AB0538 POOLED SAFETY RESULTS FROM TWO PHASE-3 TRIALS OF GUSELKUMAB IN PATIENTS WITH PSORIATIC ARTHRITIS THROUGH 1 YEAR

Background:

DISCOVER 1 & 2, two double-blind, phase-3, psoriatic arthritis (PsA) trials of guselkumab (GUS, an IL-23 inhibitor), demonstrated significant improvement with GUS vs placebo (PBO) in signs and symptoms of PsA, with good tolerability, at week (w) 24 during the PBO-controlled period.1,2 Beyond w24, all patients (pts) switched to GUS. Continued treatment maintained efficacy through w52.3,4

Objectives:

To describe pooled safety results from the DISCOVER 1 & 2 trials through 1-year of GUS treatment.

Methods:

Adults with active PsA (DISCOVER 1: ≥3 tender/swollen joints and C-Reactive protein [CRP] ≥0.3 mg/dL; DISCOVER 2: ≥5 tender/swollen joints and CRP ≥0.6 mg/dL) were randomized to subcutaneous GUS 100 mg at w0, w4, then every 8 w (q8w); GUS 100 mg q4w; or PBO. At w24, PBO pts switched to GUS 100 mg q4w. Pts were biologic naive except ~30% pts in DISCOVER 1. Safety was reported through w60 in DISCOVER 1 and through w52 in DISCOVER 2.

Results:

Baseline characteristics were similar between treatment groups in the pooled studies. Through w24 and 1 year, numbers of pts per 100 patient years with ≥1 event were similar among treatment groups for adverse events (AEs), serious AEs, infections, serious infections, and discontinuations due to AE (Table 1). At 1 year, there were no cases of active tuberculosis, opportunistic infections (including candida), or inflammatory bowel disease in GUS-treated pts; 2 deaths in PBO pts; and low incidences that were similar across treatment groups for malignancy, major adverse cardiac events, and injection-site reactions. Incidence of anti-GUS antibodies was 4.5%, and most were not neutralizing. Mild elevations in serum hepatic transaminases and decreases in neutrophil counts were consistent at 1 year with the results at w24 (Table 1).

Conclusion:

GUS regimens of q8w and q4w were well tolerated in PsA pts through 1 year of treatment in the phase-3 DISCOVER trials, consistent with the w24 results. No meaningful differences between incidences of AEs were reported in the q8w and q4w groups. The safety profile of GUS in PsA pts is generally comparable with the previously established safety profile of GUS.

References:

[1]Deodhar A et al. Lancet. 2020;395:1115

[2]Mease P et al. Lancet. 2020;395:1126

[3]Ritchlin C et al. EULAR 2020 # SAT0397

[4]McInnes I et al. EULAR 2020 # SAT0402

Table 1.

Number of Patients with AEs per 100 PY and Incidence of AEs of Interest

Time Period24 Weeks1 Year*Treatment GroupPBOGUS SC 100 mgPBO to GUS‡GUS SC 100 mgDosing ScheduleMatchingq8wq4wGUSCombined†q4wq8wq4wGUSCombined‡ N3723753737483523753731100Total PY Follow-Up173173172346204384385589Patients with AEs per 100 PY, n (95% CI)≥1 AE143 (123, 166)148 (127, 171)154 (132, 178)151 (136, 167)92 (77, 108)114 (100, 130)115 (101, 131)109 (100, 117)≥1 Serious AE7.1 (3.7, 12)4.1 (1.6, 8.4)4.7 (2.0, 9.3)4.4 (2.5, 7.3)7.0 (3.8, 11.8)4.8 (2.9, 7.6)4.0 (2.2, 6.6)4.9 (3.6, 6.6)≥1 Infection50 (39, 62)47 (37, 59)52 (42, 65)49 (42, 58)39 (31, 49)41 (34, 48)38 (31, 45)39 (35, 44)≥1 Serious Infection1.7 (0.4, 5.1)0.6 (0.0, 3.2)1.8 (0.4, 5.1)1.2 (0.3, 3.0)2.5 (0.8, 5.8)1.3 (0.4, 3.1)0.8 (0.2, 2.3)1.3 (0.7, 2.3)Discontinued due to AE4.1 (1.6, 8.4)2.9 (1.0, 6.8)4.7 (2.0, 9.3)3.8 (2.0, 6.5)3.5 (1.4, 7.1)2.1 (0.9, 4.1)2.6 (1.3, 4.8)2.6 (1.7, 3.8)AEs of Interest§, n (%)Death2 (0.5)0000000Malignancy1 (0.3)2 (0.5)02 (0.3)1 (0.3)2 (0.5)03 (0.3)Major Adverse Cardiac Events1 (0.3)01 (0.3)1 (0.1)001 (0.3)1 (0.1)Opportunistic Infections00000000Tuberculosis00000000Inflammatory Bowel Disease1 (0.3)0000000Injection-Site Reaction1 (0.3)5 (1.3)4 (1.1)9 (1.2)4 (1.1)6 (1.6)9 (2.4)19 (1.7)Anti-GUS Antibody+-6/373 (1.6)9/371 (2.4)15/744 (2.0)14/350 (4.0)18/373 (4.8)17/371 (4.6)49/1094 (4.5)

