 1) or ≥1 biologic DMARD (SELECT-PsA 2). Pts were randomized to 56 weeks (wks) of blinded treatment with UPA 15 or 30 mg once daily (QD), placebo switched to UPA 15 or 30 mg QD at Wk 24, or adalimumab (SELECT-PsA 1 only) 40 mg every other wk. LDA and REM were evaluated using the minimal disease activity (MDA; fulfillment of 5 out of 7) criteria and the Disease Activity index for Psoriatic Arthritis (DAPSA; cutoff ≤4), respectively. PROs assessed included Health Assessment Questionnaire-Disability Index (HAQ-DI), 36-Item Short-Form Survey physical component summary (SF-36 PCS), 5-Level EuroQol 5-Dimension (EQ-5D-5L) Index, and EQ-5D-5L Visual Analog Scale (VAS). Integrated data through Wk 56 from SELECT-PsA 1 and 2 from the full analysis set with both continuous UPA 15 mg and 30 mg groups were analyzed by responder status at Wks 24 and 56. Changes from baseline (BL) in PROs were analyzed using mixed effects repeated measures models (fixed effects for study, current use of non-biologic DMARDs, treatment group, visit, responder status, and continuous BL PROs). As-observed data were used in the models.

Results:

A total of 1281 pts were included in the analysis (UPA 15 mg, n=640; UPA 30 mg, n=641). MDA was achieved by 33% (UPA 15 mg) and 40% (UPA 30 mg) of patients at

Wk 24, and 40% (UPA 15 mg) and 43% (UPA 30 mg) at Wk 56; and DAPSA-REM by 10% (UPA 15 mg) and 17% (UPA 30 mg) at Wk 24, and 16% (UPA 15 mg) and 18% (UPA 30 mg) at Wk 56. Pts who achieved MDA or DAPSA-REM (responders) at Wk 56 achieved larger reductions in HAQ-DI and larger increases in SF-36 PCS, EQ-5D-5L Index and EQ-5D-5L VAS compared with non-responders (Table 1) (all p<0.0001; statistical significance was exploratory in nature). MDA or DAPSA-REM response at Wk 24 was also associated with greater PRO improvements at Wk 56 (Figure 1). Consistent with the results presented for MDA and DAPSA-REM, patients who achieved Very Low Disease Activity or DAPSA-LDA also experienced greater improvements in PROs than those who did not.

Table 1.

Change from BL in PROs at Wk 56 by MDA and DAPSA-REM responder status at Wk 56

UPA 15 mg QD(n=640)UPA 30 mg QD(n=641)Least squares mean change from BL(95% CI), unless stated otherwiseNon-responderResponderNon-responderResponderMDA, na386254368273HAQ-DI−0.26 (−0.30, −0.22)−0.61* (−0.66, −0.56)−0.27 (−0.31, −0.23)−0.69* (−0.74, −0.64)SF-36 PCS5.25 (4.60, 5.90)12.63* (11.84, 13.41)5.09 (4.42, 5.75)13.84* (13.08,14.59)EQ-5D-5L Index0.11 (0.09, 0.12)0.25* (0.23, 0.26)0.10 (0.09, 0.12)0.27* (0.25, 0.28)EQ-5D-5L VAS9.3 (7.8, 10.9)23.3* (21.4, 25.1)9.0 (7.4, 10.5)26.1* (24.4, 27.9)DAPSA-REM, na539101526115HAQ-DI−0.36 (−0.39, −0.32)−0.63* (−0.71, −0.55)−0.39 (−0.43, −0.35)−0.71* (−0.78, −0.63)SF-36 PCS6.99 (6.39, 7.59)14.54* (13.22, 15.86)7.43 (6.82, 8.03)15.16* (13.91, 16.40)EQ-5D-5L Index0.14 (0.13, 0.15)0.27* (0.24, 0.30)0.15 (0.14, 0.16)0.29* (0.26, 0.31)EQ-5D-5L VAS12.7 (11.3, 14.0)26.7* (23.7, 29.8)13.3 (11.9, 14.7)30.0* (27.1, 32.8)

*p<0.0001 vs non-responder (statistical significance was exploratory in nature)

an may vary by PRO assessed

Conclusion:

Among UPA-treated pts with PsA, improvements in quality of life and physical function were greater in pts who achieved MDA or DAPSA-REM than in those who did not. Despite DAPSA-REM being a more stringent measure (achieved by a smaller proportion of patients), these improvements were similar between MDA and DAPSA-REM responders.

References:

[1]McInnes I, et al. Ann Rheum Dis 2020;79(Suppl 1):16–7; 2. Mease PJ, et al. Ann Rheum Dis 2020

Figure 1.

Acknowledgements:

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

Disclosure of Interests:

Arthur Kavanaugh Grant/research support from: Research grants and/or personal fees from AbbVie, Amgen, Bristol-Myers Squibb, Eli Lilly, Janssen, Novartis, and Pfizer, Philip J Mease Grant/research support from: Research grants and personal fees from AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, and Janssen; and personal fees from Boehringer Ingelheim, Galapagos, Genentech, and Gilead, Kevin Douglas Employee of: Employee of AbbVie and may own stock or options, Frank Behrens Grant/research support from: Research grants from Celgene, Chugai, Janssen, Pfizer, and Roche; personal fees from AbbVie, Boehringer Ingelheim, Celgene, Chugai, Eli Lilly, Genzyme, Janssen, MSD, Novartis, Pfizer, Roche, and Sanofi; and investigator fees from Eli Lilly, Derek Haaland Speakers bureau: Advisory board/speaker bureau membership for AbbVie, Amgen, AstraZeneca, Bristol-Myers Squibb, GSK, Janssen, Novartis, Pfizer, Roche, Sanofi, and Takeda, Consultant of: Honoraria or other fees from AbbVie, Amgen, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, GSK, Janssen, MSD, Novartis, Pfizer, Roche, Sanofi, Takeda, and UCB, Grant/research support from: Research grants from AbbVie, Adiga Life Sciences, Amgen, Bristol-Myers Squibb, Can-Fite Biopharma, Celgene, Eli Lilly, Gilead, GSK, Janssen, Novartis, Pfizer, Regeneron, Sanofi Genzyme, and UCB, Penelope Palominos Speakers bureau: Advisory board/speaker bureau membership for Janssen and Novartis, Consultant of: Personal fees from AbbVie, Grant/research support from: Research support from Novartis, Pfizer, and Roche, Apinya Lertratanakul Employee of: Employee of AbbVie and may own stock or options, Michael Lane Employee of: Employee of AbbVie and may own stock or options, Ralph Lippe Employee of: Employee of AbbVie and may own stock or options, Daniel Aletaha Consultant of: AbbVie, Grünenthal, Janssen, Medac, Mitsubishi Tanabe, MSD, Pfizer, Roche, and UCB, Grant/research support from: AbbVie, Grünenthal, Janssen, Medac, Mitsubishi Tanabe, MSD, Pfizer, Roche, and UCB, Peter Nash Grant/research support from: Received honoraria and research support from AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Eli Lilly, Gilead/Galapagos, Janssen, MSD, Novartis, Pfizer, Roche, Samsung, Sanofi, and UCB.

AB0552 PROBABILITY OF ACHIEVING TREATMENT TARGETS WITH APREMILAST MONOTHERAPY IN BIOLOGIC-NAIVE PSORIATIC ARTHRITIS PATIENTS IN ACTIVE WITH MODERATE AND HIGH BASELINE DISEASE ACTIVITY

Background:

Patients with psoriatic arthritis (PsA) in moderate disease activity (ModDA) who are naive to disease-modifying antirheumatic drugs (DMARDs) have a higher probability of achieving the Clinical Disease Activity Index for PsA (cDAPSA) treatment targets after receiving apremilast 30 mg BID (APR) than those in high disease activity (HDA). In Europe, APR is indicated for the treatment of active PsA in adult patients who had an inadequate response or were intolerant to a prior DMARD therapy. Achievement of cDAPSA treatment targets with APR monotherapy in biologic-naive patients with PsA who had previously taken a maximum of 1 conventional synthetic DMARD (csDMARD) has not been evaluated.

Objectives:

To assess the predictive value of baseline clinical disease status on achieving long-term cDAPSA treatment targets at Week 52 among biologic-naive patients with PsA in the phase 3b, randomized, placebo-controlled Assessing Apremilast Monotherapy in a Clinical Trial of Biologic-Naive Patients With PsA (ACTIVE).

Methods:

ACTIVE enrolled adults with PsA who had ≥3 swollen and ≥3 tender joints and were biologic naive with prior failure of a maximum of 1 csDMARD. In this post hoc analysis, we assessed the probabilities of achieving cDAPSA treatment targets of remission (REM; ≤4) or low disease activity (LDA; >4 to ≤13) at Week 52 in patients randomized to APR and stratified by cDAPSA ModDA (>13 to ≤27) or HDA (>27) at baseline. Patients with enthesitis at baseline in each stratum were analyzed separately.

Results:

Of the 109 patients randomized to APR, 35 were in ModDA (32.1%) and 71 were in HDA (65.1%) at baseline (Table 1). For patients with ModDA vs HDA at baseline, swollen (4.6 vs 10.8) and tender (6.7 vs 21.7) joint counts were lower, and the prevalence of enthesitis was lower (42.9% vs 57.7%) (Table 1). Patients in ModDA at baseline were estimated to be more than twice as likely to achieve treatment targets at Week 52 vs patients in HDA at baseline (Figure 1). Consistent with these results, a higher proportion of patients with ModDA + enthesitis at baseline achieved treatment targets at Week 52 than patients with HDA + enthesitis at baseline (58.9% vs 32.8%).

Table 1.

Baseline Demographics and Disease Characteristics

Baseline cDAPSA CategoryModDA (n = 35)HDA (n = 71)Age, mean (SD), years48.5 (12.9)51.6 (11.8)Women, n (%)20 (57.1)36 (50.7)White, n (%)34 (97.1)71 (100.0)PsA duration, mean (SD), years4.5 (4.6)3.8 (4.5)Enthesitis, n (%)15 (42.9)41 (57.7)SJC (0-66), mean (SD)4.6 (1.6)10.8 (4.3)TJC (0-68), mean (SD)6.7 (2.2)21.7 (11.5)PtGA (0-10 NRS), mean (SD)4.9 (1.4)6.5 (2.0)PhGA (0-10 NRS), mean (SD)5.4 (1.2)6.6 (1.5)

The n represents the total sample. The number of patients with data available may vary. Not included are 3 patients in LDA at baseline. NRS = Numeric Rating Scale; PhGA = Physician’s Global Assessment of Disease Activity; PtGA = Patient’s Global Assessment of Disease Activity; SJC = swollen joint count; TJC = tender joint count.

Figure 1.

Conclusion:

Similar to observations in DMARD-naive patients with PsA, patients who were biologic naive but may have had experience with a maximum of 1 csDMARD, including those with enthesitis, and who were in ModDA at baseline had a higher probability of achieving treatment targets (cDAPSA REM or LDA) at Week 52 with continued APR treatment compared with those with HDA.

Acknowledgements:

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

Disclosure of Interests:

Peter Nash Consultant of: AbbVie, BMS, Celgene, Gilead/Galapagos, GSK, Janssen, Lilly, MSD, Novartis, Pfizer, and Samsung, Grant/research support from: AbbVie, BMS, Celgene, Gilead/Galapagos, GSK, Janssen, Lilly, MSD, Novartis, Pfizer, and Samsung, Sven Richter Employee of: Amgen Inc., Shauna Jardon Employee of: Amgen Inc., Lichen Teng Employee of: Amgen Inc., Jessica A. Walsh Consultant of: AbbVie, Amgen Inc., Janssen, Lilly, Merck, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Amgen Inc., Janssen, Lilly, Merck, Novartis, Pfizer, and UCB.

AB0525 GUSELKUMAB TREATMENT SHOWS RAPID ONSET OF EFFECT ON COMPONENTS OF AMERICAN COLLEGE OF RHEUMATOLOGY RESPONSE CRITERIA: RESULTS OF 2 RANDOMIZED PHASE 3 TRIALS

Background:

Guselkumab (GUS), an anti-interleukin-23p19-subunit monoclonal antibody, demonstrated efficacy vs placebo (PBO) in achieving American College of Rheumatology 20% improvement (ACR20) response in patients (pts) with active psoriatic arthritis (PsA) in two phase 3 trials, DISCOVER-1 & 2.1,2

Objectives:

To assess the differential treatment effects of GUS across individual components of ACR response in PsA pts participating in the DISCOVER-1 & 2 trials.

Methods:

In DISCOVER-1 & 2, 1120 pts were randomized & treated with GUS 100 mg every 4 weeks (Q4W; N=373); GUS 100 mg at Week (W)0 and W4, then Q8W (N=375); or matching PBO (N=372). Pts were evaluated by independent joint assessors at study visits. ACR20 response is defined as ≥20% improvement from baseline in both tender joint count (0-68 [TJC68]) and swollen joint count (0-66 [SJC66]) and ≥20% improvement from baseline in ≥3 of 5 assessments: Patient Assessment of Pain [Pt Pain], Patient Assessment of Global Disease Activity (arthritis) [PtGA], Physician Assessment of Global Disease Activity [PGA], Patient assessment of physical function as measured by Disability Index of the Health Assessment Questionnaire (HAQ-DI), and C-reactive protein (CRP). For each ACR component, achievement of ≥20% improvement from baseline was assessed over time through W24 for the combined (Q4W+Q8W) GUS groups, and median time to onset of treatment effect was determined with Kaplan-Meier curves by randomized group.

Results:

Median time to response for all components except SJC66 occurred earlier with GUS than PBO. Time to onset of ACR20 treatment effect is shown in Figure 1. CRP data show 56% of GUS-treated pts had diminution of systemic inflammation by W4 (Table 1). Reduction in systemic inflammation was accompanied or rapidly followed by GUS-related improvement in both PtGA and PGA (median W4-8). Although SJC66/TJC68 data showed similar patterns, there was also a high PBO response (data not shown). Consistent with early reductions in systemic inflammation, 48-61% of GUS-treated pts had ≥20% improvement in TJC68/SJC66/PGA at W4 (Table 1), and 45-48% had ≥20% improvement in HAQ-DI, PtGA, and Pt Pain by W8. By W24, >80% of GUS-treated pts had ≥20% improvement in SJC66/TJC68/PGA, followed by 63-64% with this degree of improvement in PtGA, CRP, and Pt Pain, and 57% for HAQ-DI.

Conclusion:

GUS demonstrated ACR20 improvements with separation from PBO in ACR components as early as W4, which is consistent with reduced inflammation by GUS and prior serological studies.3 At early study time points, both pts and physicians were able to discern improvements in signs and symptoms of arthritis that rapidly followed reductions in systemic inflammation (CRP). The predominant drivers of ACR20 response rates at W24 in GUS pts were SJC66/TJC68/PGA.

References:

[1]Deodhar A et al. Lancet. 2020;395:1115-25

[2]Mease P et al. Lancet. 2020;395:1126-36

[3]Siebert S et al. EULAR 2020. Presentation OP0229

Table 1.W4W8W12W16W20W24ACR20203950566061HAQ-DI score364552545657SJC66617484868788TJC68486575798081PGA506774788181PtGA354858596264Pt Pain324855586163CRP566062636464Figure 1

Disclosure of Interests:

Peter Nash Consultant of: AbbVie, Bristol Myers Squibb, Boehringer, Celgene, Gilead, Eli Lilly, Janssen, Novartis, Pfizer, Roche, Sandoz, Sun, Grant/research support from: AbbVie, Bristol Myers Squibb, Boehringer, Celgene, Gilead, Eli Lilly, Janssen, Novartis, Pfizer, Roche, Sandoz, Sun, Iain McInnes Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Gilead, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Janssen, and UCB, Christopher T. Ritchlin Consultant of: AbbVie, Amgen, Janssen, Eli Lilly, Gilead, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Amgen, and UCB, Wen-Chan Tsai Consultant of: AbbVie, Eli Lilly, Janssen, Pfizer, and Novartis, Ying Ying Leung Consultant of: Abbvie, Eli Lilly, Janssen, and Novartis, Lai-Shan Tam Consultant of: AbbVie, Boehringer Ingelheim, Janssen, Lilly, Pfizer, and Sanofi, Grant/research support from: Amgen, Boehringer Ingelheim, Janssen, GSK, Novartis, and Pfizer, Daniel Furtner Employee of: Janssen, a division of Johnson & Johnson Pte. Ltd., May Shawi Employee of: Janssen Research and Development, LLC, Stephen Xu Employee of: Janssen Research and Development LLC, Shihong Sheng Employee of: Janssen Research and Development, LLC, Alexa Kollmeier Employee of: Janssen Research and Development, LLC, Atul Deodhar Speakers bureau: AbbVie, Eli Lilly, Janssen, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly, Galapagos, GlaxoSmithKline, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Eli Lilly, GlaxoSmithKline, Novartis, Pfizer, and UCB.

POS0062-PARE REAL-WORLD PATIENT EXPERIENCE AND TREATMENT PREFERENCES IN PATIENTS WITH PSORIATIC ARTHRITIS

Background:

Despite recent advances in the treatment of psoriatic arthritis (PsA), many patients experience inadequate response or intolerance to therapy, indicating that unmet treatment-related needs remain. An understanding of patients’ experience with PsA and its treatment is needed to bring the patient’s perspective into treatment decision-making and development of new therapies.

Objectives:

To better understand real-world PsA patients’ experience with PsA via evaluation of (1) the burden and importance of common PsA symptoms and disease impacts and (2) treatment preferences.

Methods:

A cross-sectional, web-based survey was developed, informed by published literature and treatment guidelines, expert clinical opinion, and cognitive debriefing interviews with PsA patients. Adults with a self-reported diagnosis of PsA were recruited from a US rheumatology patient-centered research registry and other online patient communities. Object case best-worst scaling (BWS) was used to evaluate the relative burden of 11 PsA-related symptoms and the relative importance of improvement in 9 PsA-related disease impacts. BWS data were analyzed using a random parameters logit model. Data on patient demographics and preferences for PsA treatment attributes, including experience with methotrexate and preference for route and frequency of administration, were analyzed descriptively.

Results:

The sample of 247 respondents was 79% female, had a mean age of 53.4 years (range 24-79 years), and had a mean time since PsA diagnosis of 9.4 years, with 86% currently being treated by a rheumatologist. The most common PsA symptoms ever experienced were joint pain, morning stiffness and fatigue, while the least common symptom was skin pain/discomfort related to psoriasis patches. In the BWS, patients reported pain-related symptoms (i.e., joint pain and lower back or spine pain) as the most bothersome, while the least bothersome symptoms were psoriasis-related (Figure 1). Patients reported ability to perform physical activities as the most important disease impact to improve, followed by ability to live/function independently, sleep quality, and ability to do daily activities. Nearly half the sample (49%) stated they would strongly prefer a treatment for PsA that does not include methotrexate. Among patients who were not satisfied with methotrexate, the top reason was dislike of the short-term side effects after each dose. When asked to choose among four different ways of taking their PsA medication (oral once a day, oral twice a day, injection every 2 weeks, injection once a month), the most preferred method was oral once a day (38%) followed by injection once a month (26%), with 24% indicating no preference. Additionally, 49% of the sample felt that mode of administration was an important factor when deciding to start a new therapy.

