Secukinumab treatment showed improved quality of life in patients with chronic plaque psoriasis in Australia: Results from the HOPE study

BACKGROUND

Psoriasis imposes a disease burden that can have a profound negative impact on patients' quality of life (QoL). HOPE was the first non-interventional study conducted in patients with severe chronic plaque psoriasis in Australia that evaluated health-related QoL in response to treatment with secukinumab.

METHODS

HOPE was a prospective, open-label, single-arm, multicentre, non-interventional, exploratory study in patients with severe chronic plaque psoriasis in Australia. The study investigated the change in QoL, using the Dermatology Life Quality Index (DLQI), Assessment Quality of Life-8 Dimension questionnaire (AQoL-8D) and Psoriasis Area and Severity Index (PASI), and safety profile in response to treatment with secukinumab 300 mg SC weekly for 4 weeks followed by monthly maintenance for 58 weeks.

RESULTS

At Week 14, the mean percentage reduction in total DLQI score from baseline was -82.4% (n = 65), which indicates a substantial improvement in QoL. This level of improvement was sustained up to Week ≥58, with a mean percentage change of -87.4%. The mean percentage change from baseline for AQoL-8D weighted total score decreased from Week 14 (41.1%) to Week 58 (35.2%), indicating an improvement in patients' QoL. A high proportion of patients achieved PASI 75/90/100 responses at Week 14 (97.0%/71.2%/34.8%), with rates sustained up to Week ≥58 (100%/87.9%/43.1%). The safety profile of secukinumab was favourable, with no cumulative or unexpected safety concerns.

CONCLUSION

Secukinumab treatment demonstrated a striking improvement in patients' QoL in the HOPE study, the first real-world study in patients with severe chronic plaque psoriasis in the Australian clinical setting.

Secukinumab treatment demonstrated high drug survival and sustained effectiveness in patients with severe chronic plaque psoriasis: 21-month analysis in Australian routine clinical practice (SUSTAIN study)

BACKGROUND

Drug survival measures the rate and duration of adherence to a given therapeutic agent and evaluates its long-term effectiveness, safety, and real-world utility. The SUSTAIN study sought to establish the drug survival and effectiveness of secukinumab for patients with severe chronic plaque psoriasis (CPP) in the Australian clinical setting.

METHODS

Data of all patients (aged ≥18 years) from Australasian Psoriasis Registry (APR) treated with secukinumab were analysed. The primary objective was to describe the drug survival of secukinumab at 9 months. Key secondary objectives included drug survival of secukinumab at 3, 6, 15, and 21 months, stratified by biologic-naïve vs biologic-experienced patients; proportion of patients achieving Psoriasis Area and Severity Index (PASI) 75/90/100 responses; and changes in health-related quality of life over time utilising the Dermatology Life Quality Index (DLQI).

RESULTS

Of 294 patients included in this analysis, 110 (37.4%) were biologic-naïve and 184 (62.6%) biologic-experienced. Kaplan-Meїer drug survival rates in biologic-naïve vs biologic-experienced patients were 0.92 vs. 0.86 (9 months) and 0.82 vs. 0.68 (21 months), respectively. The proportion of patients with PASI 75/90/100 responses for biologic-naïve vs. biologic-experienced was 100/87.7/38.4 vs 98.5/61.5/27.2 (9 months) and 100/81.0/41.7 vs. 98.4/62.0/24.2 (21 months), respectively. The mean (standard deviation [SD]) DLQI in biologic-naïve vs. experienced patients was 2.2 (4.1) vs. 3.1 (5.2) (9 months) and 1.4 (2.5) vs. 3.1 (5.3) (21 months). No new safety signals were observed.

CONCLUSIONS

Secukinumab demonstrated high drug survival and sustained effectiveness in Australian real-world setting, in biologic-naïve and biologic-experienced patients with severe CPP.

Prevalence of sleep disturbance and the association between poor disease control in people with ankylosing spondylitis within the Australian clinical setting (ASLEEP study): a real-world observational study using the OPAL dataset

Introduction

Sleep disturbance and fatigue are commonly reported in ankylosing spondylitis (AS) but specific prevalence and the relationship to disease control are unknown.

Method

This retrospective non-interventional observational study of data from the OPAL dataset included patients with AS (ICD code M45, M45.0 or M08.1), aged 18 to 95 years and had completed ≥ 1 sleep questionnaire between 1 January 2019 and 30 September 2020. The prevalence of insomnia and obstructive sleep apnoea were assessed using the Insomnia Severity Index (ISI) and Multivariate Apnoea Prediction Index (MAPI), respectively. Propensity score (PS) matching based on sex, age and symptom duration increased comparability between patients administered tumour necrosis factor inhibitors (TNFi) and interleukin 17A inhibitors (IL-17Ai).

