Treatment Of Psoriatic Arthritis Research Articles

The Undeniable Benefits of Apremilast in Psoriatic Arthritis: An Observational Study from South India

Context: Ever since the introduction of apremilast in the Indian market in 2017, it was used in psoriatic arthritis with little information on the benefits of apremilast in this population, especially regarding the tolerability of the patients to tapered doses of apremilast. Aims: This study evaluates the efficacy, safety, and tolerability of apremilast in psoriatic arthritis. Settings and Design: A retrospective study was conducted on 120 patients aged ≥18 years who regularly visited one of the largest standalone rheumatology clinics between November 2018 and September 2019. Methods and Material: The proportion of patients who improved by 50% in their psoriasis area and severity index (PASI-50) score, as well as the reduction in tender joint count, swollen joint count, patient global health evaluation, and erythrocyte sedimentation rate, were all evaluated as effectiveness objectives. Statistical Analysis Used: The non-parametric test, Wilcoxon signed-rank test was used to compare between the baseline and follow-up measurements. Results: From a total of 120 patients, ninety-five patients showed a 65.09% reduction in the PASI score in the 16th week. A mean value for bath ankylosing spondylitis (BASDAI) of 4.36 at baseline was significantly reduced to 1.73 by the 16th week. Common adverse effects reported were gastritis (38.2%), diarrhea (32.4%), and fatigue (26.5%). Conclusions: Because of its tolerance and safety profile, apremilast may be regarded as a helpful medicine for the treatment of psoriatic arthritis, either alone or in combination with other medications, according to the findings of the study.

Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA): updated treatment recommendations for psoriatic arthritis 2021.

Since the second version of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations were published in 2015, therapeutic options for psoriatic arthritis (PsA) have advanced considerably. This work reviews the literature since the previous recommendations (data published 2013–2020, including conference presentations between 2017 and 2020) and reports high-quality, evidence-based, domain-focused recommendations for medication selection in PsA developed by GRAPPA clinicians and patient research partners. The overarching principles for the management of adults with PsA were updated by consensus. Principles considering biosimilars and tapering of therapy were added, and the research agenda was revised. Literature searches covered treatments for the key domains of PsA: peripheral arthritis, axial disease, enthesitis, dactylitis, and skin and nail psoriasis; additional searches were performed for PsA-related conditions (uveitis and inflammatory bowel disease) and comorbidities. Individual subcommittees used a GRADE-informed approach, taking into account the quality of evidence for therapies, to generate recommendations for each of these domains, which were incorporated into an overall schema. Choice of therapy for an individual should ideally address all disease domains active in that patient, supporting shared decision-making. As safety issues often affect potential therapeutic choices, additional consideration was given to relevant comorbidities. These GRAPPA treatment recommendations provide up-to-date, evidence-based guidance on PsA management for clinicians and people with PsA.

EE439 An MCDA Preference Index Support for the ICUR Analysis Between Psoriatic Arthritis Treatments

The PROMÉTHÉE II multi-criteria decision analysis (MCDA) method performs a preference index as a step of its implementation to express a preference level that an alternative can exert over another one, according to their performances on a set of criteria. This study aims to use the PROMÉTHÉE II’s preference index in order to support the incremental cost-utility ratio (ICUR) analysis between psoriatic arthritis treatments.

HPR21 Characteristics and Treatment Patterns of Tofacitinib Users in Taiwan, 2015-2019

Tofacitinib is the novel agent launched for the treatment of rheumatoid arthritis and psoriatic arthritis since 2012. However, the US Food and Drug Administration (FDA) has limited its use to patients who were lack of response or intolerant to TNF-alpha blockers due to safety concerns such as serious cardiac adverse events. Nevertheless, no such limitation has been implemented in Taiwan. In this study, we aimed to assess annual trends of tofacitinib use and characterize the treatment patterns of tofacitinib users in Taiwan to guide future policy making.

Does previous use of tumour necrosis inhibitors change the therapeutic effect of interleukin (IL)-17 or IL-12/23 inhibitors on psoriasis and psoriatic arthritis? Results of a systematic review.

