POSC189 A Patient Registry-Based Cross-Sectional Study of the Burden and Management of Comorbid Psoriatic Arthritis (PsA) in Patients with Systemic Lupus Erythematosus (SLE)

Abstract

Coexistence of PsA and SLE is considered rare. Given the potential for phototherapy or drug-induced exacerbation of SLE, or worsening psoriasis with some biologic treatments, this study sought to better understand the burden of real-world comorbidities critical to optimizing patient outcomes. The OM1 SLE Registry (OM1;Boston, MA) follows 46,900+ SLE patients in the U.S. managed by rheumatologists longitudinally w/deep clinical data, including laboratory, patient-reported and disease activity information, and linked claims, starting from 2013. Index date was set by the first encounter w/SLE diagnosis code and ≥18 months of baseline available. Comorbidities were defined by ≥2 outpatient diagnosis codes ≥30 days apart or one inpatient diagnosis code prior to index. Obesity was defined as BMI≥30 kg/m2. Medications were identified by prescriptions, administrations or fills. RAPID3 (Routine Assessment of Patient Index Data 3) at index was also explored. Study included 44,186 patients (92% female, mean age 51 years) from the OM1 SLE Registry, 703 (1.4%) of whom had documented PsA. Patients with co-morbid PsA were slightly older, with higher proportion male (12% vs. 8%), white (68% vs. 56%) and non-Hispanic (69% vs. 64%) patients. Patients with PsA were more likely to be obese (50% vs. 40%). Mean joint-related disease activity was moderate (mean RAPID-3=4) across patients. Proportion with other autoimmune conditions were similar. Recent treatment w/systemic steroids, methotrexate, leflunomide and TNFa and IL-17 or IL12/23 inhibitors was more common in SLE-PsA patients. Hydroxychloroquine was less commonly used in PsA patients (31% vs. 42%). Managing T-cell and B-cell-driven conditions simultaneously poses a clinical challenge, attempting to balance treating cutaneous and joint-related manifestations with exacerbating disease flares. Clinical development and availability of therapies with other mechanisms of action may provide important alternatives. Since clinical trials typically exclude many comorbid conditions, real-world data regarding these complex phenotypes provide important insights into tailored treatment strategies.