Results

Four hundred ninety-five patients were included. The mean ISI total score in the overall population was 8.6 ± 6.2. Self-reported moderate or severe clinical insomnia was present in 16% and 3.2% of patients, respectively. The mean MAPI score was 0.4 ± 0.3, self-reported apnoea was identified in 31.5% of patients and the mean FACIT-Fatigue score was 36.1 ± 10.7. In the PS matched population, the only treatment-related difference was the mean MAPI score (IL-17Ai 0.4 ± 0.3 and TNFi 0.3 ± 0.2, p = 0.046). Those with poor disease control (BASDAI ≥ 4) were more likely (odds ratio [OR] 7.29, 95% CI 2.37 to 22.46, p = 0.001) to have a greater severity of insomnia symptoms than those with good disease control.

Conclusion

In this real-world AS cohort, poor disease control was associated with sleep disturbance. Little difference in sleep disturbance was observed between biologic TNFi and IL-17Ai treatment.

Key Points

• Sleep disturbance and fatigue are common in patients with ankylosing spondylitis. • In our real-world cohort, self-reported apnoea was reported in one-third of patients; and one in five patients reported moderate to severe insomnia. • Those with poor disease control were more likely to experience greater sleep disturbance than those with good disease control.

POS0906 PREVALENCE OF SLEEP DISTURBANCE IN PATIENTS WITH ANKYLOSING SPONDYLITIS WITHIN THE AUSTRALIAN CLINICAL SETTING (ASLEEP STUDY): A REAL-WORLD OBSERVATIONAL STUDY USING THE OPAL DATASET

Background:

Sleep disorders are more prevalent in patients with ankylosing spondylitis (AS) compared to the general population. Sleep disturbance in AS, in addition to pain and fatigue, can lead to impaired physical function and reduced quality of life.

Objectives:

The primary objective was to determine the prevalence of sleep disturbance in patients with AS in a real-world Australian cohort using the Insomnia Severity Index (ISI) and Multivariate Apnoea Prediction Index (MAPI). ISI score of ≥ 15 is considered clinical insomnia. MAPI values below 0.05 are suggestive of clinical apnoea.

Methods:

Routinely collected, de-identified clinical data were sourced from the OPAL dataset. Patients aged between 18 and 95 years with a diagnosis of AS and who had completed at least one ISI or MAPI questionnaire between Jan-2019 and Sept-2020 were included. ISI and MAPI questionnaires were emailed to patients using OPAL’s electronic patient reported outcome (ePRO) delivery method or completed in the clinic using a smart device and returned to the patient’s file using a QR code. Disease activity was assessed using BASDAI collected at the same time as the sleep questionnaires. Age, sex and duration of symptoms were used to propensity match patients in the Il-17ai and TNFi group in a 1:2 ratio.

Results:

495 of the 5,323 patients identified with AS completed a questionnaire and were included in the analysis (n=395 TNFi, n=48 Il-17ai (secukinumab), n=52 other therapies). 142 were included in the propensity score matched population (n = 94 TNFi, and n = 48 Il-17ai). In the overall population the mean (SD) age was 48.3 (13.6), 55.4% were males, the mean (SD) BMI was 30.1 (19.6) at the index date and 4.8% reported depression. 51.7% had an optimal disease control (BASDAI <4). The mean (SD) ISI score was 8.6 (6.2). 48.1% reported no clinical significant insomnia, 32.7% reported subthreshold insomnia, 16% reported clinical insomnia (moderate severity) and 3.2% reported clinical insomnia (severe). The mean (SD) MAPI score was 0.4 (0.3). 292 patients (59.0%) had low risk of clinical apnoea, 134 patients (27.1%) had high risk of clinical apnoea and 69 patients 13.9% had not completed the MAPI questionnaire. In the propensity scored matched population, the TNFi and Il-17ai groups had mean (SD) ISI scores of 9.1 (6.6) and 8.9 (5.9) at index, respectively (p = 0.83) and mean (SD) MAPI scores of 0.3 (0.2) and 0.4 (0.3) at index, respectively (p=0.046), however a higher percentage of overweight and obese patients were identified in the Il-17ai treatment group. Ordered logistic regression analysis of the relationship between demographics and ISI in the matched population found that patients with BASDAI ≥4 were seven times more likely to experience greater sleep disturbance (OR 7.29, 95%CI 2.37 to 22.46, p=0.001) than those with BASDAI <4.