Tumour necrosis factor inhibitors (TNFi) were the first biologics approved for the treatment of psoriasis (PsO) and psoriatic arthritis (PsA). However, some patients are intolerant of or unresponsive to TNFi. To investigate the therapeutic effect of interleukin (IL)-17 and IL-12/23 inhibitors in patients with PsO or psoriatic arthritis PsA who were intolerant of or had responded inadequately to TNFi therapy (TNFi-experienced patients). A systematic review of randomized controlled trials searched from the PubMed, Cochrane Library and Embase databases was conducted on 17 May 2021. Responses of 75% and 90% improvement on Psoriasis Area and Severity Index (PASI75, PASI90), 20%, 50% and 70% improvement on the American College of Rheumatology response criteria (ACR20, ACR50, ACR70), and full resolution of dactylitis/enthesitis were used to assess the treatment efficacy. In total, 7 studies with a total of 3398 patients with PsA were included, 1330 of whom were intolerant of or had responded inadequately to TNFi. All studies were categorized as having low risk of bias. For IL-17A inhibitors, there were significantly higher achievements in all of the endpoints compared with placebo, but the proportions of patients achieving these endpoints were lower in TNFi-experienced patients compared with TNFi-naïve patients. However, the differences between TNFi-experienced and TNFi-naïve patients were significant only for ACR responses and for full resolution of enthesitis. For IL-12/23 inhibitors, only the results for ACR20 response were reported. Significantly more TNFi-experienced patients achieved ACR20 response compared with patients receiving placebo, and the differences in treatment efficacy between TNFi-experienced and TFNi-naïve patients was not significant. IL-17A and IL-12/23 inhibitors still had efficacy for patients with PsO or PsA had failed or were intolerant to TNFi therapy; however, the efficacy was lower than that in TNFi-naïve patients. Further studies to confirm these findings are warranted.

HSD93 Trends in the Use of Biologics for Treatment of Psoriatic Arthritis

The objective of this research was to describe secular trends in the use of biologics for the treatment of psoriatic arthritis (PsA) using real-world data.

PET/CT-Based Characterization of 18F-FDG Uptake in Various Tissues Reveals Novel Potential Contributions to Coronary Artery Disease in Psoriatic Arthritis

Background and ObjectivesPsoriasis is a heterogeneous inflammatory disease that involves the skin, joints, liver, heart, and other organs. Psoriatic arthritis (PsA) is associated with cardiovascular disease (CVD), but the relative contributions of inflammatory and metabolic dysregulation to CVD are incompletely understood. We set out to discover novel potential contributors to CVD in PsA patients by comprehensively phenotyping a cohort of PsA patients using these advanced technologies.MethodsIn this cross-sectional analysis of a cohort study, we investigated associations of systemic inflammation and metabolic dysregulation with Coronary CT angiography (CCTA)-proven coronary artery disease (CAD) in 39 subjects with PsA. We measured traditional CVD risk factors [blood pressure, Body Mass Index (BMI), diabetes, age, sex, smoking], serum markers of systemic inflammation (hsCRP, GlycA) and metabolic dysfunction (cholesterol efflux capacity), and inflammatory cytokines (IL-1β, IL-6, IL-12/IL-23, IL-17A, TNF-α, IFN-γ). We also incorporated radiographic measures of metabolic dysfunction (visceral and subcutaneous adipose volume) and tissue-specific inflammation (positron emission tomography-computed tomography, PET-CT). To quantify relative contributions of FDG (fluorodeoxyglucose) uptake and adiposity to coronary plaque, we performed multiple linear regression, controlling for Framingham risk score (FRS) and FRS + visceral adiposity.ResultsCompared with non-psoriatic volunteers, subjects with PsA had elevated markers of metabolic and inflammatory disease, which was more pronounced in subjects with moderate-to-severe skin disease. This included visceral (p = 0.005) and subcutaneous (p = 0.004) adiposity, BMI (p = 0.001), hemoglobin A1C (p = 0.037), high sensitivity C-reactive protein (p = 0.005), IL-6 (p = 0.003), IFN-γ (p = 0.006), and liver FDG uptake (p = 0.03). In subjects with PsA, visceral adiposity correlated significantly with subclinical CAD (standardized β = 0.681, p = 0.002), as did FDG uptake in bone marrow (standardized β = 0.488, p = 0.008), liver (standardized β = 0.619, p < 0.001), spleen (standardized β = 0.523, p = 0.004), and subcutaneous adipose (standardized β = 0.524, p = 0.003).InterpretationTogether, these findings reveal inflammatory and metabolic potential contributors to subclinical CAD in PsA, including adipose inflammation, and suggesting novel targets for CVD prevention and treatment in PsA.

