POS1096 CHARACTERIZATION OF A PsA COHORT IN CLINICAL ROUTINE CARE USING THE DAPSA AND ITS CORE-SET PARAMETERS.

Abstract

BackgroundA large number of therapeutics have become available to treat Psoriatic Arthritis (PSA). Still, the level of disease activity in contemporary PSA patients in clinical practice may span broadly across the range.ObjectivesTo investigate disease activity in PsA patients at their last clinical visit in a tertiary academic European centre using treat-to-target as management principle, and with access to all contemporary treatments, by Disease Activity in PSA (DAPSA) index and its components.MethodsDisease characteristics of 138 PSA patients at an academic referral centre was assessed at their last clinical visit, including DAPSA scores, DAPSA states, and DAPSA components (swollen joint count 66, tender joint count 68, patient global assessment, patients’ assessment of pain and C-reactive protein), as well as ongoing DMARD therapy. Cumulative frequencies of DAPSA core-set parameters and Health-Assessment Questionnaire Disability Indices were calculated and tabulated. All patients provided their written informed consent to participate, and this study was approved by the local ethics committee.ResultsOf 138 PsA patients included, 68 were female (49%), the mean disease duration was 11.8 years and patients had 2.4 mean swollen joints and 6.4 tender joints. Most patients received conventional synthetic DMARDs as monotherapy (73/138 53%), but about the half of patients (53%) were not at treatment target of DAPSA low disease activity or remission (Table 1). When investigating the composition of disease activity by components, about 50% of patients had ≤1 swollen joint (0-66), ≤3 tender joints (0-68), ≤4.0cm of patient global assessment (0-10) and ≤4.0cm of pain (0-10) as well as a HAQ ≤0.5 and normal CRP values.Table 1.Demographics and clinical characteristics of 138 patients at their last visit in a tertiary academic European centre (shown as numbers and percent or mean and standard deviation).N138Female68 (49%)Age (years)48.8±17.5Disease duration (years)11.9±10.2Swollen Joint Count (0-66)2.4±3.2Tender Joint Count (0-68)6.4±9.4Patient Global Assessment (VAS 0-10cm)4.0±2.9Patients Assessment of Pain (VAS 0-10cm)3.6±2.6C-reactive Protein (mg/dL)1.1±2.6Health Assessment Questionnaire (0-3)0.7±0.8DAPSA18.7±16.5TreatmentAny csDMARD91 (66%)Methotrexate78 (57%)Leflunomide10 (7%)Sulfasalazine6 (4%)Any bDMARD35 (25%)TNF inhibition30 (22%)IL17 inhibition1 (1%)IL12/23 inhibition4 (3%)csDMARD monotherapy73 (53%)bDMARD monotherapy17 (12%)bDMARD + csDMARD combination18 (13%)DAPSA disease activity stateRemission26 (19%)Low Disease Activity40 (29%)Moderate Disease Activity45 (33%)High Disease Activity27 (20%)Figure 1.Cumulative probability plots of swollen and tender joint assessments, patient global assessment (PGA), patients assessment of pain, Health Assessment Questionnaire (HAQ) Disability Index and C-reactive protein (CRP).ConclusionThis analysis of PsA patients in routine care at a European tertiary academic center showed that many patients are not on treatment target. Their presentation is oligoarticular, with moderate levels of pain and patient global assessments, but mostly normal or slightly elevated CRP levels. Despite the treat-to-target strategy and a large number of therapeutics, and overall good control of objective measures of disease activity, many patients in real life may potentially benefit from more intensive treatment escalation.AcknowledgementsThis study was supported by Amgen through a financial grant to the institution.Disclosure of InterestsAndreas Kerschbaumer Speakers bureau: AbbVie, Bristol-Myers Squibb, Amgen, Eli-Lilly, Gilead, Janssen, Merck Sharp and Dohme, Novartis and Pfizer, Josef S. Smolen Speakers bureau: AbbVie, Amgen, AstraZeneca, Astro, Bristol-Myers Squibb, Celgene, Celltrion, Chugai, Gilead, ILTOO Pharma, Janssen, Lilly, Merck Sharp & Dohme, Novartis-Sandoz, Pfizer, Roche, Samsung, Sanofi, and UCB, Grant/research support from: Abbvie, AstraZeneca, Janssen, Lilly, Merck Sharpe & Dohme, Pfizer, and Roche, Daniel Aletaha Speakers bureau: Abbvie, Amgen, Lilly, Merck, Novartis, Pfizer, Roche, Sandoz, Grant/research support from: Abbvie, Amgen, Lilly, Novartis, Roche, SoBi, Sanofi