*Through w60 for DISCOVER 1 and w52 for DISCOVER 2; †Combined GUS q8w and q4w; ‡For patients who switched from PBO to GUS, only data on and after first GUS administration were included in this group; §PBO N=370.

AE, adverse event; CI, confidence interval; GUS, guselkumab; PBO, placebo; PY, patient year; q4w, every 4 weeks; q8w, every 8 weeks; SC, subcutaneous; w, week

Disclosure of Interests:

Christopher T. Ritchlin Grant/research support from: Received grant/research support from UCB Pharma, AbbVie, Amgen, consultation fees from UCB Pharma, Amgen, AbbVie, Lilly, Pfizer, Novartis, Gilead, Janssen, Proton Rahman Speakers bureau: Received speakers fees from Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, Pfizer, Grant/research support from: Received grant/research support from Janssen and Novartis, consultation fees from Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, and Pfizer., Philip Helliwell Consultant of: Consultation fees paid to charity (AbbVie, Amgen, Pfizer, UCB) or himself (Celgene, Galapagos), Grant/research support from: Received grants/research support paid to charity (AbbVie, Janssen, Novartis), Wolf-Henning Boehncke Consultant of: Received consultation fees from Janssen, Grant/research support from: Received grant/research support from Janssen Research & Development, LLC, Iain McInnes Consultant of: Received consultation fees from AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Gilead, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: Received grant/research support from Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Janssen, and UCB, Alice B Gottlieb Speakers bureau: Received speakers fees from Pfizer, AbbVie, BMS, Lilly, MSD, Novartis, Roche, Sanofi, Sandoz, Nordic, Celltrion and UCB, Consultant of: Received consultation fees from Pfizer, AbbVie, BMS, Lilly, MSD, Novartis, Roche, Sanofi, Sandoz, Nordic, Celltrion and UCB, Grant/research support from: Received grant/research support from Pfizer, AbbVie, BMS, Lilly, MSD, Novartis, Roche, Sanofi, Sandoz, Nordic, Celltrion and UCB, Shelly Kafka Shareholder of: Shareholder of Johnson & Johnson, Employee of: Employee of Janssen Research & Development, LLC, Alexa Kollmeier Shareholder of: Shareholder of Johnson & Johnson, Employee of: Employee of Janssen Research & Development, LLC, Elizabeth C Hsia Shareholder of: Shareholder of Johnson & Johnson, Employee of: Employee of Janssen Research & Development, LLC, Xie L Xu Shareholder of: Shareholder of Johnson & Johnson, Employee of: Employee of Janssen Research & Development, LLC, May Shawi Shareholder of: Shareholder of Johnson & Johnson, Employee of: Employee of Janssen Research & Development, LLC, Shihong Sheng Shareholder of: Shareholder of Johnson & Johnson, Employee of: Employee of Janssen Research & Development, LLC, Prasheen Agarwal Shareholder of: Shareholder of Johnson & Johnson, Employee of: Employee of Janssen Research & Development, LLC, Bei Zhou Shareholder of: Shareholder of Johnson & Johnson, Employee of: Employee of Janssen Research & Development, LLC, Paraneedharan Ramachandran Shareholder of: Shareholder of Johnson & Johnson, Employee of: Employee of Janssen Research & Development, LLC, Philip J Mease Speakers bureau: Received speakers fees from Abbott, Amgen, Biogen Idec, BMS, Eli Lilly, Genentech, Janssen, Pfizer, UCB – speakers bureau, Consultant of: Received consultation fees from Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB, Grant/research support from: Received grant/research support from Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB.