Systemic Immune Inflammation Index as a Reliable Disease Activity Marker in Psoriatic Arthritis

To assess the utility of systemic immune inflammation index (SII) in predicting disease activity in psoriatic arthritis (PsA) patients.A descriptive study.Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey, from October 2020 to September 2021.This study included 106 PsA and 103 age and gender-matched healthy individuals. Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR), and SII were calculated from complete blood count parameters. The PsA disease activity was assessed by using disease activity score-ESR and DAS-CRP based on 28 joints and the Disease Activity in Psoriatic Arthritis (DAPSA) scores. The receiver operating characteristic (ROC) curve was performed to evaluate the utility of SII in determining disease activity in PsA patients.The NLR, PLR, MLR, and SII were significantly higher in PsA patients compared to healthy control (p=0.013, p=0.019, p=0.012, and p=0.002, respectively). There were statistically significant positive correlations between the DAS28-ESR, DAS28-CRP, and DAPSA and SII (p<0.001, p<0.001, and p<0.001 respectively). The SII values were significantly higher in PsA patients with moderate to severe disease activity according to DAPSA scores when compared to patients with remission or low disease activity (p<0.001). The cut-off value of 800x109/L was found for predicting disease activity in PsA.SII may be an easy, practical, economical, and readily accessible tool for monitoring disease activity and the efficacy of treatment in PsA patients.Blood cell count, Psoriatic arthritis, Systematic immune inflammation index (SII).

Psoriatic arthritis treatment to the target: a consensus, evidence-based clinical practice recommendations for the management of psoriatic arthritis and its concomitant clinical manifestations

BackgroundWe aimed to provide up-to-date, evidence-based and consensus-based recommendations for Treat-to-Target management of psoriatic arthritis (PsA) and associated clinical manifestations.In this recommendations, 14 key clinical questions were identified by scientific committee according to the Patient/Population, Intervention, Comparison, Outcomes and Timing (PICOT) approach. Literature Review team performed a systematic review to summarize evidence advocating the benefits and harms of available pharmacologic and non-pharmacologic therapies for psoriatic arthritis. Subsequently, recommendations were formulated. The level of evidence was determined for each section using the Oxford Centre for Evidence-based Medicine (CEBM) system. A 3-round Delphi process was conducted with 19 experts whom were drawn from different governorates and health centers across Egypt with diverse in their experiences, including private, governmental workplace, tertiary university hospitals, and insurance hospitals. All rounds were conducted online. A consensus was achieved on the direction and the strength of the recommendations.ResultsAn online questionnaire was sent to an expert panel who participated in the three rounds (response rate 100%). At the end of round 3, a total of 51 recommendation items, categorized into 6 sections to address the main 6 psoriatic arthritis categories, were obtained. Agreement with the recommendations (rank 7–9) ranged from 89.5 to 100%. Consensus was reached (i.e., ≥ 75%of respondents strongly agreed or agreed) on the wording of all the 51 clinical standards identified by the scientific committee. Algorithms for the management of psoriatic arthritis have been suggested.ConclusionThese recommendations provide an updated consensus on the pharmacological treatment of psoriatic arthritis and strategies to reach optimal treat-to-target outcomes in in common clinical scenarios, based on a combination of evidence and expert opinion. Best treatment decisions should be tailored to each individual patient situation.

Two cases of Erythrodermic psoriasis treated with Golimumab

Introduction and importanceErythrodermic psoriasis (EP) is a very severe subtype of psoriasis, with a challenge poses in its treatment, as currently available therapies often provide unsatisfactory results, for those many biologics have been used in the treatment of EP such as Golimumab which has been extensively studied for the treatment of psoriatic arthritis, and chronic plaque psoriasis. However, no clinical trials have been performed for EP. Case presentationWe report two cases of a 23-year old female, and a 31-year male who presented with severe psoriasis that previously un respond to ultraviolet B phototherapy, methotrexate, cyclosporine, and topical agents. Skin lesions worsened progressively and developed into erythroderma. Therefore, we administered golimumab 50 mg, which lead to the improvement of the skin lesions according to the Psoriasis Area and Severity Index score after the first administration; lesions improved further throughout the treatment course. ConclusionGolimumab may be an alternative treatment for Erythrodermic psoriasis patients unrespond to other treatments even it did not have the FDA approval, so this is an off label indication and treatment.

