POS1090 THE IMPACT OF NUMBER OF COMORBIDITIES ON ACHIEVEMENT REMISSION OR LOW DISEASE ACTIVITY BY DAPSA IN PSORIATIC ARTHRITIS. DATA FROM THE RUSSIAN OBSERVATIONAL COHORT

Abstract

BackgroundThe goal of psoriatic arthritis (PsA) treatment is achievement remission (REM) or Low Disease Activity (LDA) by DAPSA. The impact of comorbidities, especially obesity, metabolic syndrome on PsA activity and on biological treatment response are shown in some registry [1]. Obesity, hypertension and Charlson Comorbidity Index ≥1 are prognostic factors for poorer treatment outcome rates in PsA [2]. But influence of number of comorbidities on treatment response has not been fully studied in real practiceObjectivesTo evaluate the impact of number of comorbidities on achievement remission by DAPSA in PsA ptsMethods528 pts (M/F=256 (48.5%)/272 (51.5%) with PsA according to CASPAR criteria were included in the Russian observational cohort. Mean age 48.7±12.33 years (yrs.), PsA duration 122.6±81.85 months (mo.), psoriasis (Ps) duration 239.0±155.45 mo. Pts who completed ≥2 visits were analyzed. Mean observational period 73.6±83.47 mo.All pts underwent standard clinical examination: tender joint count (TJC)/68, swollen joint count (SJC)/66, Pain (VAS), Patient global assessment of disease activity (PtGA, VAS), CRP mg/l, BSA (%), BMI, HAQ, comorbidities by ICD-10, X-ray of hands and foods. DAPSA>28 indicates as high disease activity (HDA), >14-28 - moderate activity (MoDA), >4-14 – LDA, ≤4 – REM. Analyses were performed based on number of comorbidities: 1st group (gr) - without comorbidities, 2nd gr – pts with 1 comorbidity, and 3rd gr – pts with ≥ 2 comorbidities. M±SD, %, t-test, Peаrson-χ2, ORs with 95% CI were calculated. All p<0.05 were considered to indicate statistical significanceResultsIn 236 out of 528 (44.7%) pts no comorbidity found, in 145 out of 528 (27.5%) found 1 comorbidity and 147 out of 528 (27.8%) pts had ≥ 2 comorbidities.Comparative analysis in groups showed the following features: pts of 3rd gr were significantly more often females, had longer Ps and PsA duration, they were older, had worse HAQ, higher BMI, TJC (p<0.05). Joint erosions were found significantly more often in the 2nd gr compared to the 1st gr (p=0.02). No significant differences were in the frequency of axial PsA (p=0.906), Ps severity (BSA>10%) (p=0.237), the number of pts receiving bDMARDs (p=0.078). REM/LDA achievement according to DAPSA was significantly lower in the 3rd gr (15 (10,2%)/69(46.9%) comparing to the 1st gr (62 (26,3%)/94 (39.8%), and to the 2nd gr (32 (22,1%)/69 (47.6%) (p=0.007). The probability of achieving REM/LDA is 1.6 times lower in the gr of pts with ≥2 comorbidities compared to the gr of pts without comorbidities (OR 0.608, 95% CI 0.394 to 0.936) and 1.3 times lower compared to gr of pts with 1 comorbidity (OR 0.789, 95% CI 0.489 to 1.243) (Figure 1)Figure 1.Chances of REM/LDA achievement in pts with ≥2 comorbidities compared to pts with 1 comorbidity and pts without comorbiditiesConclusionIn real clinical practice comorbidities were seen in more than half PsA pts. Third of PsA pts had number of comorbidities. PsA pts with number of comorbidities are associated with high disease activity, reduced quality of life and are 1,6 times more likely to have no chance to attain REM/LDA by DAPSA. It should be considered for personalized treatmentReferences[1]Ballegaard C, et al. Arthritis Care Res (Hoboken). 2018;70(4):592-599. doi: 10.1002/acr.23333[2]Ballegaard C, et al. Rheumatology, 60(7), 2021: 3289-300, https://doi.org/10.1093/rheumatology/keaa780AcknowledgementsThe RU-PsART study groupDisclosure of InterestsYulia Korsakova Speakers bureau: Novartis, ELENA GUBAR: None declared, Elena Loginova Speakers bureau: Janssen,, Tatiana Korotaeva Speakers bureau: Pfizer, Novartis, MSD, AbbVie, Janssen, JSC BIOCAD, UCB, Lilly and Novartis-Sandoz, Consultant of: Pfizer, Novartis, MSD, AbbVie, Janssen, JSC BIOCAD, UCB, Lilly and Novartis-Sandoz, Valentina Sorotskaya: None declared, Irina Patrikeeva: None declared, Pavel Shesternya: None declared, Irina Umnova: None declared, Evgeny Nasonov: None declared