POS0909 IXEKIZUMAB IMPROVES SIGNS, SYMPTOMS AND QUALITY OF LIFE OF ANKYLOSING SPONDYLITIS IN PATIENTS IRRESPECTIVE OF HLA-B27 STATUS: POOLED RESULTS FROM THE COAST-V AND COAST-W TRIALS

Background:

Human leukocyte antigen-B27 (HLA-B27) is found in most patients (pts) with ankylosing spondylitis (AS). Although a subset of pts with AS are HLA-B27 negative (NEG), ensuring treatment efficacy in this subpopulation is important.

Objectives:

This analysis evaluated the efficacy of ixekizumab (IXE), a high-affinity monoclonal antibody selectively targeting interleukin-17A, in AS pts who are either HLA-B27 positive (POS) or NEG.

Methods:

COAST-V (NCT02696785) and COAST-W (NCT02696798) were 2 phase 3, multicenter, randomized, double-blind, PBO-controlled trials investigating the efficacy of 80-mg IXE administered every 4 weeks (Q4W) and every 2 weeks (Q2W) in pts naïve to biological disease-modifying anti-rheumatic drugs (bDMARDs; COAST-V) and in those who were inadequate responders or intolerant to 1 or 2 tumor necrosis factor inhibitors (TNFi; COAST-W). Only data from pts randomized at baseline to PBO, IXE Q4W or Q2W in both trials who met per protocol eligibility criteria were integrated and stratified based on HLA-B27 status (POS, NEG) for an ad hoc subgroup analysis. Efficacy was assessed using the Assessment of Spondyloarthritis International Society 40 (ASAS40), Bath Ankylosing Spondylitis Disease Activity Index 50 (BASDAI50) and Short Form 36 Physical Component Scores (SF-36 PCS). Missing data were imputed by non-responder imputation (NRI) for binary measure and by modified baseline observation carried forward (mBOCF). Data from PBO was reported up to Week 16 and for pooled IXE Q4W and Q2W up to Week 52.

Results:

This analysis includes pts with AS who are HLA-B27 POS (N=453; PBO=155, IXE=298) or NEG (N=62, PBO=21, IXE=41). Overall, more pts were male (82.6%, POS; 77.4%, NEG), and for IXE treated pts, the duration of disease since r-axSpA diagnosis was 10.3 (SD=9.1) and 6.9 (SD=5.6) years, among POS and NEG pts respectively (Table 1). Among IXE treated patients, the mean age of HLA-B27 NEG pts was approximately 7-8 years older than HLA-B27 POS pts. At Week 16, 39.6% (n=118/298) of HLA-B27 POS and 29.3% (n=12/41) of HLA-B27 NEG pts achieved ASAS40, and 34.6% (n=103) of HLA-B27 POS and 17.1% (n=7) of HLA-B27 NEG pts achieved BASDAI50; improvements were seen as early as Week 1 and sustained or improved up to Week 52. The mean baseline SF-36 PCS was 33.2 (SD=7.63) for HLA-B27 POS and 31.4 (SD=7.67) for HLA-B27 NEG pts. At Week 16, the mean change from baseline in SF-36 PCS was 7.3 (SD 7.6) for HLA-B27 POS and 3.7 (SD=6.83) for HLA-B27 NEG pts. Improvements were sustained to Week 52 (Figure 1).

Conclusion:

IXE improves signs, symptoms, patient-reported outcomes and health-related quality of life in HLA-B27 POS and NEG pts with AS, however the HLA-B27 POS pts have a faster and more robust response than HLA-B27 NEG pts.

Table 1.

Baseline Characteristics by HLA-B27 Positive and Negative Status

Positive HLA-B27Negative HLA-B27PBO (N=155)IXE (N=298)PBO (N=21)IXE (N=41)Male, n (%)133 (85.8)241 (80.9)18 (85.7)30 (73.2)Age of r-axSpA onset (yr), mean (SD)25.2 (9.28)26.3 (8.38)35.4 (8.43)‡34.6 (10.32)‡Duration of symptoms since r-axSpA onset (yr)18.7 (11.82)17.1 (10.38)16.0 (9.69)15.9 (12.40)C-Reactive protein (mg/L), mean (SD)16.7 (22.43)16.9 (25.50)18.1 (21.69)13.7 (14.38)ASDAS score, mean (SD)4.0 (0.78)4.0 (0.83)4.3 (0.76)4.1 (0.73)BASDAI score, mean (SD)7.1 (1.25)7.2 (1.37)7.6 (1.31)*7.4 (1.41)SF-36 PCS, mean (SD)33.7 (7.50)33.2 (7.63)34.1 (8.28)31.4 (7.67)