Executive summary: The 2022 British Society for Rheumatology guideline for the treatment of psoriatic arthritis with biologic and targeted synthetic DMARDs.

Executive summary: The 2022 British Society for Rheumatology guideline for the treatment of psoriatic arthritis with biologic and targeted synthetic DMARDs.

The 2022 British Society for Rheumatology guideline for the treatment of psoriatic arthritis with biologic and targeted synthetic DMARDs.

The 2022 British Society for Rheumatology guideline for the treatment of psoriatic arthritis with biologic and targeted synthetic DMARDs.

POS0638 RECOMMENDATIONS FOR COST-EFFECTIVE USE OF BIOLOGICAL AND TARGETED SYNTHETIC DMARDS IN INFLAMMATORY ARTHRITIS: RESULTS FROM AN INTERNATIONAL DELPHI STUDY

BackgroundBiological and targeted synthetic disease modifying antirheumatic drugs (b/tsDMARDs) are effective treatments for rheumatoid arthritis (RA), psoriatic arthritis (PsA) and spondyloarthritis (SpA), but associated with high costs. Therefore, various strategies for safe and cost-effective use of these drugs have been developed, such as tapering and biosimilar use. However, overarching recommendations on how clinicians or hospitals can use these strategies in clinical practice are absent.ObjectivesTo develop evidence-based multidisciplinary recommendations on strategies for cost-effective use of b/tsDMARDs in the treatment of RA, PsA and SpA.MethodsA task force was formed consisting of 13 experts in rheumatology, epidemiology and/or pharmacology from seven European countries. Relevant strategies for cost-effective use were collected and defined using one-to-one interviews with each task force member followed by group discussion. Next, a scoping review in PubMed and Embase was performed to summarize the evidence on each strategy, followed by a Delphi procedure and five online meetings, to form a set of overarching principles and recommendations. Levels of evidence and strengths of recommendations were determined in accordance with the 2018 EULAR additional guidance.[1] If consensus was reached on the formulation of the recommendation in the group meeting, voting on level of agreement was performed by every task force member separately using an online form. Level of agreement varied from 0 (completely disagree) to 10 (completely agree).ResultsTwelve strategies for cost-effective use of b/tsDMARDs were identified and four overarching principles were formulated (Table 1). For 10 strategies, there was enough evidence available to form one or multiple recommendation(s). In total, 20 recommendations were formulated, focussing on: the use of loading doses (2); the use of biosimilars where available (2); combining a csDMARD with a b/tsDMARD to maximise efficacy (3); the use of disease activity guided dose optimisation (4); the use of a drug formulary policy in clinical practice (1); considering using a lower dose where approved (2); improving medication adherence (1); non-medical drug switching within or between drug classes (1); therapeutic drug monitoring and other predictors for selecting or tapering a b/tsDMARD (2); and the use of different routes of administration of the same b/tsDMARD (2). The level of agreement for the recommendations varied between 7.9 (SD 1.2) and 9.8 (0.4).Table 1. Overview of strategies (A) and overarching principles (B) for cost-effective use of b/tsDMARDs in RA, PsA and SpAA.StrategiesAvoid dose loadingBiosimilar/generic drug useCombination therapyDisease activity guided dose optimisationDrug formulary policyDrug wastageInitial lower doseMedication adherenceNonmedical drug switchingOptimizing pharmacokinetic exposureResponse predictionRoute of administrationB.Overarching principlesCost-effectiveness considerations are an important aspect of treatment, and rheumatologists should have a leading role regarding this.Treat-to-target is the cornerstone of b/tsDMARD based treatment in RA, PsA and axSpA.Treatment choices must be based on shared decision making between the patient and the rheumatologist.Reimbursement policies should cover cost-effective use of pharmacological treatments, both on- and off-label, when they are evidence based and supported by (inter)national guidelines.ConclusionThese evidence-based recommendations provide caregivers in rheumatology with a consensus on strategies for cost-effective use of b/tsDMARDs in RA, PsA and SpA. Because high-quality evidence was limited, we were not able to formulate recommendations on all strategies.

Population pharmacokinetics analysis of guselkumab in healthy subjects and patients with psoriatic arthritis, plaque psoriasis and palmoplantar pustulosis.