Conclusion:

Among real-world patients with PsA, the most bothersome PsA symptoms were related to pain while patients most wanted to improve functional impacts of their disease. Patients most preferred an oral once a day treatment option and treatment regimens that do not include methotrexate. These findings can serve to better inform development of new therapies and guide shared patient-provider treatment decision making.

Disclosure of Interests:

Alexis Ogdie Consultant of: Abbvie, Amgen, BMS, Celgene, Corrona, Gilead, Janssen, Lilly, Novartis, Pfizer, UCB, Grant/research support from: Pfizer to Penn, Novartis to Penn, Amgen to Forward/NDB.

Royalties: Novartis to husband, Carol Mansfield: None declared, Kelley Myers: None declared, William Tillett Speakers bureau: AbbVie, Amgen, Celgene, Lilly, Janssen, Novartis, Pfizer Inc., and UCB, Consultant of: AbbVie, Amgen, Celgene, Lilly, Janssen, Novartis, MSD, Pfizer Inc., and UCB, Grant/research support from: AbbVie, Celgene, Eli Lilly, Janssen, Novartis, Pfizer Inc, Peter Nash Grant/research support from: Abbvie, Pfizer, Roche, Sanofi, Boerhringer, Lilly, Novartis, BMS, MSD, Janssen, Gilead, and Samsung, Colton Leach: None declared, W. Benjamin Nowell Grant/research support from: AbbVie, Amgen, and Eli Lilly, Kelly Gavigan: None declared, Patrick Zueger Shareholder of: AbbVie, Employee of: AbbVie, Erin McDearmon-Blondell Shareholder of: AbbVie, Employee of: AbbVie, Jessica A. Walsh Consultant of: AbbVie, Amgen, Eli Lilly and Company, Janssen, Merck, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Merck, Pfizer.

POS0222 PREDICTORS OF RESPONSE: BASELINE CHARACTERISTICS AND EARLY TREATMENT RESPONSES ASSOCIATED WITH ACHIEVEMENT OF REMISSION AND LOW DISEASE ACTIVITY AMONG UPADACITINIB-TREATED PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Upadacitinib (UPA) 15 mg once daily (QD) has demonstrated efficacy in phase 3 studies of patients with rheumatoid arthritis (RA).1–4 Early prediction of response to treatment with UPA could help to optimize therapy.

Objectives:

To identify baseline (BL) characteristics or Week (Wk) 12 disease activity measures that may predict the achievement of remission (REM) or low disease activity (LDA) at 6 months in patients with RA receiving UPA 15 mg.

Methods:

This ad hoc analysis included patients who were randomized to UPA 15 mg QD, as monotherapy in methotrexate (MTX)-naïve patients (SELECT-EARLY) or in combination with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), in patients with an inadequate response (IR) to MTX (SELECT-COMPARE) or ≥1 tumor necrosis factor inhibitors (TNFis) (SELECT-BEYOND and SELECT-CHOICE). The association of BL characteristics (including age, disease duration, prior/concomitant treatments, C-reactive protein [CRP], seropositivity, and disease activity) and Wk 12 disease activity parameters with the achievement of Clinical Disease Activity Index (CDAI) REM (≤2.8) or LDA (≤10) at Wk 24 (or Wk 26 in SELECT-COMPARE) was assessed by concordance statistics (C-statistics), or area under the receiver operator characteristic curve. C-index values and 95% confidence intervals were calculated by fitting a univariate logistic regression model for: demographic and BL characteristics, Wk 12 disease activity measures, and change from BL at Wk 12 in disease activity measures. A multivariate logistic regression with stepwise model selection was also performed. The proportion of patients achieving Wk 24/26 CDAI REM/LDA was stratified by ≥50% improvement from BL in swollen and/or tender joint count in 66/68 joints (SJC66/TJC68).

Results:

A total of 1377 patients were included in the analysis. Across the 4 studies, CDAI REM and LDA were achieved in 11.0–28.4% and 50.0–58.6% of patients, respectively (Table 1). BL demographics and disease characteristics were weakly predictive (C-index <0.70) of Wk 24/26 CDAI REM (C-index 0.49–0.69) or LDA (C-index 0.47–0.65), with the exception of BL Health Assessment Questionnaire-Disability Index in SELECT-BEYOND, which was moderately predictive of CDAI REM (C-index 0.73). Changes from BL in disease activity measures at Wk 12 were weakly or moderately predictive of Wk 24/26 CDAI REM (Figure 1) or LDA. CDAI value at Wk 12 was strongly predictive (C-index >0.80) of Wk 24/26 CDAI REM or LDA. Disease Activity Score in 28 joints using CRP and pain at Wk 12 were strongly predictive of Wk 24/26 CDAI REM (except in SELECT-CHOICE). Physician’s global assessment at Wk 12 was the only common predictor in the multivariate regression models for CDAI REM/LDA at Wk 24/26 across the 4 studies. A greater proportion of patients achieving ≥50% improvement in SJC66 and TJC68 at Wk 12 achieved CDAI REM (16.5–37.8% vs 0–9.4%) or LDA (66.0–72.8% vs 20.9–35.7%) at Wk 24/26 than those who did not.

Table 1.

Achievement of CDAI LDA and REM at Wk 24/26a

SELECT-EARLYSELECT-COMPARESELECT-BEYONDSELECT-CHOICEPatient populationMTX-naïveMTX-IRTNFi-IRTNFi-IRTreatmentUPA 15 mg monotherapy (n=317)UPA 15 mg + MTX(n=651)UPA 15 mg + csDMARD(n=146)UPA 15 mg + csDMARD(n=263)Efficacy at Wk 24/26a, n (%)CDAI REM (≤2.8)90 (28.4)150 (23.0)16 (11.0)60 (22.8)CDAI LDA (≤10)178 (56.2)343 (52.7)73 (50.0)154 (58.6)

a Wk 26 for SELECT-COMPARE only

Conclusion:

BL characteristics did not strongly predict response to UPA, but composite disease activity scores at Wk 12 predicted Wk 24/26 REM/LDA with UPA 15 mg QD across MTX-naïve, MTX-IR, and TNFi-IR patients. ≥50% improvement in SJC/TJC at Wk 12 was also associated with Wk 24/26 REM/LDA.

References:

[1]van Vollenhoven R, et al. Arthritis Rheumatol 2020;72:1607–20; 2. Genovese MC, et al. Lancet 2018;391:2513–24; 3. Fleischmann R, et al. Arthritis Rheumatol 2019;71:1788–800; 4. Rubbert-Roth A, et al. N Engl J Med 2020;383:1511–21.

Acknowledgements:

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

Disclosure of Interests:

Arthur Kavanaugh Consultant of: Janssen, Grant/research support from: Janssen, Zoltán Szekanecz: None declared, Edward C. Keystone Speakers bureau: Abbott, Amgen, AstraZeneca, Biotest, Bristol-Myers Squibb, Eli Lilly, Genentech, Janssen, MSD, Novartis, Pfizer, Roche, Sanofi, and UCB, Consultant of: Abbott, Amgen, AstraZeneca, Biotest, Bristol-Myers Squibb, Eli Lilly, Genentech, Janssen, MSD, Novartis, Pfizer, Roche, Sanofi, and UCB, Grant/research support from: Abbott, Amgen, AstraZeneca, Biotest, Bristol-Myers Squibb, Eli Lilly, Genentech, Janssen, MSD, Novartis, Pfizer, Roche, Sanofi, and UCB, Andrea Rubbert-Roth Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Chugai, Eli Lilly, Janssen, Novartis, Pfizer, Roche, and Sanofi, Stephen Hall Grant/research support from: Pfizer, Ricardo Xavier: None declared, Joaquim Polido-Pereira: None declared, In-Ho Song Shareholder of: May own stock or options in AbbVie, Employee of: AbbVie, Naomi Martin Shareholder of: May own stock or options in AbbVie, Employee of: AbbVie, Yanna Song Shareholder of: May own stock or options in AbbVie, Employee of: AbbVie, Samuel Anyanwu Shareholder of: May own stock or options in AbbVie, Employee of: AbbVie, Peter Nash Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer, Roche, Sanofi, and UCB.

AB0522 SAFETY PROFILE OF UPADACITINIB UP TO 3 YEARS IN PATIENTS WITH PSORIATIC ARTHRITIS: AN INTEGRATED ANALYSIS FROM THE PHASE 3 PROGRAM

Background:

The efficacy and safety of upadacitinib (UPA), an oral Janus kinase inhibitor, in patients (pts) with active psoriatic arthritis (PsA) were demonstrated through 24 weeks in the phase 3 SELECT-PsA 1 and SELECT-PsA 2 placebo-controlled clinical trials.1,2

Objectives:

To describe the long-term integrated safety profile of UPA relative to adalimumab (ADA) in pts with PsA treated in the SELECT program.

Methods:

The SELECT-PsA program enrolled pts with prior inadequate response or intolerance to ≥1 non-biologic DMARD (SELECT-PsA 1) or ≥1 biologic DMARD (SELECT-PsA 2). Both trials include UPA 15 mg and 30 mg, and only SELECT-PsA 1 includes long-term comparison with ADA 40 mg every other week. Treatment-emergent adverse events (TEAEs: AE onset ≥first dose and ≤30 days after last dose for UPA and ≤70 days for ADA) were summarized for the following: pooled UPA 15; pooled UPA 30; and ADA. TEAEs are reported as exposure-adjusted event rates (EAERs; events/100 pts years [E/100 PY]) up to a cut-off date of 20 June 2020.

Results:

2257 pts received ≥1 dose of UPA 15 (N=907; 1247.2 PYs), UPA 30 (N=921; 1257.4 PYs), or ADA (N=429; 549.7 PYs), with median (max) exposures of 69 (155), 69 (154), and 68 (152) weeks, respectively. EAERs of TEAEs and serious AEs were generally similar between UPA 15 and ADA and higher with UPA 30; rates of AEs leading to study drug discontinuation were generally similar across all groups (Table 1). Similarly, rates of serious infection were comparable between UPA 15 and ADA and higher with UPA 30 (Figure 1 next page). The most common serious infection was pneumonia. Rates of herpes zoster were lower with UPA 15 than UPA 30 but higher than ADA. Most herpes zoster events involved a single dermatome; no events involved the central nervous system or other internal organs. Lower rates of opportunistic infections (OI) excluding tuberculosis were observed with UPA 15 vs UPA 30; the most common OI was mucosal candida infection. Malignancies were reported at similar rates across all treatment groups; no events of lymphoma were reported. Age-gender-adjusted standardized incidence ratios for malignancies excluding NMSC indicated no increased risk with UPA compared to the general population. Rates of adjudicated major adverse cardiovascular events and venous thromboembolic events were ≤0.3 E/100 PY for both UPA arms; all pts had ≥1 risk factor. One adjudicated gastrointestinal perforation was reported with UPA 15.

Table 1.

Overall Treatment-emergent AEs for Upadacitinib and Adalimumab (E/100 PY [95% CI])

UPA 15 mg QDN=907(1247.2 PY)UPA 30 mg QDN=921(1257.4 PY)ADA 40 mg EOWN=429(549.7 PY)AEs263.9 (254.9, 272.9)321.5 (311.6, 331.5)286.5 (272.4, 300.7)Serious AEs10.3 (8.6, 12.1)13.2 (11.2, 15.2)9.6 (7.0, 12.2)AE leading to discontinuation6.7 (5.2, 8.1)7.8 (6.2, 9.3)7.8 (5.5, 10.2)Deathsa0.2 (-0.1, 0.4)0.2 (-0.0, 0.5)0.2 (-0.2, 0.5)

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

ADA, adalimumab; AE, adverse event; CI, confidence interval; E, event; EOW, every other week; PY, patient years; QD, once daily; UPA, upadacitinib.

Hepatic disorders were mostly transient, non-serious transaminase increases. Creatine phosphokinase elevations were reported more frequently with UPA 30 vs UPA 15; most were asymptomatic with no rhabdomyolysis reported. AEs of anemia, neutropenia, and lymphopenia were generally mild or moderate, non-serious. Except for rates of lymphopenia (higher with UPA 15), hepatic disorders, and neutropenia (both higher with ADA), lab-related TEAEs occurred at generally consistent rates between UPA 15 and ADA. Study drug discontinuation due to lab-related TEAEs was uncommon.

Conclusion:

The safety profiles of UPA 15 and ADA were generally similar; the rates of most AEs were higher with UPA 30 compared with ADA. Through the cut-off date, the safety profile of UPA 15 and UPA 30 in PsA pts demonstrated consistent results compared to what has been observed with UPA in rheumatoid arthritis.3

References:

[1]McInnes IB et al. Ann Rheum Dis, 2020; 79:12.

[2]Mease PJ et al. Ann Rheum Dis, 2020.

[3]Cohen SB et al. Ann Rheum Dis, 2020.

Figure 1

Acknowledgements:

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

Disclosure of Interests:

Gerd Rüdiger Burmester Speakers bureau: AbbVie, Gilead, Lilly, Pfizer, Consultant of: AbbVie, Gilead, Lilly, Pfizer, Kevin Winthrop Consultant of: UCB Pharma, Pfizer, Bristol-Myers Squibb, Eli Lilly, AbbVie, Gilead, Galapagos, and Roche, Grant/research support from: UCB Pharma, Pfizer, Bristol-Myers Squibb, Eli Lilly, AbbVie, Gilead, Galapagos, and Roche, Ricardo Blanco Consultant of: Abbvie, Lilly, Novartis, Pfizer, Roche, Bristol-Myers, Janssen, and MSD, Grant/research support from: Abbvie, MSD and Roche, Peter Nash Consultant of: AbbVie, BMS, Roche, Pfizer, Janssen, Amgen, Sanofi-Aventis, UCB, Eli Lilly, Novartis, and Celgene, Grant/research support from: AbbVie, BMS, Roche, Pfizer, Janssen, Amgen, Sanofi-Aventis, UCB, Eli Lilly, Novartis, and Celgene, Philippe Goupille Consultant of: AbbVie, Amgen, Biogen, BMS, Celgene, Chugai, Janssen, Lilly, Medac, MSD, Nordic Pharma, Novartis, Pfizer, Sanofi and UCB, Grant/research support from: AbbVie, Amgen, Biogen, BMS, Celgene, Chugai, Janssen, Lilly, Medac, MSD, Nordic Pharma, Novartis, Pfizer, Sanofi and UCB, Valderilio F Azevedo Consultant of: AbbVie, BMS, Pfizer, Janssen, Amgen, Novartis, Eli Lilly, UCB, Celltrion and GSK, Grant/research support from: AbbVie, BMS, Pfizer, Janssen, Amgen, Novartis, Eli Lilly, UCB, Celltrion and GSK, Carlo Salvarani Consultant of: Roche, Sanofi-Genzyme, AbbVie, Pfizer, Lilly, Novartis, Amgen, Grant/research support from: Roche, Sanofi-Genzyme, AbbVie, Pfizer, Lilly, Novartis, Amgen, Andrea Rubbert-Roth Consultant of: AbbVie, BMS, Chugai, Roche, Gilead, Janssen, Lilly, Sanofi, Amgen, Novartis, Grant/research support from: AbbVie, BMS, Chugai, Roche, Gilead, Janssen, Lilly, Sanofi, Amgen, Novartis, Elizabeth Lesser Shareholder of: AbbVie, Employee of: AbbVie, Reva McCaskill Shareholder of: AbbVie, Employee of: AbbVie, Jianzhong Liu Shareholder of: AbbVie, Employee of: AbbVie, Bosny Pierre-Louis Shareholder of: AbbVie, Employee of: AbbVie, Sandra Walko Shareholder of: AbbVie, Employee of: AbbVie, Ralph Lippe Shareholder of: AbbVie, Employee of: AbbVie, Apinya Lertratanakul Shareholder of: AbbVie, Employee of: AbbVie, Eric Ruderman Consultant of: AbbVie, Amgen, Gilead, Janssen, Lilly, Novartis, and Pfizer.

AB0529 CHARACTERIZATION OF REMISSION IN PATIENTS WITH PSORIATIC ARTHRITIS TREATED WITH UPADACITINIB: POST-HOC ANALYSIS FROM TWO PHASE 3 TRIALS

Background:

For patients (pts) with PsA, several disease activity measures are available including very low/minimal disease activity (VLDA/MDA), cutoffs based on the Disease Activity in PsA (DAPSA) score, and on the Psoriatic Arthritis Disease Activity Score (PASDAS) score.

Objectives:

To assess the rates of pts achieving these remission or low disease activity (LDA) criteria at Wk 24 using data from the SELECT-PsA 1 and SELECT-PsA 2 phase 3 studies;1,2 Additionally, we assessed the distribution of individual MDA components among pts who did or did not achieve MDA criteria at Wk 24.

Methods:

In SELECT-PsA 1 and SELECT-PsA 2, pts with PsA and prior inadequate response (IR) or intolerance to ≥1 non-biologic DMARD (N=1705) or ≥1 biologic DMARD (N=642), respectively, were randomized to once daily upadacitinib (UPA) 15mg, UPA 30mg, adalimumab (ADA) 40mg every other week (SELECT-PsA 1 only), or placebo (PBO). Remission and LDA were assessed using VLDA/MDA, DAPSA scores of ≤4/≤14, and PASDAS scores of ≤1.9/≤3.2, at Wk 24 (Table 1). Non-responder imputation (NRI) was used for handling missing data; pts rescued at Wk 16 were considered non-responders. Pairwise comparisons between UPA doses and PBO or ADA were conducted using the Cochran-Mantel-Haenszel test.

Results:

Overall, 2345 pts were analyzed; mean age 51 years, 53% female. In both studies, higher rates of remission and LDA were observed with both UPA doses vs PBO at Wk 24 (nominal P-values <0.05 for both time points; Table 1). Generally, higher rates of remission and LDA were also observed with UPA30 vs ADA in non-biologic DMARD-IR pts (nominal P-values <0.05). Greater rates of MDA/VLDA were observed at Wk 24 with UPA15 and UPA30 vs PBO in both studies and with UPA30 vs ADA in non-biologic DMARD-IR pts (nominal P-values <0.05 for all comparisons). The proportion of responder or non-responder pts receiving UPA15 or UPA30 was similar for each of the MDA components in both studies. At Wk 24, more responder and non-responder pts in both studies achieved Swollen Joint Count (SJC) 66 ≤1, Psoriasis Area and Severity Index (PASI) ≤1 or Body Surface Area-Psoriasis (BSA-Ps) ≤3%, and Leeds Enthesitis Index (LEI) ≤1 (Figure 1). Conversely, the proportion of pts Achieving Tender Joint Count (TJC) 68 ≤1 and Pt’s Global Assessment of Pain ≤1.5 tended to be lower.