Conclusion:

In this real-world AS cohort, poor disease control was associated with sleep disturbance, despite bDMARD therapy. Little difference was observed between TNFi and Il-17ai treatment. Screening for sleep disturbance and fatigue in routine clinical care may provide a more holistic view of the burden of this disease.

Table 1.

Patient characteristics and outcome scores in the propensity score matched population at index.

TNFi (n=94)Il-17ai (n=48)p valueBMI category Underweight2 (2%)1 (2%)0.094 Normal weight33 (35%)8 (17%) Overweight24 (26%)16 (33%) Obese27 (29%)21 (44%) Missing8 (9%)2 (4%)Duration of treatment (months), mean (SD)61.0 (156.7)23.7 (20.1)0.18BASDAI <443 (46%)23 (48%)0.89BASDAI > 416 (17%)8 (17%)Missing35 (37%)17 (35%)ISI score, mean (SD)9.1 (6.6)8.9 (5.9)0.83ISI category (n (%)0.83 No clinically significant insomnia44 (57%)24 (50%) Subthreshold insomnia30 (32%)15 (31%) Clinical insomnia (moderate)15 (16%)8 (17%) Clinical insomnia (severe)5 (5%)1 (2%)MAPI score, mean (SD)0.3 (0.2)0.4 (0.3)0.046MAPI, high apnoea risk Yes17 (18%)16 (33%)0.051 No62 (66%)26 (54%) Missing15 (16%)6 (12%)

Acknowledgements:

The authors acknowledge the members of OPAL Rheumatology Ltd and their patients for providing clinical data for this study, and Software4Specialists Pty Ltd for providing the Audit4 platform. We acknowledge WriteSource Medical Pty Ltd for providing statistical services. Funding for this study was provided by Novartis.

Disclosure of Interests:

Kathleen Tymms: None declared, Belinda Butcher: None declared, Tracey Sletten: None declared, Tegan Smith: None declared, Catherine OSullivan: None declared, Geoff Littlejohn Consultant of: AbbVie, Bristol Myers Squibb, Eli Lilly, Gilead, Novartis, Pfizer, Janssen, Sandoz, Sanofi and Seqirus., Ricky Sadler Employee of: Current employee of Novartis, Rebecca Tronnberg Employee of: Current employee of Novartis, Hedley Griffiths Consultant of: AbbVie, Gilead, Novartis and Lilly.

Dissociations of the Fluocinolone Acetonide Implant: The Multicenter Uveitis Steroid Treatment (MUST) Trial and Follow-up Study

PURPOSE

To describe fluocinolone acetonide implant dissociations in the Multicenter Uveitis Steroid Treatment (MUST) Trial.

DESIGN

Randomized clinical trial with extended follow-up.

METHODS

Review of data collected on the first implant in the eye(s) of participants. Dissociation was defined as the drug pellet no longer being affixed to the strut and categorized as spontaneous or surgically related.

RESULTS

A total of 250 eyes (146 patients) had at least 1 implant placed. Median follow-up time after implant placement was 6 years (range 0.5-9.2 years). Thirty-four dissociations were reported in 30 participants. There were 22 spontaneous events in 22 participants; 6-year cumulative risk of a spontaneous dissociation was 4.8% (95% confidence interval [CI]: 2.4%-9.1%). The earliest event occurred 4.8 years after placement. Nine of 22 eyes with data had a decline in visual acuity ≥5 letters temporally related to the dissociation. Thirty-nine implant removal surgeries were performed, 33 with replacement. Twelve dissociations were noted during implant removal surgeries in 10 participants (26%, 95% CI 15%-48%); 5 of these eyes had a decline in visual acuity ≥5 letters after surgery. The time from implant placement to removal surgery was longer for the surgeries at which dissociated implants were identified than for those without one (5.7 vs 3.7 years, P < .001). Overall, visual acuity declined 15 or more letters from pre-implant values in 22% of affected eyes; declines were frequently associated with complications of uveitis or its treatment.

CONCLUSION

There is an increasing risk of dissociation of Retisert implants during follow-up; the risk is greater with removal/exchange surgeries, but the risk of both spontaneous and surgically related events increases with longevity of the implants. In 22% of affected eyes visual acuity declined by 15 letters. In the context of eyes with moderate to severe uveitis for years, this rate is not unexpected.