Guselkumab, a monoclonal antibody that binds to the p19 subunit of interleukin 23, is approved for the treatment of plaque psoriasis (PsO) and psoriatic arthritis (PsA), palmoplantar pustulosis (PPP), generalized pustular psoriasis, and erythrodermic psoriasis in various countries. The purpose of this analysis was to develop a comprehensive population pharmacokinetic (PK) model for guselkumab to determine whether PK differs across different disease populations and healthy subjects. A nonlinear mixed-effects modelling approach was used to analyse 23 097 serum PK samples obtained from 2623 healthy subjects and patients with PsO, PsA and PPP across 9 phase 1-3 clinical trials. Guselkumab concentrations were adequately described by a 2-compartment linear PK model with first-order absorption and elimination. Clearance (CL), central and peripheral volume of distribution, intercompartmental flow, absorption rate constant and absolute bioavailability estimates were 0.255 L/d, 3.60 L, 1.78 L, 0.369 L/d, 0.313 d-1 and 49.2%, respectively, for a subject weighing 70 kg. Terminal half-life was estimated to be approximately 14.6days. Body weight was the primary factor affecting CL and central volume of distribution. CL of guselkumab was similar among patients with PsA, PsO and PPP, but CL in disease populations was 11-17% lower than that in healthy subjects after other covariate effects such as body weight were considered. The population pharmacokinetic analysis indicated that, after other covariate effects were taken into account, patients with PsO, PsA and PPP had similar PK characteristics, with CL in these disease populations being slightly lower than in healthy individuals.

Expert recommendations for the use of apremilast in psoriatic arthritis

Introduction and objectivesDespite the evidence, there are doubts about the positioning of apremilast in the psoriatic arthritis (PsA) treatment algorithm. The objective of this project was to collect the scientific evidence and the experience of a group of rheumatologists who are experts in the management of PsA with apremilast in clinical practice in Spain. Material and methodsA scientific committee made up of 6 experts proposed 5 clinical scenarios where the evidence on the use of apremilast in PsA was controversial: (i) Efficacy in peripheral PsA; (ii) Efficacy in enthesitis and dactylitis; (iii) Efficacy in PsA with skin involvement; (iv) Comorbidities; and (v) Apremilast safety. After this, a panel of 17 rheumatologists with expertise in PsA management discussed these scenarios and generated a questionnaire with 50 questions and 156 items following the Delphi methodology. This questionnaire was anonymously answered by the panel. ResultsAfter 2 voting rounds, the panel of experts reached consensus in 93 of the 156 items raised (59.6%) (67 in agreement and 26 in disagreement). The degree of consensus was 53.3% in the area of “Efficacy in peripheral PsA”; 60.0% in “Efficacy in enthesitis and dactylitis”; 50.0% in “Efficacy in PsA with skin involvement”; 57.1% in “Management of comorbidities in patients with PsA”; and 67.3% in “Implications of safety in the use of apremilast”. ConclusionsThe structured opinion of the experts complements the available evidence and contributes to the establishment of consensual guidelines for the use of apremilast in PsA.

Real-World Six- and Twelve-Month Drug Retention, Remission, and Response Rates of Secukinumab in 2,017 Patients With Psoriatic Arthritis in Thirteen European Countries.

There is a lack of real-life studies on interleukin-17 (IL-17) inhibition in psoriatic arthritis (PsA). We assessed real-life 6- and 12-month effectiveness (i.e., retention, remission, low disease activity [LDA], and response rates) of the IL-17 inhibitor secukinumab in PsA patients overall and across 1) number of prior biologic/targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs), 2) years since diagnosis, and 3) European registries. Thirteen quality registries in rheumatology participating in the European Spondyloarthritis Research Collaboration Network provided longitudinal, observational data collected as part of routine care for secondary use. Data were pooled and analyzed with Kaplan-Meier plots, log rank tests, Cox regression, and multiple linear and logistic regression analyses. A total of 2,017 PsA patients started treatment with secukinumab between 2015 and 2018. Overall secukinumab retention rates were 86% and 76% after 6 and 12 months, respectively. Crude (LUNDEX adjusted) 6-month remission/LDA (LDA including remission) rates for the 28-joint Disease Activity Index for Psoriatic Arthritis, the Disease Activity Score in 28 joints using the C-reactive protein level, and the Simplified Disease Activity Index (SDAI) were 13%/46% (11%/39%), 36%/55% (30%/46%), and 13%/56% (11%/47%), and 12-month rates were 11%/46% (7%/31%), 39%/56% (26%/38%), and 16%/62% (10%/41%), respectively. Clinical Disease Activity Index remission/LDA rates were similar to the SDAI rates. Six-month American College of Rheumatology 20%/50%/70% improvement criteria responses were 34%/19%/11% (29%/16%/9%); 12-month rates were 37%/21%/11% (24%/14%/7%). Secukinumab effectiveness was significantly better for b/tsDMARD-naive patients, similar across time since diagnosis (<2/2-4/>4 years), and varied significantly across the European registries. In this large real-world study on secukinumab treatment in PsA, 6- and 12-month effectiveness was comparable to that in previous observational studies of tumor necrosis factor inhibitors. Retention, remission, LDA, and response rates were significantly better for b/tsDMARD-naive patients, were independent of time since diagnosis, and varied significantly across the European countries.