Conclusion:

Regardless of previous biologic DMARD failure, pts treated with UPA15 or UPA30 achieved a higher rate of remission or LDA measured by various disease activity measures vs PBO at Wk 24; higher rates of response were observed in most of the remission and LDA measures with UPA30 vs ADA in non-biologic DMARD-IR pts. Among pts who did or did not achieve MDA criteria at Wk 24, a greater proportion of UPA-treated pts achieved physician derived measures such as SJC ≤1, PASI ≤1 or BSA-Ps ≤3%, and LEI ≤1.

References:

[1]McInnes IB, et al. Ann Rheum Dis, 2020; 79:12.

[2]Genovese MC, et al. Ann Rheum Dis, 2020; 79:139.

Table 1.

Proportion of Patients Achieving Remission and LDA Measures at Week 24

Endpoint, n (%)SELECT-PsA 1SELECT-PsA 2PBON=423ADA 40mg EOWN=429UPA 15mg QDN=429UPA 30mg QDN=423PBON=212UPA 15mg QDN=211UPA 30mg QDN=218MDA52 (12.3)143 (33.3)157 (36.6) *, #192(45.4) *, †, #6 (2.8)53 (25.1) *, #63 (28.9) *, #≥6 VLDA components25 (5.9)90 (21.0)105 (24.5) *134 (31.7) *, †3 (1.4)26 (12.3) *44 (20.2) *VLDA11 (2.6)62 (14.5)55 (12.8) *72 (17.0) *3 (1.4)16 (7.6) *21(9.6) *DAPSA REM9 (2.1)43 (10.0)47 (11.0) *79 (18.7) *, †1 (0.5)15 (7.1) *28 (12.8) *DAPSA LDA70 (16.5)198 (46.2)204 (47.6) *235(55.6) *, †14 (6.6)73 (34.6) *91 (41.7) *PASDAS REM12 (2.8)51 (11.9)60 (14.0) *91 (21.5) *, †4 (1.9)20 (9.5) *31 (14.2) *PASDAS LDA63 (14.9)168 (39.2)195 (45.5) *211 (49.9) *, †9 (4.2)69 (32.7) *82 (37.6) *

*P ≤ 0.05 for UPA15 and UPA30 vs PBO; †P ≤ 0.05 for UPA30 vs ADA; #Statistically significant in the multiplicity-controlled analysis.

MDA (5/7) and VLDA (7/7): TJC ≤ 1; SJC ≤ 1; PASI ≤ 1 or BSA-Psoriasis ≤ 3%; Patient’s Assessment of Pain NRS ≤ 1.5; PtGA-Disease Activity NRS ≤ 2.0; HAQ-DI score ≤ 0.5; and tender entheseal points ≤ 1.

DAPSA REM ≤ 4; DAPSA LDA ≤ 14.

PASDAS REM ≤ 1.9; PASDAS LDA ≤ 3.2.

Figure 1

Acknowledgements:

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

Disclosure of Interests:

Philip J Mease Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers, Celgene, Galapagos, Gilead, GlaxoSmithKline, Janssen, Lilly, Merck, Novartis, Pfizer, Sun Pharma, and UCB., Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers, Celgene, Galapagos, Gilead, GlaxoSmithKline, Janssen, Lilly, Merck, Novartis, Pfizer, Sun Pharma, and UCB., Grant/research support from: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers, Celgene, Galapagos, Gilead, GlaxoSmithKline, Janssen, Lilly, Merck, Novartis, Pfizer, Sun Pharma, and UCB., Arthur Kavanaugh Consultant of: AbbVie Inc., Amgen, Astra-Zeneca, BMS, Celgene, Centocor-Janssen, Pfizer, Roche, and UCB, Grant/research support from: AbbVie Inc., Amgen, Astra-Zeneca, BMS, Celgene, Centocor-Janssen, Pfizer, Roche, and UCB, Dafna D Gladman Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene Corporation, Eli Lilly, Galapagos, Gilead, Janssen, Novartis, Pfizer Inc, and UCB, Oliver FitzGerald Speakers bureau: AbbVie, Amgen, BMS, Celgene, Janssen, Lilly, Novartis, Pfizer and UCB, Consultant of: AbbVie, Amgen, BMS, Celgene, Janssen, Lilly, Novartis, Pfizer and UCB, Grant/research support from: AbbVie, Amgen, BMS, Celgene, Janssen, Lilly, Novartis, Pfizer and UCB, Enrique Soriano Speakers bureau: AbbVie, Amgen, Bristol Myers, Celgene, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi, and UCB, Consultant of: AbbVie, Amgen, Bristol Myers, Celgene, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi, and UCB, Grant/research support from: AbbVie, Amgen, Bristol Myers, Celgene, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi, and UCB, Peter Nash Speakers bureau: AbbVie, BMS, Roche, Pfizer, Janssen, Amgen, Sanofi-Aventis, UCB, Eli Lilly, Novartis, and Celgene, Consultant of: AbbVie, BMS, Roche, Pfizer, Janssen, Amgen, Sanofi-Aventis, UCB, Eli Lilly, Novartis, and Celgene, Grant/research support from: AbbVie, BMS, Roche, Pfizer, Janssen, Amgen, Sanofi-Aventis, UCB, Eli Lilly, Novartis, and Celgene, Dai Feng Shareholder of: AbbVie, Employee of: AbbVie, Apinya Lertratanakul Shareholder of: AbbVie, Employee of: AbbVie, Kevin Douglas Shareholder of: AbbVie, Employee of: AbbVie, Ralph Lippe Shareholder of: AbbVie, Employee of: AbbVie, Laure Gossec Consultant of: AbbVie,Amgen, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Samsung, Sanofi, UCB, Grant/research support from: Lilly, Pfizer, and Sandoz.

AB0550 EFFICACY OF UPADACITINIB IN PATIENTS WITH ACTIVE PSORIATIC ARTHRITIS AND A LOW OR HIGH SWOLLEN JOINT COUNT: A SUBGROUP ANALYSIS OF 2 PHASE 3 STUDIES (SELECT-PsA 1 AND SELECT-PsA 2)

Background:

Although most patients with psoriatic arthritis (PsA) enrolled in clinical trials have polyarticular arthritis, patients in clinical practice may present with oligoarthritis. Data on the efficacy of Janus kinase inhibitors in patients with PsA with low joint counts are limited.

Objectives:

To evaluate the efficacy of upadacitinib (UPA) in subgroups of patients with PsA with a low (baseline swollen joint count [SJC] <5) or high (SJC ≥5) SJC (LSJ or HSJ).

Methods:

Data were pooled across the SELECT-PsA 11 (non-biologic disease-modifying antirheumatic drug [non-bDMARD] inadequate response [IR] or intolerance) and SELECT-PsA 22 (bDMARD IR or intolerance) trials, which both enrolled patients with ≥3 involved joints (SJC ≥3 and tender joint count [TJC] ≥3). Subgroup analysis was performed for patients with LSJ or HSJ treated with UPA 15 mg once daily (QD) or placebo (PBO). Efficacy endpoints included minimal disease activity (MDA), very low disease activity (VLDA), Psoriatic Arthritis Disease Activity Score (PASDAS) low disease activity (LDA; ≤3.2), PASDAS remission (≤1.9), and 20/50/70% improvement in American College of Rheumatology (ACR) criteria (ACR20/50/70), all at Week 24, and Psoriasis Area Severity Index (PASI) 75 and static Investigator Global Assessment of Psoriasis (sIGA) 0/1 at Week 16.

Results:

At baseline, patients with HSJ (n=1060) had similar demographic characteristics but tended to have higher overall disease activity than patients with LSJ across multiple disease domains (n=215; Table 1). UPA efficacy appeared comparable in patients with LSJ and HSJ, with similar proportions of patients achieving composite (MDA, VLDA, PASDAS LDA, and PASDAS remission) measures at Week 24, and skin endpoints (PASI 75 and sIGA 0/1) at Week 16 (Figure 1). At Week 24, 60.0/36.8/22.1% of patients with LSJ receiving UPA 15 mg achieved ACR20/50/70 vs 40.0/17.5/5.8% in the PBO group; rates were 70.3/49.7/26.2% (UPA 15 mg) and 36.1/15.3/3.3% (PBO) in those with HSJ.

Table 1.

Baseline characteristics

PBOUPA 15 mg QDTotalLSJn=120HSJn=515LSJn=95HSJn=545LSJn=215HSJn=1060Female, n (%)65 (54.2)266 (51.7)49 (51.6)302 (55.4)114 (53.0)568 (53.6)Age (years), mean (SD)52.2 (12.7)51.5 (12.0)52.0 (10.6)52.0 (12.4)52.1 (11.8)51.8 (12.2)Duration since PsA symptoms (years), mean (SD)10.5 (9.2)11.1 (10.2)9.8 (8.2)10.3 (8.9)10.2 (8.7)10.7 (9.6)BMI, mean (SD)29.7 (6.3)31.1 (7.2)29.8 (6.2)30.7 (6.9)29.7 (6.2)30.9 (7.0)Prior failed bDMARDs, n (%)03 (2.5)15 (2.9)1 (1.1)15 (2.8)4 (1.9)30 (2.8)122 (18.3)113 (21.9)22 (23.2)104 (19.1)44 (20.5)217 (20.5)24 (3.3)31 (6.0)7 (7.4)28 (5.1)11 (5.1)59 (5.6)≥34 (3.3)20 (3.9)7 (7.4)27 (5.0)11 (5.1)47 (4.4)Use of ≥1 non-bDMARD atbaseline, n (%)87 (72.5)360 (69.9)63 (66.3)388 (71.2)150 (69.8)748 (70.6)Dactylitis (LDI >0), n (%)21 (17.5)169 (32.8)15 (15.8)176 (32.3)36 (16.7)345 (32.5)Enthesitis (LEI >0), n (%)60 (50.0)325 (63.1)60 (63.2)343 (62.9)120 (55.8)668 (63.0)TJC68, mean (SD)12.5 (11.3)23.9 (15.8)14.6 (13.5)23.1 (15.8)13.4 (12.3)23.5 (15.8)SJC66, mean (SD)3.5 (0.5)13.2 (8.3)3.6 (0.5)12.9 (9.0)3.6 (0.5)13.0 (8.7)HAQ-DI, mean (SD)1.0 (0.6)1.2 (0.7)0.9 (0.6)1.2 (0.6)0.9 (0.6)1.2 (0.7)hs-CRP > ULN (mg/L), n (%)82 (68.3)363 (70.5)62 (65.3)388 (71.2)144 (67.0)751 (70.8)BSA-Ps, median (range)3.0 (0.1–70.0)4.0 (0.1–95.0)2.0 (0.1–80.0)3.0 (0.1–97.0)3.0 (0.1–80.0)3.0 (0.1–97.0)BSA-Ps ≥ 3%, n (%)57 (47.5)285 (55.3)44 (46.3)300 (55.0)101 (47.0)585 (55.2)PASI (baseline BSA-Ps ≥ 3%), mean (SD)7.7 (7.5)12.1 (11.9)8.2 (7.0)10.2 (10.0)7.9 (7.2)11.1 (11.0)PASI (baseline BSA-Ps ≥ 3%), median (range)5.3 (0.1–39.4)7.9 (0.3–64.8)6.5 (0.2–35.4)6.8 (0.1–70.8)6.0 (0.1–39.4)7.3 (0.1–70.8)

Conclusion:

UPA efficacy was generally similar in patients with PsA with LSJ or HSJ, with both patient groups showing improvements in composite clinical endpoints and skin responses vs PBO.

References:

[1]McInnes I, et al. Ann Rheum Dis 2020;79(Suppl. 1):16–17;

[2]Mease PJ, et al. Ann Rheum Dis 2020; Epub ahead of print.

Acknowledgements:

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

Disclosure of Interests:

Laure Gossec Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, MSD, Novartis, Pfizer, Roche, Sanofi, and UCB, Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, MSD, Novartis, Pfizer, Roche, Sanofi, and UCB, Dafna D Gladman Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Galapagos, Gilead, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Amgen, Celgene, Eli Lilly, Novartis, Pfizer, and UCB, Erin McDearmon-Blondell Shareholder of: May own stock or options in AbbVie, Employee of: AbbVie, Philipp Sewerin Consultant of: AbbVie, Amgen, Axiom Health, Biogen, Bristol-Myers Squibb, Celgene, Chugai, Deutscher Psoriasis Bund, Eli Lilly, Fresenius Kabi, Gilead, Hexal, Janssen, Johnson & Johnson, Medi-login, Mediri, Novartis, Onkowissen, Pfizer, Roche, Rheumazentrum Rhein-Ruhr, Sanofi, Swedish Orphan Biovitrum, and UCB, Grant/research support from: AbbVie, Amgen, Biogen, Bristol-Myers Squibb, Bundesministerium fuer Bildung und Forschung, Deutsche Forschungsgesellschaft, Deutscher Psoriasis Bund, Eli Lilly, Fresenius Kabi, Gilead, Hexal, Janssen, Novartis, Pfizer, Rheumazentrum Rhein-Ruhr, Roche, Sanofi, and UCB, Christopher T. Ritchlin Consultant of: AbbVie, Amgen, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, Sun, and UCB, Grant/research support from: AbbVie, Amgen, and UCB, Dai Feng Shareholder of: May own stock or options in AbbVie, Employee of: AbbVie, Apinya Lertratanakul Shareholder of: May own stock or options in AbbVie, Employee of: AbbVie, R Ranza Consultant of: AbbVie, Eli Lilly, Janssen, Novartis, and Pfizer, Grant/research support from: AbbVie, Janssen, Novartis, and Pfizer, Lai-Shan Tam Consultant of: AbbVie, Boehringer Ingelheim, Eli Lilly, Janssen, Pfizer, and Sanofi, Grant/research support from: Amgen, Boehringer Ingelheim, GSK, Janssen, Novartis, and Pfizer, Antonio Marchesoni Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, MSD, Novartis, Pfizer, and UCB, Laura C Coates: None declared., Peter Nash Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer, Roche, Sanofi, and UCB, Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer, Roche, Sanofi, and UCB.

POS1045 Ixekizumab efficacy on spinal pain, disease activity and quality of life in patients with psoriatic arthritis presenting with symptoms suggestive of axial involvement

Background:

Many patients with psoriatic arthritis (PsA) experience back pain and stiffness, which may suggest axial involvement [1]. The prevalence of axial involvement in PsA varies between 25-70% [2]. Ixekizumab (IXE), a monoclonal antibody with high affinity for IL17-A, has been studied in Phase 3 trials in patients with PsA (SPIRIT-P1 [Biologic-naïve; NCT01695239] and SPIRIT-P2 [Inadequate response or intolerant to 1 or 2 TNF inhibitors (TNFi); NCT02349295]) [3] [4].

Objectives:

To determine the efficacy of IXE up to 52 weeks (Wks) in reducing axial symptoms in patients with active PsA presenting with symptoms suggestive of axial involvement.

Methods:

This post-hoc analysis included data from two subpopulations of patients with PsA (pooled SPIRIT-P1 and -P2). Symptoms suggestive of axial involvement were defined as Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) Q2 (back pain) ≥4, and an average of Q5 + Q6 (intensity and duration of morning stiffness in the spine) ≥4 at baseline. Patients included in the sensitivity analysis subgroup 1 were, in addition to the above-mentioned overall analysis criteria, <45 years of age, while patients included in sensitivity analysis subgroup 2 were aged <45 but also had elevated C-reactive protein (CRP) (> 5 mg/l) at baseline. Efficacy of IXE was analysed using BASDAI questions, total BASDAI, mBASDAI (without Q3), and Ankylosing Spondylitis Disease Activity Score (ASDAS) change from baseline, as well as BASDAI50 response and Short-Form-36 physical component summary (SF-36 PCS) improvement, at Wks 16, 24 and 52. Treatment comparison was done using logistic regression for BASDAI50, and analysis of covariance (ANCOVA) model for other endpoints. Missing data for binary and continuous endpoints were imputed by non-responder imputation and modified baseline observation carried forward (mBOCF), respectively.

Results:

A total of 313 patients (placebo (PBO), N=151; IXE Q4W, N=162) met the overall analysis inclusion criteria. Baseline values for BASDAI and ASDAS related endpoints were balanced across treatment arms (Table 1). Improvement in axial symptoms were significantly greater in patients treated with IXE compared to PBO at Wks 16 and 24 (Figure 1. next page) Improvement in quality of life (QoL) measures (SF-36 PCS) were also significantly greater in patients treated with IXE compared to PBO at Wks 16 and 24 (Table 1). Similar results were observed for patients < 45 years, and in patients < 45 years with CRP > 5 mg/l at baseline (sensitivity analysis, data not shown).

Table 1.

Baseline values and change from baseline (mBOCF) in the overall analysis population at Wks 16, 24 and 52 for BASDAI and ASDAS related endpoints in patients with PsA and axial pain. Data presented as mean (SD) unless otherwise specified. ‡p<0.001 vs PBO.

Conclusion:

IXE is effective in reducing axial symptoms and improving QoL in patients with active PsA presenting with symptoms suggestive of axial involvement.

References:

[1]Yap KS. Ann Rheum Dis. 2018;77(11)

[2]Feld J. Nat Rev Rheumatol. 2018;14

[3]Orbai A. Clin Exp Rheumatol. 2020[online]

[4]Genovese MC. Rheumatol. 2018;57(11)

Figure 1.

Change from baseline (mBOCF) in BASDAI and ASDAS related endpoints in patients with PsA and axial pain in the overall analysis population. Data presented as mean (SD). ‡p<0.001 vs PBO.

Acknowledgements:

Edel Hughes, an employee of Eli Lilly and Company, provided editorial and writing support.

