POS1119 ARE WE TREATING-TO-TARGET IN SPONDYLOARTHRITIS (SPA)? A ONE-YEAR ANALYSIS FROM THE ASIA PACIFIC LEAGUE OF ASSOCIATIONS FOR RHEUMATOLOGY (APLAR) SPA REGISTRY

Abstract

BackgroundData on the extent to which internationally agreed treat-to-target (T2T) recommendations were applied in clinical practice in patients with spondyloarthritis (SpA) across the Asia-Pacific region is lacking. The APLAR SpA Registry is a multi-centre study aiming to assess the utility of early diagnosis and intensive protocolized treatment to patients with SpA on the long-term outcome.ObjectivesThis analysis aimed to evaluate the extent of T2T achievement after 1-year intensive treatment in patients with SpA.MethodsPatients who fulfilled the CASPAR 2006 classification criteria for psoriatic arthritis (PsA), and 2009 ASAS classification for axial spondylitis (AxSpA) were recruited. The current analysis included the first 99 patients reaching the 1-year timepoint across 6 Asia-Pacific regions.Results49 patients with PsA (age: 52±11 years, 27(55%) male, disease duration: 6.0±7.9 years) and 50 patients with AxSpA (age: 40±14 years, 36(72%) male, disease duration: 5.9±7.6 years) were included. All of them were Asian. After 1-year treatment, there were significant improvements in disease activity (Disease Activity in Psoriatic Arthritis (DAPSA): 15.3±11.6 at baseline vs 10.1±11.2 at 1-year,p=0.002; Ankylosing Spondylitis Disease Activity Score (ASDAS): 2.4±1.0 at baseline vs 1.9±0.9 at 1-year,p=0.003). Other characteristics are shown in Table 1. Concerning medication use, there was an increase in the number of PsA patients receiving conventional synthetic disease-modifying drugs (csDMARDS, 65% at baseline to 72% at 1-year) and biologic DMARDS (bDMARDS, 24% at baseline to 43% at 1-year). For AxSpA, the prevalence of csDMARDs use decreased (30% at baseline to 18% at 1-year) while the prevalence of bDMARDs use increased (32% at baseline and 54% at 1-year). Patients in both groups required less NSAIDs (Figure 1). Regarding T2T, 63% and 51% of PsA patient achieved DAPSA-low disease activity (DAPSA-LDA) and minimal disease activity (MDA) respectively, while 66% of patients with Axial SpA achieved ASDAS-LDA. The MDA and ASDAS-LDA achievement rate was slightly higher than that of the tight control arm of TICOPA (41%)[1]and TICOSPA cohort (60%)[2]respectively. The bDMARDs use in TICOPA cohort was 37% and that in TICOSPA was 57%, both comparable to our APLAR SpA cohort (Figure 1). There was no significant difference in baseline demographics and clinical features between patients who could or could not achieve treatment target, except a lower patients’ pain and global assessment, and lower functional disability in patients who achieved DAPSA-LDA at 1-year.Table 1.Clinical features and disease activity in patients with SpA in the APLAR region at baseline and 1-yearPsA (n=49)AxSpA (n=50)BaselineYear 1BaselineYear 1pAge, years52±1140±14NRS Patients’ pain assessment, 0-104±23±2*4±23±2*NRS Patients’ global assessment, 0-104±23±2*4±23±2*NRS Physicians’ global assessment, 0-103±22±2*4±23±2*PASS, acceptable3373%4189%3167%4492%*TJ count, 0-684±53±6*1±21±2SJ count, 0-662±41±3*0±00±1Dactylitis digit1±20±1*0±00±0PASI3.81±5.382.17±3.27*SPRACC, 0-150±10±1*0±10±1ESR, mm/h20±1817±1225±2119±13CRP, mg/L7.3±8.94.3±4.9*20.9±62.38.4±19.4DAPSA15.27±11.6010.06±11.21*ASDAS CRP2.43±1.001.93±0.87*BASDAI3.6±2.22.6±2.1*BASFI2.8±2.31.9±2.2*BASMI3±23±2*HAQ-DI0.503±0.6140.372±0.4690.470±0.4710.318±0.428*Figure 1.Medication use at baseline and 1-yr in patients with PsA (Upper panel)/ Axial SpA (middle panel) and T2T achievement in PsA and Axial SpA patients in APLAR SpA registry and other studies (lower panel)ConclusionImplementing the T2T strategy in a patient with SpA is feasible in the selected sites of the APLAR SpA registry. We expect more long-term outcome data in the following years regarding other outcomes.