COVID-19 in Patients with Psoriatic Arthritis

The COVID-19 pandemic has a negative impact on all aspects of human life and can lead to the exacerbation of chronic diseases. At the same time, it is known that a higher risk of infection and a more severe course of coronavirus infection is found in the elderly, as well as in people with serious comorbidities. Psoriatic arthritis (PsA) is a type of inflammatory arthritis that is often diagnosed in patients with psoriasis. Specific treatment of patients with chronic inflammatory joint disease include nonsteroidal anti-inflammatory drugs, glucocorticosteroids, disease-modifying antirheumatic drugs, new biological agents, including monoclonal antibodies to IL-6, IL-1, TNF-a, target disease modifying drugs. Medications used for PsA treatment can potentially have both negative and positive effects on the course of COVID-19. The objective: to analyze the features of COVID-19 in patients with PsA and to study the comorbid pathology after coronavirus infection. Materials and methods. The study involved 174 people with a verified diagnosis of PsA. Patients were divided into two groups. Group I included 112 (64.4%) persons who had COVID-19, and group II - 62 (35.6%) who had not had coronavirus infection at the time of first examination. Patients in group I significantly differed from group II in age (p &lt;0.001) and duration of PsA (p &lt;0.001), showed a significantly higher degree of psoriatic skin lesions and activity of the underlying disease (p = 0.001) compared to patients from group II. The participants of the study underwent examination characterize the course of the psoriatic disease and skin lesions and risk of cardiovascular disease. Results. To date, there are no clear scientific data that reveal the specific features of COVID-19 infection and the effect of antirheumatic therapy on the development of dangerous complications associated with coronavirus infection in patients with PsA. The analysis of comorbid pathology has found cardiovascular pathology in 67 (59.8%) of patients, including arterial hypertension – in 58 (51.8%) people, metabolic syndrome – in 34 (30.4%), diseases of the digestive system – in 32 (28.6%) and respiratory system – in 24 (21.4%) of persons. Conclusions. Patients with higher activity and duration of the PsA were significantly more likely to get COVID-19 and demonstrated higher total cardiovascular risk for the next 10 years. Further research is needed to study the impact of specific basic rheumatological drugs on the outcomes of COVID-19 and to analyze the broader effects of the pandemic on the course of psoriatic arthritis.

P255 Collaboration in the treatment of psoriasis and psoriatic arthritis: a survey of UK clinical practice