Disclosure of Interests:

Atul Deodhar Speakers bureau: Janssen, Novartis, Pfizer, Paid instructor for: Boeheringer Ingelheim, Pfizer, Consultant of: AbbVie, Amgen, Boeheringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly, Galapagos, Glaxo Smith Kline, Janssen, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Eli Lilly, Glaxo Smith Kline, Novartis, Pfizer, UCB, Dafna D Gladman Consultant of: Abbvie, Amgen, BMS, Galapagos, Gilead, Eli Lilly, Janssen, Novartis, Pfizer, UCB, Grant/research support from: Abbvie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer, UCB, Rebecca Bolce Shareholder of: Employee and shareholder of Eli Lilly and Company, Employee of: Employee and shareholder of Eli Lilly and Company, David Sandoval Shareholder of: Eli Lilly and Company, Employee of: Currently employed by Eli Lilly and Company, So Young Park Shareholder of: Eli Lilly & Company, Employee of: Eli Lilly & Company, Soyi Liu Leage Shareholder of: Owns Lilly shares (company producing drug/devices for use in rheumatology), Employee of: Employee of Eli Lilly and Company, Peter Nash Speakers bureau: Honoraria for lectures on behalf Abbvie, BMS, Celgene, Roche, Sanofi, Lilly, Novartis, Janssen, Pfizer, Boehringer, Samsung, Consultant of: Advice on behalf Abbvie, BMS, Celgene, Roche, Sanofi, Lilly, Novartis, Janssen, Pfizer, Boehringer, Samsung, Grant/research support from: Research funding for clinical trials on behalf Abbvie, BMS, Celgene, Roche, Sanofi, Lilly, Novartis, Janssen, Pfizer, Boehringer, Samsung, Denis Poddubnyy Speakers bureau: AbbVie, Bristol-Myers Squibb, Lilly, MSD, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Biocad, Gilead, GlaxoSmithKline, Eli Lilly, MSD, Novartis, Pfizer, Samsung Bioepis, and UCB, Grant/research support from: AbbVie, Eli Lilly, MSD, Novartis, and Pfizer.

POS1044 EFFECT OF SECUKINUMAB VERSUS ADALIMUMAB ON ACR CORE COMPONENTS AND HEALTH-RELATED QUALITY OF LIFE IN PATIENTS WITH PSORIATIC ARTHRITIS: RESULTS FROM THE EXCEED STUDY

Background:

EXCEED (NCT02745080) was the first fully blinded head-to-head trial to evaluate the efficacy and safety of secukinumab (SEC) versus (vs) adalimumab (ADA) monotherapy in patients with active psoriatic arthritis (PsA) with a primary endpoint of American College of Rheumatology (ACR) 20 at Week 52. Although SEC narrowly missed statistical significance for superiority vs ADA, numerically higher response for other musculoskeletal endpoints and composite indices were observed with SEC.1

Objectives:

To explore the effect of SEC and ADA on ACR core components, function and Health-related Quality of Life (HRQoL) outcomes.

Methods:

Patients were randomised 1:1 to receive SEC 300 mg (N=426) subcutaneous (s.c.) at baseline, Week 1-4, followed by every 4 weeks until Week 48 or ADA 40 mg (N=427) s.c. at baseline followed by same dosing every 2 weeks until Week 50. The primary, key secondary and some exploratory endpoints at Week 52 were previously reported.1 A supportive analysis for ACR50 response using logistic regression model and trimmed means model for Health Assessment Questionnaire-Disability Index (HAQ-DI) with gender and smoking status as factors was performed to adjust for imbalances in baseline characteristics. An exploratory analysis of ACR core components with SEC vs ADA at Week 52 was conducted using a mixed-effects repeated measures model that included tender and swollen joint counts, patient and physician global assessment, PsA pain (VAS) and erythrocyte sedimentation rate. HRQoL variables were also exploratory and assessed based on Short Form Health Survey Physical/Mental Component Summary (SF-36 PCS/MCS) scores and Dermatology Life Quality Index (DLQI).

Results:

The demographic and baseline disease characteristics were comparable across treatment groups, except for an imbalance in sex (females: 51.2% vs 46.4%) and smoking status (yes: 21.8% vs 17.8%) in SEC and ADA group, respectively. At Week 52, ACR50 responses were 49.0% and 44.8% (P=0.0929) and HAQ-DI mean change from baseline were −0.69 and −0.58 (P=0.0314) in SEC and ADA treatment groups, respectively after adjusting for gender and smoking status. No major difference across ACR core components was observed in both treatment groups at Week 52 (Table 1). At Week 52, SEC presented similar improvement in SF-36 PCS/MCS score and numerically higher improvement in DLQI compared to ADA (Figure 1).

Conclusion:

Secukinumab provided similar improvements in ACR core components and SF-36 based quality of life at Week 52 with adalimumab. Greater improvement in HAQ-DI response and DLQI was demonstrated with secukinumab compared to adalimumab.

References:

[1]McInnes IB, et al. Lancet. 2020; 395:1496–505.

Table 1.

ACR Core Components at Week 52

VariablesSecukinumab 300 mg(N=426)Adalimumab 40 mg(N=427)P-valueBL, mean ± SELSM change from BL ± SEBL, mean ± SELSM change from BL ± SETender joint score(based on 78 joints)19.4 ± 13.86−14.27 ± 0.4420.6 ± 14.81−13.90 ± 0.450.5549Swollen joint score(based on 76 joints)9.7 ± 7.30−8.41 ± 0.1910.2 ± 7.86−8.06 ± 0.200.1962Patients global assessment64.0 ± 19.67−33.81 ± 1.1461.9 ± 20.75−31.61 ± 1.190.1825Physicians global assessment60.0 ± 17.12−46.24 ± 0.8061.4 ± 15.92−43.63 ± 0.840.0243Psoriatic arthritis pain (VAS)58.6 ± 23.49−30.21 ± 1.1857.9 ± 22.42−29.44 ± 1.230.6500Erythrocyte sedimentation rate (mm/h)23.8 ± 18.93−9.63 ± 0.6223.9 ± 17.99−9.28 ± 0.640.7029

LS mean and nominal P-values are from a mixed-effects repeated measures model with treatment group, analysis visit as factors, weight and BL score as covariates, and by treatment and BL score as interaction terms, unstructured covariance structure. ACR, American College of Rheumatology; BL, baseline; LSM, least squares mean; N, total number of randomised patients; SE, standard error; VAS, visual analogue scale

Figure 1.

HRQoL Analysis at Week 52

Disclosure of Interests:

Philippe Goupille Speakers bureau: AbbVie, Amgen, Biogen, BMS, Celgene, Chugai, Janssen, Eli Lilly, Medac, MSD, Nordic Pharma, Novartis, Pfizer, Sanofi and UCB, Consultant of: AbbVie, Amgen, Biogen, BMS, Celgene, Chugai, Janssen, Eli Lilly, Medac, MSD, Nordic Pharma, Novartis, Pfizer, Sanofi and UCB, Grant/research support from: AbbVie, Amgen, Biogen, BMS, Celgene, Chugai, Janssen, Eli Lilly, Medac, MSD, Nordic Pharma, Novartis, Pfizer, Sanofi and UCB, Frank Behrens Paid instructor for: Eli Lilly, Consultant of: Pfizer, AbbVie, Sanofi, Eli Lilly, Novartis, Genzyme, Boehringer Ingelheim, Janssen, MSD, Celgene, Roche and Chugai, Grant/research support from: Pfizer, Janssen, Chugai, Celgene and Roche, Laura C Coates Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Biogen, BMS, Celgene, Domain, Eli Lilly, Gilead, GSK, Janssen, Medac, Novartis, Pfizer, Serac and UCB, Grant/research support from: AbbVie, Amgen, Celgene, Eli Lilly, Janssen, Novartis, Pfizer and UCB, Jordi Gratacos-Masmitja Speakers bureau: AbbVie, Amgen, BMS, Celgene, Janssen, Eli Lilly, Novartis and Pfizer, Consultant of: AbbVie, Amgen, BMS, Celgene, Janssen, Eli Lilly, Novartis and Pfizer, Grant/research support from: AbbVie, Amgen, BMS, Celgene, Janssen, Eli Lilly, Novartis and Pfizer, Philip J Mease Speakers bureau: AbbVie, Amgen, Genentech, Janssen, Eli Lilly, Merck, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Boehringer Ingelheim, Galapagos, Celgene, Genentech, Gilead, Janssen, Eli Lilly, Novartis, Pfizer, SUN Pharma, and UCB, Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Galapagos, Genentech, Gilead, Janssen, Eli Lilly, Merck, Novartis, Pfizer, SUN Pharma, and UCB, Dafna D Gladman Consultant of: Amgen, AbbVie, BMS, Celgene, Eli Lilly, Gilead, Galapagos, Janssen, Novartis, Pfizer and UCB, Grant/research support from: Amgen, AbbVie, Celgene, Eli Lilly, Janssen, Novartis, Pfizer and UCB, Peter Nash Speakers bureau: Novartis, Abbvie, Roche, Pfizer, BMS, Janssen, Celgene, UCB, Eli Lilly, MSD, Sanofi, Gilead, Consultant of: Novartis, Abbvie, Roche, Pfizer, BMS, Janssen, Celgene, UCB, Eli Lilly, MSD, Sanofi, Gilead, Grant/research support from: Novartis, Abbvie, Roche, Pfizer, BMS, Janssen, Celgene, UCB, Eli Lilly, MSD, Sanofi, Gilead, Arthur Kavanaugh Consultant of: AbbVie, Amgen, Celgene, Eli Lilly, Janssen, Novartis, and UCB, Grant/research support from: AbbVie, Amgen, Celgene, Eli Lilly, Janssen, Novartis, and UCB, Ruvie Martin Shareholder of: Novartis, Employee of: Novartis, Weibin Bao Shareholder of: Novartis, Employee of: Novartis, Corine Gaillez Shareholder of: Novartis and BMS, Employee of: Novartis, Iain McInnes Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Janssen, Eli Lilly, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Janssen, Eli Lilly, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Janssen, Eli Lilly, Novartis, Pfizer, and UCB.

POS1035 UPADACITINIB AS MONOTHERAPY AND IN COMBINATION WITH NON-BIOLOGIC DMARDs FOR THE TREATMENT OF PSORIATIC ARTHRITIS: SUBGROUP ANALYSIS FROM TWO PHASE 3 TRIALS

Background:

Approximately 40% of PsA patients (pts) on advanced therapy are on monotherapy.1,2 Upadacitinib (UPA) showed efficacy and safety in pts with active PsA in the Phase 3 SELECT-PsA 1 and SELECT-PsA 2 clinical trials.3,4

Objectives:

Assess efficacy and safety in subgroups of pts treated with UPA as monotherapy or in combination with non-biologic disease-modifying antirheumatic drugs (non-bDMARDs).

Methods:

The SELECT-PsA program enrolled pts with prior inadequate response (IR) or intolerance to ≥1 non-bDMARD (N=1705) and prior IR or intolerance to ≥1 bDMARD (N=642). Data from both trials was integrated for pts receiving placebo (PBO), UPA 15 mg once daily (QD) and UPA 30 mg QD. Stable background treatment of ≤2 non-bDMARDs was permitted, but not required. Analysis includes UPA monotherapy vs combination therapy for endpoints: ACR20/50/70 responses and change from baseline in pain and HAQ-DI (Wk 12); Static Investigator Global Assessment of Psoriasis of 0 or 1 and at least a 2-point improvement from baseline and PASI75/90/100 responses (Wk 16); proportion of pts achieving resolution of enthesitis, dactylitis, and minimal disease activity (Wk 24). Binary outcomes, using the Cochran-Mantel-Haenszel-method and continuous outcomes, using mixed-effects model, were analyzed for repeated measures in the subgroups of UPA monotherapy and combination therapy. Point estimates and 95% confidence intervals (CIs) of PBO subtracted treatment effect were calculated. Treatment-emergent adverse events (TEAEs) were analyzed.

Results:

Of 1916 pts, 574 (30%) received monotherapy and 1342 (70%) received combination therapy; 84% in combination therapy group received MTX +/- another non-bDMARD. Both UPA monotherapy and combination therapy led to improvements in efficacy vs PBO and across endpoints, for each dose, generally consistent point estimates of PBO subtracted treatment effect and associated overlapping CIs were observed (Figure 1). Generally, frequency of AEs and serious AEs, were comparable with UPA administered as monotherapy and combination therapy (Table 1). Frequency of AEs of serious infections and hepatic disorder were lower with monotherapy while frequency of AEs leading to discontinuation of study drug were lower with combination therapy. Most hepatic disorders were transient transaminase elevations.

Conclusion:

In the SELECT PsA trials, efficacy and safety of UPA was generally consistent when administered as monotherapy or when given in combination with non-bDMARDs. Results from this analysis support the use of UPA with or without concomitant non-bDMARDs.

References:

[1]Ianculescu I and Weisman MH, Clin Exp Rheumatol 2015; 33:S94–S97.

[2]Mease PJ, et al. RMD Open 2015; 1:e0000181.

[3]McInnes IB, et al. Ann Rheum Dis, 2020; 79:12.

[4]Genovese MC, et al. Ann Rheum Dis, 2020; 79:139.

Acknowledgements:

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

Disclosure of Interests:

Peter Nash Speakers bureau: AbbVie, BMS, Roche, Pfizer, Janssen, Amgen, Sanofi-Aventis, UCB, Eli Lilly, Novartis, and Celgene, Consultant of: AbbVie, BMS, Roche, Pfizer, Janssen, Amgen, Sanofi-Aventis, UCB, Eli Lilly, Novartis, and Celgene, Grant/research support from: AbbVie, BMS, Roche, Pfizer, Janssen, Amgen, Sanofi-Aventis, UCB, Eli Lilly, Novartis, and Celgene, Pascal Richette Speakers bureau: AbbVie, Biogen, Janssen, BMS, Roche, Pfizer, Amgen, Sanofi-Aventis, UCB, Lilly, Novartis, and Celgene, Consultant of: AbbVie, Biogen, Janssen, BMS, Roche, Pfizer, Amgen, Sanofi-Aventis, UCB, Lilly, Novartis, and Celgene, Laure Gossec Speakers bureau: Abbvie, Amgen, Biogen, BMS, Celgene, Lilly, Novartis, Pfizer, Janssen, Sandoz, Sanofi-Aventis, UCB, Consultant of: Abbvie, Amgen, Biogen, BMS, Celgene, Lilly, Novartis, Pfizer, Janssen, Sandoz, Sanofi-Aventis, UCB, Grant/research support from: Abbvie, Amgen, Biogen, BMS, Celgene, Lilly, Novartis, Pfizer, Janssen, Sandoz, Sanofi-Aventis, UCB, Antonio Marchesoni Speakers bureau: AbbVie, BMS, Celgene, Eli-Lilly, Janssen, MSD, Novartis, Pfizer, and UCB, Consultant of: AbbVie, BMS, Celgene, Eli-Lilly, Janssen, MSD, Novartis, Pfizer, and UCB, Christopher T. Ritchlin Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Janssen, Novartis, UCB, Grant/research support from: UCB, Koji Kato Shareholder of: AbbVie, Employee of: AbbVie, Erin McDearmon-Blondell Shareholder of: AbbVie, Employee of: AbbVie, Elizabeth Lesser Shareholder of: AbbVie, Employee of: AbbVie, Reva McCaskill Shareholder of: AbbVie, Employee of: AbbVie, Dai Feng Shareholder of: AbbVie, Employee of: AbbVie, Jaclyn Anderson Shareholder of: AbbVie, Employee of: AbbVie, Eric Ruderman Consultant of: AbbVie, Amgen, Gilead, Janssen, Lilly, Novartis, and Pfizer.

Efficacy of secukinumab and adalimumab in patients with psoriatic arthritis and concomitant moderate-to-severe plaque psoriasis: results from EXCEED, a randomized, double-blind head-to-head monotherapy study

Background

Secukinumab [an interleukin (IL)‐17A inhibitor] has demonstrated significantly higher efficacy vs. etanercept (a tumour necrosis factor inhibitor) and ustekinumab (an IL‐12/23 inhibitor) in patients with moderate‐to‐severe plaque psoriasis.

Objectives

To report 52‐week results from a prespecified analysis of patients with active psoriatic arthritis (PsA) having concomitant moderate‐to‐severe plaque psoriasis from the head‐to‐head EXCEED monotherapy study comparing secukinumab with adalimumab.

Methods

Patients were randomized to receive secukinumab 300 mg via subcutaneous injection at baseline, week 1–4, and then every 4 weeks until week 48 or adalimumab 40 mg via subcutaneous injection every 2 weeks from baseline until week 50. Assessments in patients with concomitant moderate‐to‐severe psoriasis, defined as having affected body surface area > 10% or Psoriasis Area and Severity Index (PASI) ≥ 10 at baseline, included musculoskeletal, skin and quality‐of‐life outcomes. Missing data were handled using multiple imputation.

Results

Of the 853 patients [secukinumab (N = 426), adalimumab (N = 427)], 211 (24·7%) had concomitant moderate‐to‐severe psoriasis [secukinumab (N = 110, 25·8%), adalimumab (N = 101, 23·7%)]. Up to week 50, 5·5% of patients discontinued secukinumab vs.17·8% in the adalimumab group. The proportion of patients who achieved American College of Rheumatology (ACR) 20 response was 76·4% with secukinumab vs. 68·3% with adalimumab (P = 0·175), PASI 100 response was 39·1% vs. 23·8% (P = 0·013), and simultaneous improvement in ACR 50 and PASI 100 response at week 52 was 28·2% vs. 17·7%, respectively (P = 0·06). Secukinumab demonstrated consistently higher responses vs. adalimumab across skin endpoints.

Conclusions

This prespecified analysis in PsA patients with concomitant moderate‐to‐severe plaque psoriasis in the EXCEED study provides further evidence that IL‐17 inhibitors offer a comprehensive biological treatment to manage the concomitant features of psoriasis and PsA.

What is already known about this topic?

Secukinumab, an interleukin‐17A inhibitor, has previously been reported to have significantly higher efficacy in head‐to‐head trials vs. etanercept and ustekinumab in patients with moderate‐to‐severe plaque psoriasis.

What does this study add?

The results of the study provide valuable head‐to‐head data on the efficacy of two biologics with different mechanisms of action (secukinumab and adalimumab) as first‐line biological monotherapy for patients with psoriatic arthritis and concomitant moderate‐to‐severe plaque psoriasis.

The findings of this study can further help physicians to make informed and evidence‐based decisions for the treatment of patients with active psoriatic arthritis who have concomitant moderate‐to‐severe plaque psoriasis.

Linked Comment: E. Sbidian and L. Pina‐Vegas. Br J Dermatol 2021; 185:1085.

Tofacitinib in psoriatic arthritis patients: skin signs and symptoms and health-related quality of life from two randomized phase 3 studies

Background

Psoriatic arthritis (PsA) is a chronic, systemic immune‐mediated inflammatory musculoskeletal disease. The onset of dermatologic symptoms often precedes rheumatic manifestations. Tofacitinib is an oral Janus kinase inhibitor for the treatment of PsA that has been shown to improve dermatologic symptoms in patients with PsA.

Objectives

To investigate the efficacy of tofacitinib in improving dermatologic endpoints in adult patients with active PsA.