Abbreviations: ASDAS, Assessment of Spondyloarthritis International Society 40; BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; HLA-B27, Human leukocyte antigen-B27; IXE, pooled ixekizumab every 2 weeks and every 4 weeks; N, total number of patients in group; n, number of patients in category/subgroup; PBO, placebo; r-axSpA, axial spondyloarthritis; SD, standard deviation; SF-36 PCS, Short Form 36 Physical Component Scores; yr, years.

p-value: vs. HLA-B27 positive: *≤0.05,‡<0.0001

Figure 1.

Comparisons done using t-test and chi-square test for continuous and categorical variables.

Disclosure of Interests:

John D Reveille Consultant of: UCB (Union Chimique Belge), Eli Lilly, Novartis, and Pfizer, Grant/research support from: Janssen 2018; Eli Lilly 2020, Proton Rahman Speakers bureau: Abbott, AbbVie, Amgen, Bristol-Meyers Squibb, Celgene, Eli Lilly, Janssen, Novartis, and Pfizer, Consultant of: Abbot, AbbVie, Amgen, Bristol-Meyers Squibb, Celgene, Eli Lilly, Janssen, Novartis, and Pfizer, Grant/research support from: Janssen and Novartis, David Sandoval Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Talia Muram Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Rebecca Bolce Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, So Young Park Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Martin Rudwaleit Speakers bureau: AbbVie, Bristol-Meyers Squibb, Chugai, Janssen, Eli Lilly, MSD (Merck Sharp and Dohme), Novartis, Pfizer, UCD (Union Chimique Belge), Consultant of: AbbVie, Janssen, Eli Lilly, Novartis, Pfizer, UCB (Union Chimique Belge)

AB0557 ACHIEVING TREATMENT TARGETS IN PSORIATIC ARTHRITIS WITH APREMILAST IN CANADIAN PRACTICE: REAL WORLD RESULTS FROM APPRAISE

Background:

Real-world evidence on achieving treatment targets with apremilast (APR) in patients (pts) with PsA is limited. In the phase 3 PALACE trials, pts reached remission (REM)/low disease activity (LDA) targets at 52 wks most frequently when early APR treatment was initiated and pts were in moderate disease activity, as measured by Clinical Disease Activity Index for PsA (cDAPSA) score. In APPRAISE, we assessed APR effectiveness/tolerability in pts with PsA in routine clinical practice in Canada.

Objectives:

This interim efficacy analysis focused on the available data on APR effectiveness measuring rate of achieving cDAPSA REM or LDA at 12 mos and Pt Acceptable Symptom Status (PASS) results.

Methods:

The prospective, multicenter, observational APPRAISE study assessed APR effectiveness/tolerability in adults with active PsA in routine clinical care enrolled from July 2018-March 2020. Pts were followed from treatment initiation to 12 mos, with visits suggested every 4 mos. The primary effectiveness endpoint was the rate of achieving at least LDA (cDAPSA <14) at 12 mos. Pt-reported outcome measures were assessed. Data reported are as observed in pts continuing APR treatment.

Results:

In total, 101 pts were enrolled in APPRAISE. Mean age was 52 yrs; 56% were women. Mean (SD) PsA duration at baseline (BL) was 6 (8) yrs. Oligoarticular disease (≤4 joint involvement) was most common (41%), followed by polyarticular (35%). Most pts (92%) received prior conventional DMARDs and 17% received prior biologic therapy; concomitant MTX was reported in 41% at BL. By 12 mos, 41/101 enrolled pts discontinued, 35 reached 12 mos follow-up (4 mos: n=92; 8 mos: n=61), and 25 have yet to reach 12 mos. The majority (92%) of discontinuations due to lack/loss of effectiveness or AEs occurred within 4-8 mos. AEs were primarily GI related early in treatment. The proportion of pts with continued APR achieving cDAPSA REM/LDA treatment targets increased significantly over time (Figure 1). Significant reductions were seen over 12 mos in swollen/tender joint counts and plaque psoriasis, with reduced mean (SD) body surface area of −4% (9%) (Table 1). Prevalence of dactylitis/enthesitis at BL, 4, 8, and 12 mos was 17%/33%, 9%/24%, 5%/19%, and 0%/21%, respectively. Pain assessment (VAS) significantly improved over time. The proportion of pts achieving PASS with continued APR increased significantly over 12 mos (BL: 27%; 12 mos: 65%) (Figure 1). COVID restrictions impacted in-office assessment visits, necessitating reliance on virtual visits.