Abstract Background/Aims Treatment guidelines for psoriatic arthritis consider both skin and joint involvement and recommend collaborative multidisciplinary team (MDT) working when selecting therapy. However, multidisciplinary practice for psoriatic disease (PD) has not been well studied, with little data on service models and current practice. This survey explored collaborative working in PD treatment by rheumatology and dermatology healthcare professionals (HCPs) to provide a better understanding of current working patterns, collaborating specialties, as well as benefits and challenges of combined clinics for PD management. Methods An online survey was emailed to rheumatology and dermatology HCPs using professional networks. We requested information on role, collaborating specialties, benefits and barriers to collaborative working in PD, and the impact of COVID-19. The ideal service model and additional comments completed the survey. Results We received 80 responses between October 2020 and April 2021, covering England, Wales, Scotland and Northern Ireland. Of these, 56 respondents (70.0%) were consultants, 22 (27.5%) clinical nurse specialists and one each a lead pharmacist (1.3%) and specialist registrar (1.3%). Rheumatology HCPs accounted for 40.0% of respondents (n = 32) and dermatology HCPs for 60.0% (n = 48). As part of their PD MDT, most respondents (n = 60, 75.0%) worked collaboratively with other specialties. Combined clinics, whether virtual, face to face or an MDT, accounted for 51.5% of collaborative working for rheumatology HCPs and 58.9% for dermatology HCPs. Collaboration with other specialists mainly occurred by email or written referrals (Table 1). The most important perceived benefits of combined clinics were shared knowledge, better patient outcomes and patient satisfaction. The biggest challenges to setting up combined clinics were job plan time (rated as ‘difficult’ or ‘very difficult’ by 78.8% of respondents), logistics (67.5%) and unsupportive senior management (66.3%), while 77.5% felt COVID-19 had partial or significant impact on combined clinics. Conclusion This is the first survey to explore UK collaborative working in PD. Approaches varied, with different models of working and little consistency. While HCPs appreciated the benefits of collaborative working, numerous challenges in establishing formal arrangements were identified. More evidence is needed to demonstrate the perceived benefits of collaborative working in improving patient outcomes by standardising best practice. Disclosure A. Kaul: Consultancies; AK has received payment for advisory boards from AbbVie, Janssen, Leo, MSD, Novartis and Pfizer. Honoraria; AK has received speaker fees from AbbVie, Eli Lilly, Janssen, Leo, MSD, Novartis and Pfizer. L. Savage: Consultancies; LS has received payment for advisory boards from AbbVie, Almirall, Biogen, Eli Lilly, Galderma, Janssen-Cilag, Leo, Novartis, Pfizer and UCB. Honoraria; LS has received speaker fees from AbbVie, Amgen, Almirall, Celgene, Celltrion, Eli Lilly, Galderma, Janssen-Cilag, Leo, Novartis, Pfizer, MSD and UCB. Grants/research support; LS has received grants/research funding from Pfizer. P. Gorecki: Other; PG is an employee of Janssen-Cilag Ltd.

P220 Long-term safety profile of upadacitinib in patients with rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis

P220 Long-term safety profile of upadacitinib in patients with rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis

P257 Are there regional variations in access to biological disease modifying anti-rheumatic drugs for the treatment of psoriatic arthritis in England?

Abstract Background/Aims There are regional variations in access to biologic disease modifying anti-rheumatic drugs (bDMARDs) for patients with rheumatoid arthritis in the UK, with relative under-treatment according to established best practice. Similar concerns exist for access to biologic therapies for patients with psoriatic arthritis (PsA). In this study we set out to understand regional variations in access to bDMARDS for the treatment of PsA in England. Methods Formularies are mandated to be published by the National Institute for Health and Care Excellence (NICE). ValueBase, a personalised business intelligence company specialising in healthcare, tracks every change for every drug on every published formulary every day with data from January 2017 in 184 formularies. The Availability Index (AI) is used to standardise individual formulary listing differences. It is scored from 0-100 and calculated by dividing the ‘base score’ for prescribing initiators by the ‘prescribing position’. The ‘base score’ values included 0 (not recommended), 5 (unlisted/under review), 30 (restricted availability), 45 (specialist/hospital only), 65 (initiated by specialist, continued in primary care) and 100 (all prescribers). We would expect the optimal score to be &amp;gt; 45 as these are specialist medications. The ‘prescribing position’ included where the drug is ranked on the formulary (e.g., first line). Results For anti-TNFa, the mean AI was 45 ([standard deviation] SD 16, minimum 0, maximum 100). For the IL-17 inhibitors, the mean AI was 48 (SD 17, the minimum 0, maximum 100). For the IL-23 inhibitors, the mean AI was 48 (SD 18, minimum 30, maximum 100). For the JAK inhibitors, the mean AI was 24 (SD 22, minimum 0, maximum AI 50). For the other monoclonal antibodies, the mean AI was 45 (SD 14, minimum 0, maximum 100). The rate of formulary adoption for new drugs approved since 2016 varied considerably (Table 1). Conclusion There are regional variations in access to bDMARDs for treatment of PsA in England. Such differences have also been demonstrated in other countries (e.g., Sweden) and call for further improvement towards delivering equitable PsA care, both nationally and internationally. Disclosure A. Vivekanantham: None. L. Coates: None. W. Tillett: Consultancies; WRT has received research funding, consulting, or speaker fees from Abbvie, Amgen, Celgene, Eli Lilly, Janssen, MSD, Novartis, Pfizer and UCB.