Methods

This analysis included data from two placebo‐controlled, double‐blind, phase 3 studies in patients with active PsA and an inadequate response (IR) to ≥1 conventional synthetic disease‐modifying antirheumatic drug (csDMARD) who were tumor necrosis factor inhibitor (TNFi)‐naïve (OPAL Broaden; NCT01877668) or an IR to ≥1 TNFi (OPAL Beyond; NCT01882439). Patients had active plaque psoriasis at screening and received a stable dose of one csDMARD during the study. Patients were randomized to tofacitinib 5 mg twice daily (BID), 10 mg BID, adalimumab 40 mg subcutaneous injection once every 2 weeks (OPAL Broaden only) or placebo (to Month 3). Dermatologic endpoints: Psoriasis Area and Severity Index (PASI) total score; PASI90 overall; PASI75 and PASI90 by baseline PASI severity; Physician’s Global Assessment of Psoriasis; Nail Psoriasis Severity Index; Dermatology Life Quality Index total and sub‐dimension scores; Itch Severity Item; and Patient’s Global Joint and Skin Assessment‐Visual Analog Scale‐Psoriasis question.

Results

In patients with active PsA, including those stratified by mild or moderate/severe dermatologic symptoms, greater improvements from baseline and percentage of responders were observed in tofacitinib‐treated patients vs. placebo for the majority of analyzed dermatologic endpoints at Months 1 and 3, and improvements were maintained to Month 12 in OPAL Broaden and Month 6 in OPAL Beyond. Similar effects were observed in adalimumab‐treated patients vs. placebo in OPAL Broaden across dermatologic endpoints.

Conclusions

Tofacitinib provides a treatment option for patients with active PsA, including the burdensome dermatologic symptoms of PsA.

OP0227 SECUKINUMAB VERSUS ADALIMUMAB HEAD-TO-HEAD COMPARISON IN BIOLOGIC-NAÏVE PATIENTS WITH ACTIVE PSORIATIC ARTHRITIS THROUGH 52-WEEKS (EXCEED): A RANDOMISED, DOUBLE-BLIND, PHASE-3B STUDY

Background:

Secukinumab (SEC), an interleukin-17A inhibitor, has demonstrated improvements on multiple domains of psoriatic arthritis (PsA).1Adalimumab (ADA), a TNF inhibitor, is widely used as a first–line biologic in PsA.

Objectives:

To report efficacy and safety outcomes from the head-to-head EXCEED trial (NCT02745080) that compares SECvs.ADA as first–line biologic monotherapy through 52-weeks (wks), with a musculoskeletal primary endpoint in pts with active PsA.

Methods:

Head-to-head, phase-3b, randomised, double-blind trial: biologic naïve active PsA pts were randomised to receive SEC 300mg subcutaneous at baseline, Wk1-4, and then every 4wks (q4w) until Wk48 or ADA 40mg subcutaneous at baseline and then q2w until Wk50. The primary endpoint was superiority of SECvs.ADA on ACR20 response at Wk52. Binary and continuous variables were analysed using logistic-regression model and MMRM, respectively. Safety analysis included patients who received ≥1 dose of study-drug.

Results:

853 pts were randomised to receive SEC (n=426) or ADA (n=427). Baseline demographics and disease characteristics were comparable between treatment-groups except higher proportion of female pts and pts without enthesitis in the SEC group. ACR20 response at Wk52 for SECvs.ADA were 67·4%vs.61·5%, respectively (p=0·0719) (Figure). Higher clinical responses were observed with SECvs.ADA for a range of musculoskeletal, skin, and higher-hurdle outcomes (Table). A higher retention rate was observed for SEC (85.7%)vs.ADA (76.3%). Safety profiles of SEC and ADA were consistent with previous reports.2,3

Conclusion:

Results suggest that SEC is at least as efficacious as ADA on musculoskeletal endpoints whilst providing higher responses on skin endpoints, and is associated with a higher retention rate. No new safety signals were reported.

References:

[1]van der Heijde, et al. Rheumatol. (Oxford).2019; DOI10.1093/rheumatology/kez420.

[2]Deodhar A, et al. Arthritis Res Ther. 2019;21:111.

[3]Burmester GR, et al. Ann Rheum Dis.2013; 72:517-24.

Figure.

ACR20 Response through Wk 52

Table.

Efficacy Outcomes at Wk 52

Endpoints, % response unless specified otherwiseSEC 300 mg(N=426)ADA 40 mg(N=427)P-value (unadjusted)*ACR2067·461·50·0719aACR2066·959·50·0239Key SecondarybPASI 9065·443·2<0·0001ACR5049·044·80·2251HAQ-DI mean change from baseline ± SE-0·58 ± 0.03-0·56 ± 0.030·5465cResolution of enthesitis (based on LEI)60·554·20·1498ExploratoryMDA43·037·90·1498VLDA18·116·60·6107DAPSA LDA+Remission61·753·10·0178PASDAS LDA+Remission51·144·10·0557

*Unadjusted P-valuesvsADA

Binary variables were analysed using logistic regression. Pts who discontinued study treatment prematurely or took csDMARDs after week-36 were considered non-responders. Multiple imputation was used for all other missing data. HAQ-DI mean change from baseline was analysed using mixed-effect model repeated measures

aNon-responder imputation was used for pre-specified sensitivity analysis

bN=215 in SEC and N=202 in ADA in psoriasis subset

cN=234 in SEC and N=264 in ADA in enthesitis subset

Disclosure of Interests:

Iain McInnes Grant/research support from: Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Janssen, and UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Gilead, Janssen, Novartis, Pfizer, and UCB, Frank Behrens Grant/research support from: Pfizer, Janssen, Chugai, Celgene, Lilly and Roche, Consultant of: Pfizer, AbbVie, Sanofi, Lilly, Novartis, Genzyme, Boehringer, Janssen, MSD, Celgene, Roche and Chugai, 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, Arthur Kavanaugh Grant/research support from: Abbott, Amgen, AstraZeneca, BMS, Celgene Corporation, Centocor-Janssen, Pfizer, Roche, UCB – grant/research support, Christopher T. Ritchlin Grant/research support from: UCB Pharma, AbbVie, Amgen, Consultant of: UCB Pharma, Amgen, AbbVie, Lilly, Pfizer, Novartis, Gilead, Janssen, Peter Nash Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Jordi Gratacos-Masmitja Grant/research support from: a grant from Pfizzer to study implementation of multidisciplinary units to manage PSA in SPAIN, Consultant of: Pfizzer, MSD, ABBVIE, Janssen, Amgen, BMS, Novartis, Lilly, Speakers bureau: Pfizzer, MSD, ABBVIE, Janssen, Amgen, BMS, Novartis, Lilly, Philippe Goupille Grant/research support from: AbbVie, Amgen, Biogen, BMS, Celgene, Chugai, Lilly, Janssen, Medac, MSD France, Nordic Pharma, Novartis, Pfizer, Sanofi and UCB, Consultant of: AbbVie, Amgen, Biogen, BMS, Celgene, Chugai, Lilly, Janssen, Medac, MSD France, Nordic Pharma, Novartis, Pfizer, Sanofi and UCB, Speakers bureau: AbbVie, Amgen, Biogen, BMS, Celgene, Chugai, Lilly, Janssen, Medac, MSD France, Nordic Pharma, Novartis, Pfizer, Sanofi and UCB, Tatiana Korotaeva Grant/research support from: Pfizer, Consultant of: Abbvie, BIOCAD, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Novartis-Sandoz, Pfizer, UCB, Speakers bureau: Abbvie, BIOCAD, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Novartis-Sandoz, Pfizer, UCB, Alice B Gottlieb Grant/research support from:: Research grants, consultation fees, or speaker honoraria for lectures from: Pfizer, AbbVie, BMS, Lilly, MSD, Novartis, Roche, Sanofi, Sandoz, Nordic, Celltrion and UCB., Consultant of:: Research grants, consultation fees, or speaker honoraria for lectures from: Pfizer, AbbVie, BMS, Lilly, MSD, Novartis, Roche, Sanofi, Sandoz, Nordic, Celltrion and UCB., Speakers bureau:: Research grants, consultation fees, or speaker honoraria for lectures from: Pfizer, AbbVie, BMS, Lilly, MSD, Novartis, Roche, Sanofi, Sandoz, Nordic, Celltrion and UCB., Ruvie Martin Shareholder of: Novartis, Employee of: Novartis, Kevin Ding Employee of: Novartis, Pascale Pellet Shareholder of: Novartis, Employee of: Novartis, Shephard Mpofu Shareholder of: Novartis, Employee of: Novartis, Luminita Pricop Shareholder of: Novartis, Employee of: Novartis

THU0198 EFFICACY AND SAFETY OF FILGOTINIB FOR PATIENTS WITH RHEUMATOID ARTHRITIS WITH INADEQUATE RESPONSE TO METHOTREXATE: FINCH 1 52-WEEK RESULTS

Background:

Filgotinib (FIL) is an oral, potent, selective JAK1 inhibitor. FINCH 1 (NCT02889796) assessed FIL efficacy and safety in patients (pts) with rheumatoid arthritis (RA) with inadequate response to methotrexate (MTX-IR); primary outcome results at week (W)12 and W24 were previously reported.1

Objectives:

To present FINCH 1 W52 results.

Methods:

This global, phase 3, double-blind, active- and placebo (PBO)-controlled study randomised MTX-IR pts with active RA on a background of stable MTX 3:3:2:3 to oral FIL 200 mg or FIL 100 mg once daily, subcutaneous adalimumab (ADA) 40 mg every 2W, or PBO up to W52; pts receiving PBO at W24 were rerandomised to FIL 100 or 200 mg. Efficacy was assessed from clinical, radiographic, and pt-reported outcomes; W52 comparisons were not adjusted for multiplicity. Safety endpoints included adverse events (AEs) and laboratory abnormalities.

Results:

Of 1755 treated pts, 1417 received study drug through W52. The majority (81.8%) were female, mean (standard deviation [SD]) RA duration was 7.8 (7.6) years, and baseline mean (SD) DAS28(CRP) was 5.7 (0.9). FIL efficacy was sustained through W52; 54%, 43%, and 46% of pts receiving FIL 200 and 100 mg and ADA, respectively, had W52 DAS28(CRP) <2.6 (nominal p for FIL 200 vs ADA = 0.024) (Figures 1–2, Table 1). FIL safety profile through W52 was consistent with W24 data. AEs of interest were infrequent and balanced among treatments (Table 2); 82 pts (4.7%) discontinued treatment due to AEs.

Table 1.

Efficacy outcomes at week 52

FIL 200 mg(n = 475)FIL 100 mg(n = 480)ADA(n = 325)ACR20/50/70, %78/62/4476/59/3874/59/39DAS28(CRP) ≤3.2, %66+5959mTSSa0.18+++0.450.61HAQ-DIb−0.93+−0.85−0.85SF-36 PCSb12.011.512.4FACIT-Fb11.912.211.7

aLeast squares mean change from baseline.

bMean change from baseline.

+p <0.05,+++p <0.001 vs ADA; not adjusted for multiplicity.

ADA, adalimumab; FIL, filgotinib; mTSS, modified van der Heijde TSS.

Table 2.

Treatment-emergent AEs through week 52

Event, n (%)FIL 200(n = 475)FIL 100 mg(n = 480)ADA(n = 325)All AEs352 (74.1)350 (72.9)239 (73.5)Serious AEs35 (7.4)40 (8.3)22 (6.8)Infection206 (43.4)194 (40.4)129 (39.7)Serious infection13 (2.7)13 (2.7)10 (3.1)Herpes zoster6 (1.3)4 (0.8)2 (0.6)VTE1 (0.2)01 (0.3)MACE (adjudicated)02 (0.4)1 (0.3)Malignancy (excluding NMSC)2 (0.4)2 (0.4)2 (0.6)NMSC1 (0.2)1 (0.2)0Death3 (0.6)1 (0.2)1 (0.3)

Data omitted for patients rerandomised from placebo to FIL.

ADA, adalimumab; AE, adverse event; FIL, filgotinib; MACE, major adverse cardiovascular event; NMSC, nonmelanoma skin cancer; VTE, venous thromboembolism.

Conclusion:

Through W52, both FIL 200 and 100 mg showed sustained efficacy based on clinical and pt-reported outcomes and radiographic progression and were well tolerated in MTX-IR pts with RA, with faster onset and numerically greater efficacy for FIL 200 vs 100 mg.

References:

[1]Combe et al.,Ann Rheum Dis.2019; 78 (Suppl 2):77–8.

Disclosure of Interests:

Bernard Combe Grant/research support from: Novartis, Pfizer, Roche-Chugai, Consultant of: AbbVie; Gilead Sciences, Inc.; Janssen; Eli Lilly and Company; Pfizer; Roche-Chugai; Sanofi, Speakers bureau: Bristol-Myers Squibb; Gilead Sciences, Inc.; Eli Lilly and Company; Merck Sharp & Dohme; Pfizer; Roche-Chugai; UCB, Alan Kivitz Shareholder of: AbbVie, Amgen, Gilead, GSK, Pfizer Inc, Sanofi, Consultant of: AbbVie, Boehringer Ingelheim,,Flexion, Genzyme, Gilead, Janssen, Novartis, Pfizer Inc, Regeneron, Sanofi, SUN Pharma Advanced Research, UCB, Paid instructor for: Celgene, Genzyme, Horizon, Merck, Novartis, Pfizer, Regeneron, Sanofi, Speakers bureau: AbbVie, Celgene, Flexion, Genzyme, Horizon, Merck, Novartis, Pfizer Inc, Regeneron, Sanofi, Yoshiya Tanaka Grant/research support from: Asahi-kasei, Astellas, Mitsubishi-Tanabe, Chugai, Takeda, Sanofi, Bristol-Myers, UCB, Daiichi-Sankyo, Eisai, Pfizer, and Ono, Consultant of: Abbvie, Astellas, Bristol-Myers Squibb, Eli Lilly, Pfizer, Speakers bureau: Daiichi-Sankyo, Astellas, Chugai, Eli Lilly, Pfizer, AbbVie, YL Biologics, Bristol-Myers, Takeda, Mitsubishi-Tanabe, Novartis, Eisai, Janssen, Sanofi, UCB, and Teijin, Désirée van der Heijde Consultant of: AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Cyxone, Daiichi, Eisai, Eli-Lilly, Galapagos, Gilead Sciences, Inc., Glaxo-Smith-Kline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, UCB Pharma; Director of Imaging Rheumatology BV, J-Abraham Simon-Campos: None declared, Herbert S.B. Baraf Grant/research support from: Horizon; Gilead Sciences, Inc.; Pfizer; Janssen; AbbVie, Consultant of: Horizon; Gilead Sciences, Inc.; Merck; AbbVie, Speakers bureau: Horizon, Uma Kumar: None declared, Franziska Matzkies Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Beatrix Bartok Shareholder of: Gilead Sciences Inc., Employee of: Gilead Sciences Inc., Lei Ye Shareholder of: Gilead Sciences Inc., Employee of: Gilead Sciences Inc., Ying Guo Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Chantal Tasset Shareholder of: Galapagos (share/warrant holder), Employee of: Galapagos, John Sundy Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Angelika Jahreis Shareholder of: Gilead Sciences, Inc., Employee of: Gilead Sciences, Inc., Neelufar Mozaffarian Shareholder of: Gilead, Employee of: Gilead, Robert B.M. Landewé Consultant of: AbbVie; AstraZeneca; Bristol-Myers Squibb; Eli Lilly & Co.; Galapagos NV; Novartis; Pfizer; UCB Pharma, Sang-Cheol Bae: None declared, Edward Keystone Grant/research support from: AbbVie; Amgen; Gilead Sciences, Inc; Lilly Pharmaceuticals; Merck; Pfizer Pharmaceuticals; PuraPharm; Sanofi, Consultant of: AbbVie; Amgen; AstraZeneca Pharma; Bristol-Myers Squibb Company; Celltrion; F. Hoffman-La Roche Ltd.; Genentech, Inc; Gilead Sciences, Inc.; Janssen, Inc; Lilly Pharmaceuticals; Merck; Myriad Autoimmune; Pfizer Pharmaceuticals, Sandoz, Sanofi-Genzyme, Samsung Bioepsis., Speakers bureau: AbbVie; Amgen; Bristol-Myers Squibb; Celltrion; F. Hoffman-La Roche Ltd, Janssen, Inc; Merck; Pfizer Pharmaceuticals; Sanofi-Genzyme; UCB, Peter Nash Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB

OP0228 EFFICACY AND SAFETY OF IXEKIZUMAB VERSUS ADALIMUMAB (SPIRIT-H2H) WITH AND WITHOUT CONCOMITANT CONVENTIONAL SYNTHETIC DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (DMARD) IN BIOLOGIC DMARD-NAÏVE PATIENTS WITH PSORIATIC ARTHRITIS: 52-WEEK RESULTS

Background:

Ixekizumab (IXE), a high-affinity monoclonal antibody selectively targeting IL-17A, was superior to adalimumab (ADA) at Week (Wk) 24 for simultaneous achievement of ACR50 and 100% improvement from baseline in the Psoriasis Area and Severity Index (PASI 100) (primary endpoint) in patients (pts) with active PsA from SPIRIT-H2H1. SPIRIT-H2H had two major secondary endpoints and achieved both: noninferiority of IXE to ADA for ACR50 at Wk 24, and superiority of IXE to ADA for PASI 100 at Wk 24.

Objectives:

To determine how concomitant conventional synthetic DMARD (csDMARD) use affects safety and efficacy of IXE and ADA in prespecified subgroups defined by biologic monotherapy, concomitant MTX use, and concomitant csDMARD use through Wk 52 in SPIRIT-H2H.

Methods:

SPIRIT-H2H (NCT03151551) was a 52-week, multicentre, randomised, open-label, assessor-blinded, parallel-group study evaluating the efficacy and safety of IXE versus ADA in adults with PsA and naïve to biologic DMARDs. Patients were required to have active PsA fulfilling Classification for Psoriatic Arthritis (CASPAR) criteria and ≥3/68 tender and ≥3/66 swollen joints, ≥3% plaque psoriasis BSA involvement, no prior treatment with bDMARDs, and with prior inadequate response to ≥1 csDMARD (but not necessarily current treatment with csDMARDs). Randomization (1:1) was stratified by concomitant use of csDMARD and the presence/absence of moderate to severe PsO (baseline: BSA≥10% + PASI≥12, + static Physician’s Global Assessment≥3). Patients (N=566) received IXE/ADA through 52 wks according to the labelled dose dependent on presence/absence of moderate-to-severe PsO. In this prespecified subgroup analysis by presence or absence of csDMARDs, efficacy outcomes through wk 52 were compared between IXE and ADA using logistic regression models and Fisher’s exact tests. Missing data were imputed using non-responder imputation.