Conclusion:

Pts with PsA receiving APR were assessed at regular intervals in routine clinical care in Canada. This interim analysis revealed a greater number of pts receiving APR (66%) who completed the 12-mo follow-up achieved REM or LDA, as measured by cDAPSA over 12 mos. A majority of pts (65%) reported satisfaction with their disease state, as measured by PASS. No new safety signals were observed.

Table 1.

Change in Clinical Parameters and Pt-Reported Outcomes From BL to 4, 8, and 12 Mos

Outcome Measure*, Mean (SD)BL (n = 101)4 Mos (n = 92)8 Mos (n = 61)12 Mos (n = 35)Disease/Clinical Parameters Tender joint count (0-68)7.5 (6.7)−2.5 (6.3)*−3.9 (5.2)*−2.2 (6.4) Swollen joint count (0-66)5.4 (5.4)−3.0 (4.5)*−3.1 (4.3)*−3.1 (4.4)* PhGA42.9 (18.8)−19.0 (24.6)*−24.2 (24.2)*−21.2 (26.3)* Body surface area, %3.1 (6.1)−2.2 (6.0)*−2.7 (7.5)*−4.2 (9.1)* cDAPSA22.2 (13.3)−7.9 (12.1)*−10.1 (13.5)*−6.9 (12.0)*Pt-Reported Outcomes PtGA, mm50.0 (24.6)−10.2 (27.5)*−9.1 (31.9)*−3.6 (39.7) Pain, mm48.3 (25.3)−9.5 (26.2)*−12.2 (28.7)*−7.3 (26.0) HAQ-DI0.9 (0.7)−0.13 (0.5)*−0.15 (0.6)−0.1 (0.7)

*Denotes significant change from BL (P<0.05) from paired-sample t-tests; note that mean change from BL may be greater than the mean BL value when improvements of large magnitude, for pts with relatively elevated BL values, are observed in samples with lower n’s. HAQ-DI = Health Assessment Questionnaire-Disability Index; PhGA = Physician’s Global Assessment; PtGA = Patient’s Global Assessment.

Acknowledgements:

This study was funded by Celgene and Amgen Inc. Writing support was funded by Amgen Inc. and provided by Kristin Carlin, RPh, MBA, of Peloton Advantage, LLC, an OPEN Health company.

Disclosure of Interests:

Vinod Chandran Consultant of: AbbVie, Amgen, BMS, Celgene Corporation, Eli Lilly, Janssen, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Amgen, BMS, Celgene Corporation, Eli Lilly, Janssen, Novartis, Pfizer, UCB, Louis Bessette Consultant of: AbbVie, Amgen, BMS, Celgene Corporation, Eli Lilly, Janssen, Merck, Pfizer, Sanofi, Novartis, UCB, Grant/research support from: AbbVie, Amgen, BMS, Celgene Corporation, Eli Lilly, Janssen, Merck, Pfizer, Sanofi, Novartis, UCB, Carter Thorne Speakers bureau: AbbVie, Amgen, Celgene Corporation, Eli Lilly, Medexus/Medac, Merck, Novartis, Pfizer, Sandoz, Sanofi, Consultant of: Centocor, Medexus/Medac, Merck, Grant/research support from: Novartis, Pfizer, Maqbool Sheriff Speakers bureau: AbbVie, Celgene Corporation, Eli Lilly, Janssen, Merck, Pfizer, Sandoz, Proton Rahman Speakers bureau: AbbVie, Amgen, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, UCB, Dafna D Gladman Consultant of: AbbVie, Amgen, BMS, Celgene Corporation, Eli Lilly, Galapagos, Gilead, Janssen, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Amgen, BMS, Celgene Corporation, Eli Lilly, Galapagos, Gilead, Janssen, Novartis, Pfizer, UCB, Sabeen Anwar Consultant of: AbbVie, Amgen Inc., BMS, Novartis, and Pfizer, Grant/research support from: AbbVie, Amgen Inc., Eli Lilly, Janssen, and Pfizer, Jennifer Jelley Employee of: Amgen Canada Inc., Anne-Julie Gaudreau Employee of: Amgen Canada Inc., Manprit Chohan Employee of: Amgen Canada Inc., John S. Sampalis Employee of: JSS Medical Research.