Results:

At baseline, 167 of 283 IXE-treated patients and 169 of 283 ADA-treated patients had concomitant MTX use. Of these, 9.0% (15/167) and 7.1% (12/169) treated with IXE and ADA, respectively, were taking an additional csDMARD (sulfasalazine, cyclosporine, or leflunomide). A significantly greater proportion of patients on IXE versus ADA achieved the primary endpoint or PASI 100 when used as monotherapy or in combination with csDMARD (Figure 1A and 1C). At Wk 52, the proportion of patients achieving ACR50 was not statistically different between IXE and ADA, regardless of monotherapy or concomitant csDMARD use (Figure 1B). A significantly higher proportion of patients achieved MDA on IXE compared to ADA in the monotherapy subgroup (49% vs 33%), while the response rates were similar in both combination subgroups (Figure 1D). These data support consistent ACR50, PASI 100, and MDA response for IXE across all three subgroups. Frequencies of adverse events were similar across the three subgroups for IXE and ADA (Figure 2).

Conclusion:

As with prior studies,2,3consistent efficacy across multiple PsA disease-specific endpoints was observed with IXE in SPIRIT-H2H, regardless of whether IXE was taken as monotherapy or in combination with MTX or another csDMARD. No unexpected safety signals were found for either agent.

References:

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

[2]Coates et al, RMD Open 2017;3:e000567.

[3]Nash et al, RMD Open 2018;4:e000692.

Disclosure of Interests:

Josef S. Smolen Grant/research support from: AbbVie, AstraZeneca, Celgene, Celltrion, Chugai, Eli Lilly, Gilead, ILTOO, Janssen, Novartis-Sandoz, Pfizer Inc, Samsung, Sanofi, Consultant of: AbbVie, AstraZeneca, Celgene, Celltrion, Chugai, Eli Lilly, Gilead, ILTOO, Janssen, Novartis-Sandoz, Pfizer Inc, Samsung, Sanofi, Anthony Sebba Consultant of: Genentech, Gilead, Lilly, Regeneron Pharmaceuticals Inc., Sanofi, Speakers bureau: Lilly, Roche, Sanofi, Eric Ruderman Consultant of: Pfizer, Amanda Gellett 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, Aubrey Trevelin Sprabery 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, Sreekumar Pillai Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Paulo Reis Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Peter Nash Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB

THU0218 INCIDENCE AND RISK FACTORS FOR HERPES ZOSTER IN RHEUMATOID ARTHRITIS PATIENTS RECEIVING UPADACITINIB

Background:

Upadacitinib (UPA) is an oral JAK inhibitor approved for the treatment of rheumatoid arthritis (RA). The background rate of herpes zoster (HZ) in patients (pts) with RA is around 0.98/100 person years (PY)1. Pts with RA receiving JAK inhibitors have been reported to have an increased risk of HZ.

Objectives:

To evaluate the incidence and risk factors for HZ in pts with RA receiving UPA relative to active comparators in the Phase 3 clinical trial program.

Methods:

The incidence rate of HZ was determined in pts receiving UPA (as monotherapy [mono] or combination therapy) in five randomized Phase 3 trials (SELECT-EARLY, SELECT-MONOTHERAPY, SELECT-NEXT, SELECT-COMPARE, and SELECT-BEYOND), of which 4 evaluated both the UPA 15 and 30 mg once-daily (QD) doses and 1 trial (SELECT-COMPARE) evaluated only the 15 mg QD dose. Incidence of HZ was also determined in pts receiving adalimumab (ADA) + methotrexate (MTX) in SELECT-COMPARE and MTX mono in SELECT-EARLY. Risk factors for HZ were assessed using univariate and multivariate Cox regression models. Data cut-off was 30 June 2019.

Results:

Overall, 2629 pts who received UPA 15 mg QD (4565.8 patient-years [PY]), 1204 pts who received UPA 30 mg QD (2309.7 PY), 579 pts who received ADA + MTX (768.6 PY), and 314 pts who received MTX mono (456.0 PY) were analyzed. Fewer than 5% of pts across the treatment groups reported prior HZ vaccination. HZ (n/100 PY [95% CI]) occurred in 142 pts (3.1 [2.6–3.7]) with UPA 15 mg, 126 pts (5.5 [4.5–6.5]) with UPA 30 mg, 8 pts (1.0 [0.4–2.1]) with ADA + MTX, and 5 pts (1.1 [0.4–2.6]) with MTX mono. Most of the HZ cases (~71%) with UPA (Table) and all cases with ADA + MTX and MTX mono involved a single dermatome. Ophthalmic involvement was seen in 6 (4.2%) and 3 (2.4%) cases in the UPA 15 and 30 mg groups, respectively, and unilateral involvement with multiple dermatomes was seen in 26 (18.3%) and 23 (18.3%) cases. There was a single case of HZ meningitis reported in a Japanese pt on UPA 30 mg. In multivariate analyses, prior history of HZ and Asian region were associated with an increased risk of HZ in both the UPA groups (p≤0.01;Figure). In addition, pts ≥65 years old had increased risk of HZ in the 15 mg group.

Conclusion:

HZ events in pts with RA receiving UPA were more common in the 30 mg vs 15 mg group, and in both UPA groups compared with the ADA + MTX and MTX groups.

References:

[1]Smitten AL, et al. Arthritis Rheum 2007;57:1431–8

Table.

Summary of extent of involvement in pts with HZ

Categories, n (%)aAny UPA 15 mg QD(N=2629)Any UPA 30 mg QD(N=1204)Total patients with ≥1 HZ event142 (5.4)126 (10.5)Single dermatome101 (71.1)89 (70.6)Ophthalmic involvement6 (4.2)3 (2.4)HZ Oticus (Ramsay Hunt Syndrome)2 (1.4)1 (0.8)Multidermatomal (unilateral)b26 (18.3)23 (18.3)Disseminated, cutaneous only (no CNS involvement)c7 (4.9)8 (6.3)Disseminated with CNS or visceral involvement01 (0.8)dMissing8 (5.6)5 (4.0)

aPts may fall into >1 category;b≤2 adjacent dermatomes;c≥3 dermatomes, unilateral nonadjacent dermatomes, or bilateral dermatomes;dHZ meningitis

Figure.

Multivariable-adjusted risk factors for HZ in pts receiving UPA

Disclosure of Interests: :

Kevin Winthrop Grant/research support from: Bristol-Myers Squibb, Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly, Galapagos, Gilead, GSK, Pfizer Inc, Roche, UCB, Peter Nash Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Kunihiro Yamaoka Speakers bureau: AbbVie GK, Astellas Pharma Inc., Bristol-Myers Squibb, Chugai Pharmaceutical Co. Ltd, Mitsubishi-Tanabe Pharma Corporation, Pfizer Japan Inc., and Takeda Pharmaceutical Company Ltd, Eduardo Mysler Grant/research support from: AbbVie, Lilly, Pfizer, Roche, BMS, Sandoz, Amgen, and Janssen., Consultant of: AbbVie, Lilly, Pfizer, Roche, BMS, Sandoz, Amgen, and Janssen., Leonard Calabrese Consultant of: AbbVie, GSK, Bristol-Myers Squibb, Genentech, Janssen, Novartis, Sanofi, Horizon, Crescendo, and Gilead, Speakers bureau: Sanofi, Horizon, Crescendo, Novartis, Genentech, Janssen, and AbbVie, Nasser Khan Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Jose Jeffrey Enejosa Shareholder of: AbbVie, Employee of: AbbVie, Yanna Song Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Jessica Suboticki Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Jeffrey R. Curtis Grant/research support from: Abbvie, Amgen, BMS, Corrona, Crescendo, Janssen, Pfizer, Regeneron/Sanofi, and UCB, Consultant of: AbbVie, Amgen, BMS, Corrona, Crescendo, Janssen, Pfizer, Sanofi/Regeneron, and UCB

AB0802 SAFETY PROFILES OF IXEKIZUMAB VERSUS ADALIMUMAB: 52-WEEK RESULTS FROM A HEAD-TO-HEAD COMPARISON IN PATIENTS WITH ACTIVE PSORIATIC ARTHRITIS

Background:

Ixekizumab (IXE) was shown to be superior to adalimumab (ADA) in achievement of simultaneous improvement of joint and skin disease (ACR50 and PASI100) in patients with active psoriatic arthritis (PsA) and inadequate response to conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs).1

Objectives:

To compare the safety and tolerability profile of IXE vs ADA in patients with PsA up to 52 weeks of treatment.

Methods:

SPIRIT-H2H (NCT03151551) was an open-label, head-to-head, blinded assessor clinical trial which included patients with active PsA (≥3 tender joint count + ≥3 swollen joint count) and plaque psoriasis (BSA ≥3%) who were inadequate responders to csDMARD therapy but naïve to biologic DMARDs. Patients were randomized (1:1) to approved dosing of IXE or ADA. Safety events were assessed at each patient visit up to Week 52. Frequencies of adverse events (AEs) were based on the number of patients in the safety population (patients who received ≥1 dose of study drug). Cases of inflammatory bowel disease (IBD) and cerebro-cardiovascular events were adjudicated by external committees. Kaplan-Meier analysis of time to onset of serious adverse events (SAEs) was performed.

Results:

Of the 283 patients randomized to each treatment, 87% (246/283) of patients who received IXE and 84% (237/283) of patients who received ADA completed 52 weeks of treatment. The frequency of treatment-emergent AEs (TEAEs) was similar between the groups (74% IXE vs 69% ADA), however fewer severe TEAEs were reported in the IXE group (3.2% IXE vs 7.1% ADA) (Table). SAEs were significantly more frequent in the ADA group compared to the IXE group (12% vs 4.2%; p<0.001), and the time to develop a patient’s first SAE was significantly shorter for ADA versus IXE (p<0.001; Figure). Discontinuations due to AEs were numerically more frequent in the ADA group versus the IXE group (7.4% vs 4.2%; p=0.15). IXE-treated patients reported more injection-site reactions (ISR) than ADA-treated patients (11% vs. 3.5%; p=0.002). Study withdrawals due to ISR were comparable, and only one injection-site reaction was severe on ADA (Table). There were two IBD cases reported for IXE; one case was confirmed as IBD.

Conclusion:

Safety results were consistent with previous trials with IXE and ADA. Compared with IXE, patients with PsA treated with ADA had significantly more serious AEs.

References:

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

Table.

Safety results at 52 weeks

IXE N=283n (%)ADA N=283n (%)TEAEs209 (74)194 (69) Severea9 (3.2)20 (7.1) Related to study treatmentb98 (35)87 (31)Serious adverse events12 (4.2)35 (12)***Deaths00Discontinuation due to AE12 (4.2)21 (7.4)Serious infections3 (1.1)4 (1.4)Injection-site reactionsc30 (11)10 (3.5)** Severe01 (0.4) Resulted in discontinuation2 (0.7)3 (1.1)Anaphylaxis00Inflammatory bowel disease2 (0.7)0 Ulcerative colitis1 (0.4)d0 Crohn’s disease1 (0.4)0Cerebro-cardiovascular events5 (1.8)7 (2.5) MACE02 (0.7)Malignancies04 (1.4)Depression5 (1.8)9 (3.2)Interstitial lung disease01 (0.4)Cytopenias9 (3.2)12 (4.2)Hepatic events18 (6.4)20 (7.1)

aPatients with multiple occurrences of the same event are counted under the highest severity.bThe TEAE’s relationship to study treatment was judged by the investigator.cMedDRA high-level term.dThis event was adjudicated but it was not a confirmed IBD. ***p<0.001; **p<0.01 by Fisher’s exact test. ADA=adalimumab, AE=adverse event; IBD=inflammatory bowel disease; IXE=ixekizumab; MACE=major adverse cardiovascular event; TEAE=treatment-emergent adverse event.

Disclosure of Interests:

Philip J Mease Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Janssen, Eli Lilly, Novartis, Pfizer, Sun Pharma, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Janssen, Eli Lilly, Galapagos, Gilead, Novartis, Pfizer, Sun Pharma, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Genentech, Janssen, Novartis, Pfizer, UCB Pharma, Josef S. Smolen Grant/research support from: AbbVie, AstraZeneca, Celgene, Celltrion, Chugai, Eli Lilly, Gilead, ILTOO, Janssen, Novartis-Sandoz, Pfizer Inc, Samsung, Sanofi, Consultant of: AbbVie, AstraZeneca, Celgene, Celltrion, Chugai, Eli Lilly, Gilead, ILTOO, Janssen, Novartis-Sandoz, Pfizer Inc, Samsung, Sanofi, Arthur Kavanaugh Grant/research support from: Abbott, Amgen, AstraZeneca, BMS, Celgene Corporation, Centocor-Janssen, Pfizer, Roche, UCB – grant/research support, Peter Nash Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Gaia Gallo 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, Christophe Sapin Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Mark C. Genovese Grant/research support from: Abbvie, Eli Lilly and Company, EMD Merck Serono, Galapagos, Genentech/Roche, Gilead Sciences, Inc., GSK, Novartis, Pfizer Inc., RPharm, Sanofi Genzyme, Consultant of: Abbvie, Eli Lilly and Company, EMD Merck Serono, Genentech/Roche, Gilead Sciences, Inc., GSK, Novartis, RPharm, Sanofi Genzyme

FRI0340 COMPARISON OF SECUKINUMAB VERSUS ADALIMUMAB EFFICACY ON SKIN OUTCOMES IN PSORIATIC ARTHRITIS: 52-WEEK RESULTS FROM THE EXCEED STUDY

Background:

Psoriatic arthritis (PsA) is a heterogeneous disease comprising musculoskeletal and dermatological manifestations, especially plaque psoriasis.1Secukinumab (SEC), an IL-17A inhibitor, provided significantly greater PASI 75/100 responses in a head-to-head trialversus (vs.) etanercept, a TNF inhibitor, in patients (pts) with moderate-to-severe plaque psoriasis.2The objective of the EXCEED study (NCT02745080) was to investigate whether SEC is superior to adalimumab (ADA), a TNF inhibitor, as monotherapy in biologic-naive active PsA pts with active plaque psoriasis (defined as having at least one psoriatic plaque of ≥2 cm diameter or nail changes consistent with psoriasis or documented history of plaque psoriasis).

Objectives:

To report the pre-specified skin outcomes from the EXCEED study in the subset of pts with at least 3% body surface area (BSA) affected with psoriasis at baseline.

Methods:

Head-to-head, phase-3b, randomised, double-blind, active-controlled, multicentre, parallel-group trial: pts were randomised to receive SEC 300 mg subcutaneous at baseline, Week 1-4, followed by dosing every 4 weeks (q4w) until Week 48 or ADA 40 mg subcutaneous at baseline followed by same dosing q2w until Week 50. The primary endpoint was superiority of SECvs.ADA on ACR20 response at Week 52. Pre-specified outcomes included the proportion of pts achieving a combined ACR50 and PASI 100 response, PASI 100 response, and absolute PASI score ≤3. Missing data was handled using multiple imputation.

Results:

853 pts were randomised to receive SEC (n=426) or ADA (n=427). At baseline, there were 215 and 202 pts having at least 3% BSA affected with psoriasis in the SEC and ADA groups, respectively. A higher proportion of patients achieved simultaneous improvement in ACR50 and PASI 100 response with SECvs.ADA (30·7%vs.19·2%; P=0·0087 [Figure]). Higher efficacy was demonstrated for SECvs.ADA for PASI 100 responses and for the proportion of pts achieving absolute PASI score ≤3 (Table).

Conclusion:

In this pre-specified analysis, SEC provided higher responses compared to ADA in achievement of simultaneous improvement of joint and skin disease (combined ACR50 and PASI 100 response) and in skin specific endpoints (PASI 100 and PASI score ≤3) at Week 52.

References:

[1]Coates LC and Helliwell PS.Clinical Med.2017;17:65–70.

[2]Langley RG et al.N Engl J Med.2014;371:326–38.

Figure.

Combined ACR50 and PASI 100 Response through Week 52

Table.

Skin Specific Outcomes at Week 52

Endpoints, data is presented as % responseSEC 300 mg(N = 215)ADA 40 mg(N = 202)P-value (unadjusted)PASI 10046·029·70·0007Absolute PASI score ≤379·265·00·0015

P value vs. adalimumab; Unadjusted P values are presented

N, number of patients in psoriasis subset

Multiple imputation was used for handling missing data

ADA, adalimumab; BSA, body surface area; PASI, psoriasis area severity index; SEC, secukinumab

Acknowledgments:

Suchita Dubey (Novartis) provided medical writing support.

Disclosure of Interests:

Alice B Gottlieb Grant/research support from:: Research grants, consultation fees, or speaker honoraria for lectures from: Pfizer, AbbVie, BMS, Lilly, MSD, Novartis, Roche, Sanofi, Sandoz, Nordic, Celltrion and UCB., Consultant of:: Research grants, consultation fees, or speaker honoraria for lectures from: Pfizer, AbbVie, BMS, Lilly, MSD, Novartis, Roche, Sanofi, Sandoz, Nordic, Celltrion and UCB., Speakers bureau:: Research grants, consultation fees, or speaker honoraria for lectures from: Pfizer, AbbVie, BMS, Lilly, MSD, Novartis, Roche, Sanofi, Sandoz, Nordic, Celltrion and UCB., Frank Behrens Grant/research support from: Pfizer, Janssen, Chugai, Celgene, Lilly and Roche, Consultant of: Pfizer, AbbVie, Sanofi, Lilly, Novartis, Genzyme, Boehringer, Janssen, MSD, Celgene, Roche and Chugai, Peter Nash Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, 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, Kevin Ding Employee of: Novartis, Pascale Pellet Shareholder of: Novartis, Employee of: Novartis, Luminita Pricop Shareholder of: Novartis, Employee of: Novartis, Iain McInnes Grant/research support from: Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Janssen, and UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Gilead, Janssen, Novartis, Pfizer, and UCB

OP0107 ETANERCEPT WITHDRAWAL AND RE-TREATMENT IN PATIENTS WITH INACTIVE NON-RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS AT 24 WEEKS: RESULTS OF RE-EMBARK, AN OPEN-LABEL, PHASE IV TRIAL

Background:

In the RE-EMBARK trial (NCT02509026), etanercept (ETN)-treated patients with non-radiographic axial spondyloarthritis (nr-axSpA) who achieved inactive disease (defined as Ankylosing Spondylitis Disease Activity Score with C-reactive protein [ASDAS CRP] <1.3) in Period 1 (P1)1discontinued ETN for ≤40 weeks.

Objectives:

To assess the proportion of patients with inactive disease after P1 who experienced disease flare (ASDAS with erythrocyte sedimentation rate [ASDAS ESR] ≥2.1) within 40 weeks of ETN withdrawal and to estimate time to flare following ETN withdrawal.

Methods:

RE-EMBARK was a multicenter, open-label, Phase IV trial of ETN in patients with active nr-axSpA (meeting Assessment in SpondyloArthritis international Society criteria and with ASDAS CRP ≥2.1) and an inadequate response to ≥2 nonsteroidal anti-inflammatory drugs (NSAIDs) while taking a stable dose of 1 NSAID for ≥2 weeks before the first ETN dose. All patients received ETN (50 mg/week) plus NSAID for the first 24 weeks (P1). At week 24, patients with inactive disease discontinued ETN for ≤40 weeks (Period 2 [P2]). Those who experienced flare during P2 were re-treated with ETN for 12 weeks in Period 3 (P3). Kaplan-Meier (KM) analysis and Cox proportional hazard models were used to 1) estimate the probability of experiencing flare within a given time period, and 2) compare data between RE-EMBARK and the EMBARK trial (NCT01258738) of patients with nr-axSpA who met RE-EMBARK P2 entry criteria (achieved inactive disease after 24 weeks of ETN treatment) and continued treatment for a further ≤40 weeks.

Results:

Of the 209 patients in P1 (mean age, 33 years; women, 46%; white, 89%), 119 (57%) entered P2. The proportion of patients experiencing ≥1 flare increased from 22% (25/112) at P2 week 4 to 67% (77/115) at P2 week 40. Overall, 75% (86/115) of patients in P2 experienced flare and 50% experienced flare within 16 weeks (95% CI: 13-24 weeks, KM analysis). Conversely, data from the comparator EMBARK trial suggested that <25% of patients receiving continuous ETN treatment over 40 weeks experienced flare. Cox proportional hazard model analysis showed an 85% relative risk reduction of experiencing flare during P2 in patients with inactive disease who continued ETN treatment vs those who discontinued. By P3 end 62% (54/87) of patients re-treated with ETN re-achieved inactive disease; 50% of patients who re-achieved inactive disease in P3 did so within 5 weeks (95% CI: 4-8 weeks, KM analysis). The observed trend of clinical improvement (P1), worsening (P2), and improvement (P3) was reflected in other clinical measures (Figure) plus measures of joint damage (Spondyloarthritis Research Consortium of Canada Sacroiliac Joint magnetic resonance imaging score) and quality of life (EQ-5D visual analog scale score); mean (standard deviation) score changes from each study period baseline–end were –6.1 (11.7) [P1], +1.5 (4.4) [P2], –2.0 (8.8) [P3] and +27.7 (26.7) [P1], –26.4 (30.5) [P2], +32.1 (26.3) [P3], respectively. There were no unexpected safety signals.

Conclusion:

For patients with nr-axSpA who achieved inactive disease with ETN and then discontinued treatment, a quarter maintained treatment-free inactive disease for 40 weeks and 50% maintained an ASDAS ESR score of <2.1 for ≥16 weeks. Re-starting ETN allowed 62% of patients who flared to re-achieve inactive disease within 12 weeks.

References:

[1]Van den Bosch F, et al.Ann Rheum Dis2019;78:896-7

Acknowledgments:

Medical writing support was provided by Lorna Forse, PhD, of Engage Scientific Solutions and was funded by Pfizer.

Disclosure of Interests:

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, James Cheng-Chung Wei Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Novartis, Pfizer Inc, UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Chugai, Eisai, Janssen, Novartis, Pfizer Inc, Sanofi-Aventis, UCB Pharma, Peter Nash Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Francisco J. Blanco Grant/research support from: Sanofi-Aventis, Lilly, Bristol MS, Amgen, Pfizer, Abbvie, TRB Chemedica International, Glaxo SmithKline, Archigen Biotech Limited, Novartis, Nichi-iko pharmaceutical Co, Genentech, Jannsen Research & Development, UCB Biopharma, Centrexion Theurapeutics, Celgene, Roche, Regeneron Pharmaceuticals Inc, Biohope, Corbus Pharmaceutical, Tedec Meiji Pharma, Kiniksa Pharmaceuticals, Ltd, Gilead Sciences Inc, Consultant of: Lilly, Bristol MS, Pfizer, Daniela Graham Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Chuanbo Zang Shareholder of: Pfizer, Employee of: Pfizer, Edmund Arthur Shareholder of: Pfizer, Employee of: Pfizer, Cecilia Borlenghi Shareholder of: Pfizer, Employee of: Pfizer, Bonnie Vlahos Shareholder of: Pfizer, Employee of: Pfizer, Atul Deodhar Grant/research support from: AbbVie, Eli Lilly, GSK, Novartis, Pfizer, UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB

OP0225 TOFACITINIB AS MONOTHERAPY FOLLOWING METHOTREXATE WITHDRAWAL IN PATIENTS WITH PSORIATIC ARTHRITIS PREVIOUSLY TREATED WITH OPEN-LABEL TOFACITINIB + METHOTREXATE: A RANDOMISED, PLACEBO-CONTROLLED SUBSTUDY OF OPAL BALANCE

Background:

Tofacitinib is an oral JAK inhibitor for the treatment of psoriatic arthritis (PsA).

Objectives:

To assess tofacitinib 5 mg BID as monotherapy after methotrexate (MTX) withdrawal vs with continued background MTX in patients (pts) with PsA.

Methods:

OPAL Balance (NCT01976364) was an open-label (OL) long-term extension (LTE) study of tofacitinib in pts with PsA who participated in Phase (P)3 studies (OPAL Broaden,NCT01877668; OPAL Beyond,NCT01882439). Pts who completed ≥24 months’ tofacitinib treatment in the LTE (stable 5 mg BID for ≥3 months) and were receiving oral MTX (7.5–20 mg/week; stable for ≥4 weeks) entered the multicentre, 12-month, double-blind, MTX withdrawal substudy. Pts remained on OL tofacitinib 5 mg BID and were randomised 1:1 to receive placebo (tofacitinib monotherapy, ie, blinded MTX withdrawal) or MTX (tofacitinib + MTX; same stable doses). Primary endpoints were changes from substudy baseline (Δ) in PASDAS and HAQ-DI at Month (M)6. Secondary efficacy endpoints were assessed at all time points. Safety was assessed throughout the substudy.

Results:

Of 180 pts randomised, 179 were treated (tofacitinib monotherapy n=90; tofacitinib + MTX n=89). Pt characteristics were similar between treatment arms. At M6, least squares mean (LSM) (standard error [SE]) ΔPASDAS was 0.229 (0.079) for tofacitinib monotherapy and 0.138 (0.081) for tofacitinib + MTX, and LSM (SE) ΔHAQ-DI was 0.043 (0.027) and 0.017 (0.028), respectively (Figure 1); no clinically meaningful differences were observed. Efficacy and pt-reported outcomes were generally similar between treatment arms at M6 and M12 (data not shown). Rates of pts achieving minimal disease activity, and maintaining an absence of enthesitis and dactylitis, were sustained to M12 in both treatment arms (Figure 2). Adverse event rates (Table) and laboratory parameters were comparable between treatment arms, but liver enzyme elevations were more common with tofacitinib + MTX.

Conclusion:

No clinically meaningful differences in efficacy and safety were observed in PsA pts who received OL tofacitinib 5 mg BID as monotherapy after MTX withdrawal vs with continued MTX. Safety was consistent with previous P3 studies. The substudy was an estimation study and not powered for hypothesis testing.

Table.

Safety outcomes to Month 12

Pts with events, n (%) AEs of special interestTofacitinib monotherapy N=90Tofacitinib + MTXN=89AE43 (47.8)41 (46.1)Serious AE4 (4.4)3 (3.4)Discontinuations due to AE3 (3.3)4 (4.5)Death00 Herpes zoster (serious/non-serious)1 (1.1)2 (2.2) Serious infection02 (2.2) Opportunistic infectiona01 (1.1) Malignancy (excl. NMSC)a1 (1.1)1 (1.1) NMSCa00 Major adverse cardiovascular eventa00 Venous thromboembolismc00 Arterial thromboembolismc1 (1.1)0 Gastrointestinal perforationa00 Interstitial lung diseaseb00Laboratory parametersdALT ≥3×ULN05 (5.6) ALT (IU/L), mean (SE)-2.7 (1.6)2.5 (1.3)AST ≥3×ULN03 (3.4) AST (IU/L), mean (SE)-1.5 (1.2)1.7 (0.8)

Reviewed by independentaexternal/binternal adjudication committee

cPer Standardised MedDRA Query terms

dWithout regard to baseline abnormality

ALT, alanine aminotransferase; AST, aspartate aminotransferase; ULN, upper limit of normal

Acknowledgments:

Study sponsored by Pfizer Inc. Medical writing support was provided by Christina Viegelmann of CMC Connect and funded by Pfizer Inc.

Disclosure of Interests:

Peter Nash Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Laura C Coates: None declared, 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, Alan Kivitz Shareholder of: AbbVie, Amgen, Gilead, GSK, Pfizer Inc, Sanofi, Consultant of: AbbVie, Boehringer Ingelheim,,Flexion, Genzyme, Gilead, Janssen, Novartis, Pfizer Inc, Regeneron, Sanofi, SUN Pharma Advanced Research, UCB, Paid instructor for: Celgene, Genzyme, Horizon, Merck, Novartis, Pfizer, Regeneron, Sanofi, Speakers bureau: AbbVie, Celgene, Flexion, Genzyme, Horizon, Merck, Novartis, Pfizer Inc, Regeneron, Sanofi, Dafna D Gladman Grant/research support from: AbbVie, Amgen Inc., BMS, Celgene Corporation, Janssen, Novartis, Pfizer, UCB – grant/research support, Consultant of: AbbVie, Amgen Inc., BMS, Celgene Corporation, Janssen, Novartis, Pfizer, UCB – consultant, Frank Behrens Grant/research support from: Pfizer, Janssen, Chugai, Celgene, Lilly and Roche, Consultant of: Pfizer, AbbVie, Sanofi, Lilly, Novartis, Genzyme, Boehringer, Janssen, MSD, Celgene, Roche and Chugai, James Cheng-Chung Wei Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Novartis, Pfizer Inc, UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Chugai, Eisai, Janssen, Novartis, Pfizer Inc, Sanofi-Aventis, UCB Pharma, Dona Fleishaker Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Joseph Wu Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Cunshan Wang Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Ana Belen Romero Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Lara Fallon Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Ming-Ann Hsu Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Keith Kanik Shareholder of: Pfizer Inc, Employee of: Pfizer Inc

AB0831 COMPARISON OF DIFFERENT REMISSION INDICES IN PATIENTS WITH PSORIATIC ARTHRITIS: A POST HOC ANALYSIS OF DATA FROM PHASE 3 TOFACITINIB STUDIES

Background:

An international task force has agreed that remission and low disease activity (LDA) are treatment targets for patients (pts) with PsA, and recommends the Disease Activity Index in Psoriatic Arthritis (DAPSA) and minimal disease activity (MDA) to assess disease activity states.1Tofacitinib is an oral Janus kinase inhibitor for the treatment of PsA.

Objectives:

In this post hoc analysis, we compared DAPSA LDA with MDA, and DAPSA remission with very low disease activity (VLDA) and DAS28-3(CRP) remission, in pts with PsA receiving tofacitinib.

Methods:

Data were pooled from 2 Phase 3 studies (OPAL Broaden [12 months;NCT01877668]; OPAL Beyond [6 months;NCT01882439]) for pts receiving tofacitinib 5 or 10 mg twice daily (BID) or placebo (PBO). DAPSA was determined by summing: swollen joint count (SJC66); tender/painful joint count (TJC68); Patient’s Global Assessment of Arthritis (PtGA; visual analogue scale [VAS]); pain (VAS); and CRP. Pts were classified as achieving MDA or VLDA when meeting ≥5 (MDA) or 7 (VLDA) of the following criteria: TJC68 ≤1; SJC66 ≤1; Psoriasis Activity and Severity Index ≤1 or body surface area ≤3%; pain (VAS) ≤15; PtGA (VAS) ≤20; HAQ-DI ≤0.5; tender entheseal points (using Leeds Enthesitis Index [LEI]) ≤1. A logistic regression model was used to assess demographic and baseline characteristics as predictors of a trend in DAPSA scores at Month (M)3. DAPSA LDA (≤14), MDA, DAPSA remission (DAPSA ≤4), VLDA and DAS28-3(CRP) remission (DAS28-3[CRP]<2.6) rates were compared at M1, M3 and M6 for pts receiving tofacitinib 5 mg BID and at M6 for pts receiving tofacitinib 5 or 10 mg BID. Agreement between disease activity indices at M6 was evaluated using a kappa test. The percentage of tofacitinib-treated pts who achieved MDA, VLDA and non-response was reported at M6, stratified by achievement of DAPSA LDA, remission or non-response.

Results:

This analysis included 709 pts: tofacitinib 5 mg BID, n=237; tofacitinib 10 mg BID, n=236; PBO, n=236. At M3, older patients treated with tofacitinib, and tofacitinib- or PBO-treated pts with higher baseline SJC66, TJC68, PtGA VAS, HAQ-DI, LEI and Pain VAS, were significantly (p<0.05) more likely to have higher DAPSA. DAPSA LDA, MDA, remission (DAPSA and DAS28-3[CRP]) and VLDA rates generally increased from M1 to M6 for patients receiving tofacitinib 5 mg BID (Figure a). At M6, most tofacitinib-treated pts who achieved MDA, and all who achieved VLDA, were also in DAPSA remission or LDA (Figure b). At least moderate agreement (defined by kappa values 0.41–0.60) was observed between DAPSA LDA and MDA, and between DAPSA remission and VLDA, with both doses of tofacitinib at M6 (Figure c).

Conclusion:

Remission and LDA rates generally increased over time in pts with PsA receiving tofacitinib. DAPSA LDA showed moderate agreement with MDA, and DAPSA remission showed at least moderate agreement with VLDA, confirming that DAPSA and MDA are useful measurement tools to assess disease activity in pts with PsA treated with tofacitinib.

References:

[1]Smolen et al. Ann Rheum Dis 2018;77:3-17.

Acknowledgments:

Study sponsored by Pfizer Inc. Medical writing support was provided by Sarah Piggott of CMC Connect, McCann Health Medical Communications, and funded by Pfizer Inc.

Disclosure of Interests:

Emilce Schneeberger: None declared, Gustavo Citera Grant/research support from: AbbVie, Amgen, Eli Lilly, Gema, Genzyme, Novartis and Pfizer Inc, Consultant of: AbbVie, Amgen, Eli Lilly, Gema, Genzyme, Novartis and Pfizer Inc, Peter Nash Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Josef S. Smolen Grant/research support from: AbbVie, AstraZeneca, Celgene, Celltrion, Chugai, Eli Lilly, Gilead, ILTOO, Janssen, Novartis-Sandoz, Pfizer Inc, Samsung, Sanofi, Consultant of: AbbVie, AstraZeneca, Celgene, Celltrion, Chugai, Eli Lilly, Gilead, ILTOO, Janssen, Novartis-Sandoz, Pfizer Inc, Samsung, Sanofi, 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, Enrique Soriano Grant/research support from: AbbVie, Eli Lilly, GlaxoSmithKline, Novartis, Pfizer Inc, Sandoz, Consultant of: AbbVie, Eli Lilly, GlaxoSmithKline, Novartis, Pfizer Inc, Sandoz, Speakers bureau: AbbVie, Amber, Bristol-Myers Squibb, Eli Lilly, Novartis, Pfizer Inc, Roche, Claudia Helling Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Annette E Szumski Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Rajiv Mundayat Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Daniela Graham Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Dario Ponce de Leon Shareholder of: Pfizer Inc, Employee of: Pfizer Inc

AB0814 SUSTAINED IMPROVEMENTS IN PHYSICAL FUNCTION, QUALITY OF LIFE, AND WORK PRODUCTIVITY WITH IXEKIZUMAB IN PATIENTS WITH ACTIVE PSORIATIC ARTHRITIS AND PREVIOUS INADEQUATE RESPONSE TO TUMOUR NECROSIS FACTOR-INHIBITORS: 3-YEAR RESULTS FROM SPIRIT-P2 TRIAL

Background:

Ixekizumab (IXE), a high-affinity monoclonal antibody that selectively targets IL-17A, has shown improvements compared to placebo (PBO) not only in disease activity but also in various patient-reported outcomes (PROs) assessing physical function, quality of life (QoL), and work productivity in PsA patients treated for 24 weeks and sustained up to 52 weeks.1, 2

Objectives:

To report the effects of treatment with IXE on these PROs after up to 3 years of treatment.

Methods:

In SPIRIT-P2 (NCT02349295), a Phase 3 trial, 363 adult patients with active PsA and prior inadequate response or intolerance to 1 or 2 TNF inhibitors (TNFis) were randomized 1:1:1 to IXE 80 mg every 4 weeks (IXEQ4W; N=122) or every 2 weeks (IXEQ2W; N=123), or PBO (N=118) in the double-blind treatment period (Weeks 0-24). Both IXE regimens had a starting dose of 160 mg. Results are reported from a subset of the intent-to-treat population who were randomized to IXE at baseline (Week 0). The following PROs were assessed during Weeks 0-156: HAQ-DI (minimally clinically important difference [MCID] an improvement ≥0.35), medical outcomes survey Short Form-36 (SF-36) Physical and Mental Component Summary (PCS and MCS), European Quality of Life 5 Dimensions Visual Analog Scale (EQ-5D VAS), and Work Productivity and Activity Impairment Questionnaire-Specific Health Problem (WPAI-SHP; absenteeism, presenteeism, work productivity, and activity impairment). Missing values were imputed by observed analysis and modified baseline observation carried forward (mBOCF) for continuous data or by modified non-responder imputation (mNRI) for categorical data.

Results:

Mean baseline scores for SF-36 (PCS and MCS), EQ-5D VAS, and WPAI-SHP (Figure 1) and HAQ-DI (mean [SD]: IXEQ4W=1.2 [0.6]; IXEQ2W=1.2 [0.6]), indicated impaired physical function and QoL. The percentage of patients of who completed 156 weeks of the study in IXEQ4W and IXEQ2W arms were 57.4% (n=70) and 44.7% (n=55), respectively. Patients receiving IXE treatment up to 3 years reported sustained improvements in SF-36 (PCS and MCS), EQ-5D VAS, and WPAI-SHP (presenteeism, work productivity, and activity impairment) (Figure 1). Observed HAQ-DI mean change from baseline in IXEQ4W: -0.46 (0.62) and IXEQ2W: -0.48 (0.55). The percentage of IXE treated patients achieving MCID for HAQ-DI (improvement ≥0.35) was sustained at 3 years (Figure 2).

Figure 1.

Summary of Patient-Reported Outcomes presented as change from baseline at Week 156 (Observed and mBOCF): Intent-to-Treat Population (Patients Randomized to IXE at Baseline)

Figure 2.

Patients achieving HAQ-DI MCID Response up to Week 156 (Observed) and at Week 156 (mNRI) among patients with HAQ-DI≥0.35 at baseline: Intent-to-Treat Population (Patients Randomized to IXE at Baseline)

Conclusion:

Improvements in PROs, measuring physical and mental function, quality of life, and work productivity are maintained up to 3 years with IXE treatment in patients with active PsA who have had an inadequate response or intolerance to 1 or 2 TNFis.

References:

[1]Nash P, et al. Lancet. 2017;389(10086):2317-2327.

[2]Genovese MC, et al. Rheumatology (Oxford). 2018;57(11):2001-2011.

Disclosure of Interests:

Ana-Maria Orbai Grant/research support from: Abbvie, Eli Lilly and Company, Celgene, Novartis, Janssen, Horizon, Consultant of: Eli Lilly; Janssen; Novartis; Pfizer; UCB. Ana-Maria Orbai was a private consultant or advisor for Sun Pharmaceutical Industries, Inc, not in her capacity as a Johns Hopkins faculty member and was not compensated for this service., Jordi Gratacos-Masmitja Grant/research support from: a grant from Pfizzer to study implementation of multidisciplinary units to manage PSA in SPAIN, Consultant of: Pfizzer, MSD, ABBVIE, Janssen, Amgen, BMS, Novartis, Lilly, Speakers bureau: Pfizzer, MSD, ABBVIE, Janssen, Amgen, BMS, Novartis, Lilly, Eva Dokoupilova Grant/research support from: Eli Lilly and Abbvie, Bernard Combe Grant/research support from: Novartis, Pfizer, Roche-Chugai, Consultant of: AbbVie; Gilead Sciences, Inc.; Janssen; Eli Lilly and Company; Pfizer; Roche-Chugai; Sanofi, Speakers bureau: Bristol-Myers Squibb; Gilead Sciences, Inc.; Eli Lilly and Company; Merck Sharp & Dohme; Pfizer; Roche-Chugai; UCB, Arnaud Constantin Grant/research support from: Study was sponsored by Sanofi Genzyme, Consultant of: Consulting fees from Abbvie, BMS, Celgene, Gilead, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi, UCB, Amanda M. Gellett Shareholder of: Eli Lilly and company, Employee of: Eli Lilly and company, Aubrey Trevelin Sprabery Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Julie Birt Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Vladimir Geneus Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Peter Nash Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Conclusion:

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

References:

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

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

Disclosure of Interests:

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

SAT0431 PROPORTIONS OF PATIENTS ACHIEVING A MINIMAL DISEASE ACTIVITY STATE UPON TREATMENT WITH TILDRAKIZUMAB IN A PSORIATIC ARTHRITIS PHASE 2B STUDY

Background:

Tildrakizumab (TIL) is a high-affinity anti–interleukin-23p19 monoclonal antibody approved in the US, EU, and Australia to treat moderate to severe plaque psoriasis. A randomised, double-blind, placebo-controlled, multiple-dose, phase 2b study evaluating the efficacy and safety of TIL was recently completed (NCT02980692).

Objectives:

To characterise and evaluate the rate of minimal disease activity (MDA) up to week (W)52 from the phase 2b study.

Methods:

Patients (pts) ≥18 years old with active psoriatic arthritis (PsA)2and ≥3 tender and ≥3 swollen joints were randomised 1:1:1:1:1 to receive TIL 200 mg every 4 weeks (Q4W) to W52, TIL 200 mg Q12W to W52, TIL 100 mg Q12W to W52, TIL 20 mg Q12W to W24→TIL 200 mg Q12W to W52, or placebo (PBO) Q4W to W24→TIL 200 mg Q12W to W52. MDA was assessed throughout the study; an MDA response was achieved when 5 of 7 criteria were met.3Safety was assessed throughout the study and included treatment-emergent adverse event (TEAE) monitoring.

Results:

Of 500 pts screened, 391 were randomised and received ≥1 dose of study drug. At baseline (BL), mean age was 48.8 years, 55% were female, 97% were White, mean body mass index was 29.7 kg/m2, and pts had PsA for a median (range) of 4.4 (0–42.8) years since diagnosis. Baseline disease characteristics related to MDA varied little between study arms (Table).

By W24, MDA state was achieved in significantly more pts receiving TIL vs PBO (24%–39% vs 7%; p<0.02 for all groups); the proportion further increased with continued TIL treatment to W52 (45%–64%), including pts who switched from PBO to TIL (47%) (Figure).

Among the overall pt population from BL→W24/W25→W52, 50.4%/39.9% and 2.3%/1.0% experienced a TEAE and serious TEAE, respectively. From BL→W24, 1 serious infection (chronic tonsillitis) was reported for TIL 20 mg→200 mg Q12W arm. From W25→W52, there was 1 malignancy (TIL 20→200 mg Q12W). There were no reports of candidiasis, uveitis, inflammatory bowel disease, major adverse cardiac events, or deaths from BL→W24 or W25→W52.

Table.

Baseline disease characteristics related to minimal disease activity

TIL 200 mg Q4Wn = 78TIL 200 mg Q12Wn = 79TIL 100 mg Q12Wn = 77TIL 20→200 mg Q12Wn = 78PBO→TIL 200 mg Q12Wn = 79Swollen joint count10.410.011.09.411.8Tender joint count16.619.521.319.019.7Patient GADA score57.861.160.361.965.2Patient pain assessment55.459.659.260.964.2Enthesitis (LEI) score*1.91.52.22.21.5PASI†7.66.28.86.65.0HAQ-DI score1.01.01.01.11.2

Data are reported as mean.

*Total patients analysed (n) = 76, 79, 76, 78, 78, respectively.

†Total patients analysed (n) = 75, 79, 76, 75, 75, respectively.

GADA, global assessment of disease activity; HAQ-DI, Health Assessment Questionnaire Disability Index; LEI, Leeds Enthesitis Index; PASI, Psoriasis Area and Severity Index; PBO, placebo; Q4W, every 4 hours; Q12W, every 12 hours; TIL, tildrakizumab.

Conclusion:

TIL produced clinically meaningful improvement in pts with PsA, resulting in a large proportion of pts achieving MDA by W52, and was well tolerated through W52.

References:

[1]Reich, et al.Lancet2017;390:276−88.

[2]Taylor, et al.Arthritis Rheum2006;54:2665–73.

[3]Coates, et al.Ann Rheum Dis2010;69:48−53.

Disclosure of Interests:

Peter Nash Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Michael E Luggen Grant/research support from: AbbVie; Amgen; Eli Lilly; Genentech; Nichi-Iko; Novartis; Pfizer; R-Pharm; and Sun Pharmaceutical Industries, Inc., Consultant of: AbbVie; Amgen; Eli Lilly; Genentech; Nichi-Iko; Novartis; Pfizer; R-Pharm; and Sun Pharmaceutical Industries, Inc., Speakers bureau: AbbVie; Amgen; Eli Lilly; Genentech; Nichi-Iko; Novartis; Pfizer; R-Pharm; and Sun Pharmaceutical Industries, Inc., Luis Espinoza: None declared, Ferran J García Fructuoso Grant/research support from: AbbVie, Eli Lilly, Gedeon Richter, MedImmune, Nichi-Iko, Pfizer, Sanofi-Aventis, Takeda, and UCB, Consultant of: AbbVie, Eli Lilly, Gedeon Richter, MedImmune, Nichi-Iko, Pfizer, Sanofi-Aventis, Takeda, and UCB, Speakers bureau: AbbVie, Eli Lilly, Gedeon Richter, MedImmune, Nichi-Iko, Pfizer, Sanofi-Aventis, Takeda, and UCB, Richard C Chou Consultant of: Sun Pharmaceutical Industries, Inc, Alan M Mendelsohn Shareholder of: Johnson and Johnson, Employee of: Sun Pharmaceutical Industries, Inc, Stephen Rozzo Employee of: Sun Pharmaceutical Industries, Inc, Iain McInnes Grant/research support from: Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Janssen, and UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Gilead, Janssen, Novartis, Pfizer, and UCB

FRI0357 IMPROVED PAIN AND FATIGUE WITH IXEKIZUMAB TREATMENT IN PATIENTS WITH ACTIVE PSORIATIC ARTHRITIS AND PREVIOUS INADEQUATE RESPONSE TO TNF INHIBITORS: THREE YEAR FOLLOW-UP FROM A PHASE 3 STUDY (SPIRIT-P2)

Background:

Psoriatic arthritis (PsA) is a chronic and complex inflammatory disease with both articular and extra-articular symptoms. Pain and fatigue are two of the most common patient-reported symptoms. Improvements in pain and fatigue have been demonstrated with up to 2 years of treatment with ixekizumab (IXE) in patients who had an inadequate response or intolerance to tumor necrosis factor inhibitors (TNFi).1,2

Objectives:

To report improvements in pain and fatigue in TNFi-experienced patients with PsA who were treated with IXE for 3 years (156 weeks).

Methods:

SPIRIT-P2 (NCT02349295) was a 156-week, Phase 3 study that included patients who met the Classification Criteria for Psoriatic Arthritis (CASPAR) and had an inadequate response or intolerance to 1 or 2 TNFi. Although there was a placebo group through Week 24, these data were derived only from patients in the intent-to-treat population randomized to IXE at baseline. After a 160-mg starting dose, patients received 80 mg subcutaneous IXE every 2 or 4 weeks (Q2W or Q4W). Patients self-rated their symptoms using the Joint Pain Visual Analog Scale (Joint Pain VAS; 0 [none] to 100 [worst imaginable]), the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36; with the domains ranging from 0 [worst] to 100 [best]), and the Fatigue Severity Numeric Rating Scale (Fatigue NRS; 0 [none] to 10 [worst imaginable]). Minimum clinically important difference (MCID) cutoffs were ≥10 for Joint Pain VAS, ≥5 for SF-36 domains, and ≥3 for Fatigue NRS. Missing values were imputed by modified baseline observation carried forward for continuous variables and modified non-responder imputation for categorical variables.

Results:

The proportions of patients who completed Week 156 were 70/122 (57.4%) in the IXE Q4W group and 55/123 (44.7%) in the IXE Q2W group. At Week 156, mean change from baseline for the Joint Pain VAS was -28.9 (IXE Q4W) and -25.3 (IXE Q2W) (Fig. A). In addition, 51.8% of patients on IXE reported clinically meaningful improvement of joint pain (56.1% IXE Q4W, 47.5% IXE Q2W) at Week 156. Patients reported an 18-point mean improvement in the SF-36 bodily pain domain at Week 156 (Fig. B). Patients also reported improvements in fatigue up to Week 156 (Fig. C), with 35.0% of patients achieving the MCID on the Fatigue NRS (39.4% IXE Q4W, 30.6% IXE Q2W). Improvement in fatigue was supported by a14-point mean improvement in the vitality domain of the SF-36 at Week 156 (Fig. D).

Conclusion:

In patients with PsA who had an inadequate response or intolerance to TNFi, improvements in pain and fatigue were sustained through 3 years of IXE treatment in both the Q2W and Q4W treatment groups.

References:

[1]Kavanaugh A, Marzo-Ortega H, Vender R, et al.Clin Exp Rheumatol. 2019;37(4):566-574.

[2]Turkiewicz A, Gellett A, Kerr L, et al. [abstract]Arthritis Rheumatol. 2018;70(S9):2577.

Disclosure of Interests:

Ana-Maria Orbai Grant/research support from: Abbvie, Eli Lilly and Company, Celgene, Novartis, Janssen, Horizon, Consultant of: Eli Lilly; Janssen; Novartis; Pfizer; UCB. Ana-Maria Orbai was a private consultant or advisor for Sun Pharmaceutical Industries, Inc, not in her capacity as a Johns Hopkins faculty member and was not compensated for this service., Kurt de Vlam Grant/research support from: Celgene, Consultant of: Celgene, Eli Lilly and Company, UCB, Novartis, and Pfizer, Speakers bureau: Celgene, Eli Lilly and Company, UCB, Novartis, and Pfizer, Peter Nash Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Julie Birt Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Gaia Gallo Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Keri Stenger Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Vladimir Geneus Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Bernard Combe Grant/research support from: Novartis, Pfizer, Roche-Chugai, Consultant of: AbbVie; Gilead Sciences, Inc.; Janssen; Eli Lilly and Company; Pfizer; Roche-Chugai; Sanofi, Speakers bureau: Bristol-Myers Squibb; Gilead Sciences, Inc.; Eli Lilly and Company; Merck Sharp & Dohme; Pfizer; Roche-Chugai; UCB

AB0352 CONSENSUS STATEMENT: USE OF JAKINIB THERAPY IN IMMUNE MEDIATED INFLAMMATORY DISEASES

Background:

Janus kinase inhibitor therapy is approved for use in a variety of Immune mediated inflammatory diseases.

Objectives:

With 4 agents approved & 1 in development, it is timely to undertake a systematic literature review (SLR) of evidence across indications for efficacy, safety & management issues.

Methods:

Existing data was evaluated by a steering committee & subsequently by a 25 person expert committee leading to a consensus statement to assist the clinician once the decision had been made to commence a Jakinib. The Committee included patients, rheumatologists, gastroenterologist, haematologist, dermatologist & infectious disease specialists. SLR of Medline, Embase, Cochrane, abstracts from 2018 EULAR & ACR congresses & Epistemonikos identified 1,178 RA & PsA, 128 SLE, & 1339 “other indications” unique references meeting criteria that included randomized & open label clinical trials, registries, phase 4 trials, & meta-analyses. Warnings from regulators issued after the end of the SLR search date were taken into consideration. Cochrane risk of bias tool was used.

Results:

General principles included (1) shared decision making, (2) adherence to T2T principles, (3) reference to disease specific product information & (4) reference to country/region specific treatment algorithms. Mode of action & indications are discussed & consensus was reached on pre-treatment screening, contra-indications, monitoring, treatment dose, co-medications & adverse effects (see Table 1.), with 80-100% agreement. A research agenda was formulated to update the review as new information becomes available.

Table 1.

Baseline characteristics of the patients

1. Patient history, examination2. Routine Laboratory testing: FBC diff LFTs Renal function, lipids at wk 123. Hepatitis Bs Ag & Ab, core Ab & Hep C ab, & HIV in high risk individuals.4.TB screening as per national guidelines5.Assess & update vaccination status6.Consider VTE risk factors – prior history, familial VTE, use of Cox2 inhibitorsB. Monitoring1. FBC diff LFTs mth 1, & mth 3 with lipids, repeat periodically2. Annual skin examination3. Evaluated response using validated disease specific measures of disease activity – be aware ESR/CRP may be reduced independently of reduction in disease activity or infectionC. Contra-indications (consult label & warnings)1. Severe active (or chronic) infection, including tuberculosis and opportunist infections2. Current malignancies3.Pregnancy & lactation4. Severe organ dysfunction eg severe hepatic disease (Child-Pugh C) or severe renal disease5. Allergy to Jak ihibitor6. History of VTE (relative contra-indication, careful consideration +/_ anticoagulation)Table.

Peripheral blood cell counts for each week.

D. Adverse Effects.1. Serious infections including opportunist infections, TB, Herpes Zoster, are increased. The risk is lowered with reduction or elimination of concomitant corticosteroid2.Rates of malignancy do not appear elevated although the risk of NMSC may be elevated3. Lymphopenia, neutropenia, elevated liver transaminases, & lipid changes have been noted4. An increased risk of VTE has been reported in a safety trial of tofacitinib & in the placebo-controlled trial period of baricitinib in RA patients5. Elevations of CPK noted but have been rarely associated with clinical events6. Elevations of creatinine noted but not associated with renal failure or hypertension

Conclusion:

The consensus provides an assessment of evidence for efficacy & safety of an important therapeutic class with guidance on practical management issues.

Acknowledgments:

Unrestricted grants were provided by Abbvie & Lilly with no input into the planning & development of the recommendations, nor influence or attendance at the meeting nor review of the abstract, with full disclosures from participants & the opportunity to declare any feelings of conflict of interest.

Disclosure of Interests:

Peter Nash Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, MSD, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Andreas Kerschbaumer Paid instructor for: Celgene, Speakers bureau: Andreas Kerschbaumer has received lecture fees from Bristol-Myers Squibb, Gilead, Merck Sharp and Dohme and Pfizer., Désirée van der Heijde Consultant of: AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Cyxone, Daiichi, Eisai, Eli-Lilly, Galapagos, Gilead Sciences, Inc., Glaxo-Smith-Kline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, UCB Pharma; Director of Imaging Rheumatology BV, Josef S. Smolen Grant/research support from: AbbVie, AstraZeneca, Celgene, Celltrion, Chugai, Eli Lilly, Gilead, ILTOO, Janssen, Novartis-Sandoz, Pfizer Inc, Samsung, Sanofi, Consultant of: AbbVie, AstraZeneca, Celgene, Celltrion, Chugai, Eli Lilly, Gilead, ILTOO, Janssen, Novartis-Sandoz, Pfizer Inc, Samsung, Sanofi

Cost savings with a new screening algorithm for pulmonary arterial hypertension in systemic sclerosis

BACKGROUND

Screening for pulmonary arterial hypertension (PAH) in systemic sclerosis (SSc) is now standard care in this disease. The existing Australian Scleroderma Interest Group algorithm (ASIGSTANDARD ) is based on transthoracic echocardiography (TTE) and pulmonary function tests (PFT). Recently, ASIG has derived and validated a new screening algorithm (ASIGPROPOSED ) that incorporates N-terminal pro-B-type natriuretic peptide level together with PFT in order to decrease reliance on TTE, which has some limitations. Right heart catheterisation (RHC) remains the gold standard for the diagnosis of PAH in patients who screen 'positive'.

AIM

To compare the cost of PAH screening in SSc with ASIGSTANDARD and ASIGPROPOSED algorithms.

METHODS

We applied both ASIGSTANDARD and ASIGPROPOSED algorithms to 643 screen-naïve SSc patients from the Australian Scleroderma Cohort Study (ASCS), assuming a PAH prevalence of 10%. We compared the costs of screening, the number of TTE required and both the total number of RHC required and the number of RHC needed to diagnose one case of PAH, and costs, according to each algorithm. We then extrapolated the costs to the estimated total Australian SSc population.

RESULTS

In screen-naïve patients from the ASCS, ASIGPROPOSED resulted in 64% fewer TTE and 10% fewer RHC compared with ASIGSTANDARD , with $1936 (15%) saved for each case of PAH diagnosed. When the costs were extrapolated to the entire Australian SSc population, there was an estimated screening cost saving of $946 000 per annum with ASIGPROPOSED , with a cost saving of $851 400 in each subsequent year of screening.

CONCLUSIONS

ASIGPROPOSED substantially reduces the number of TTE and RHC required and results in substantial cost savings in SSc-PAH screening compared with ASIGSTANDARD .

A counterexample to a conjecture on optimal list ordering

A number of items are arranged in a line. At each unit of time one of the items is requested, the i th being requested with probability Pi. We consider rules which reorder the items between successive requests in a fashion which depends only on the position in which the most recently requested item was found. It has been conjectured that the rule which always moves the requested item one closer to the front of the line minimizes the average position of the requested item. An example with six items shows that the conjecture is false.

A hamiltonian approach to optimal stochastic resource allocation

The problem of scheduling items for service with random service times is formulated as an optimal control problem. Pontryagin's maximum principle is used to determine the optimal schedule in certain cases.