POS1026 GUSELKUMAB PROVIDES SUSTAINED IMPROVEMENTS IN WORK PRODUCTIVITY AND NON-WORK ACTIVITY IN PATIENTS WITH PSORIATIC ARTHRITIS: RESULTS THROUGH 1 YEAR OF A PHASE 3 TRIAL

Background:

DISCOVER-2 was a Phase 3 trial of the first-in-class anti-IL-23-specific mAb guselkumab (GUS) in patients (pts) with psoriatic arthritis (PsA). PsA impacts patients’ productivity at work and in daily activity.1

Objectives:

To evaluate the effect of GUS on work productivity and daily activity in DISCOVER-2 through 1 year using the Work Productivity and Activity Impairment Questionnaire: PsA (WPAI- PsA).

Methods:

Bio-naïve adults with active PsA despite nonbiologic DMARDs &/or NSAIDs received subcutaneous GUS 100 mg every 4 weeks (Q4W); GUS 100 mg W0, W4, then Q8W; or placebo (PBO). At W24, PBO pts crossed over to GUS 100 mg Q4W. WPAI-PsA assesses PsA-related work time missed (absenteeism), impairment while working (presenteeism), impaired overall work productivity (absenteeism + presenteeism), and daily activity during the previous week. A shift analysis evaluated proportions of pts employed vs unemployed (regardless of desire to work) over time. Among pts working at baseline, least-squares (LS) mean changes from baseline in WPAI-PsA domains were determined using a mixed-effects model for repeated measures analysis, whereby mean changes in WPAI-PsA domains were calculated for each multiple imputation (MI) dataset using an analysis of covariance (ANCOVA); the reported LSmean is the average of all MI datasets. Also, among pts employed at baseline, indirect savings from improved overall work productivity were estimated using 2020 EU mean yearly wage estimate (all occupations).2

Results:

In pts working at baseline, significant improvement in work productivity and non-work activity vs PBO was observed at W24. Productivity gains seen with GUS at W24 continued to improve through 1 year (Table 1). Shift analysis showed relatively stable employment in pts employed at baseline (62% of shift analysis cohort) through 1 year of GUS (>91% continued to work when assessed at W16, W24, and W52 [data not shown]). For those unemployed at baseline (38% of cohort), the proportion of pts working increased by ~10% following 1 year of GUS (Figure 1). Potential yearly indirect savings from improved overall work productivity were: €7409 GUS Q4W and €7039 GUS Q8W vs €4075 PBO at W24 and were €8520 GUS Q4W, €9632 GUS Q8W, and €6668 PBO→GUS Q4W at W52.

Conclusion:

Improvement in work productivity and non-work activity was greater with GUS vs PBO among pts with active PsA through W52. Improvements demonstrated may result in reduction in PsA costs associated with work productivity.

References:

[1]Tillett W et al. Rheumatol (Oxford). 2012;51:275–83.

[2]OECD (2020). Average wages (indicator). https://data.oecd.org/earnwage/average-wages.htm

Table 1.

Model-based estimates of LSmean changea (95% CI) from baseline in WPAI-PsA domains among pts working at baseline and with an observed change through W24 (N=474) and W52 (N=475)

Change from baselineGUS 100mg Q4WGUS 100mg Q8WPBO(W0-24)PBO → GUS 100 mg Q4W (W24-52)VisitW24W52W24W52W24W52Absenteeism, N145145147147162163LSmean-3.4 (-6.5,-0.3)-4.1 (-6.8,-1.5)-3.0 (-6.0,0.1)-4.0 (-6.6,-1.3)-3.0 (-6.0, 0.04)-3.0 (-5.5,-0.4)Diff vs. PBO-0.4 (-4.6,3.8)-0.01 (-4.2, 4.2)Presenteeism, N145145147147162163LSmean-20.1 (-23.7,-16.6)-22.4 (-26.3,-18.6)-19.6 (-23.2,-16.1)-25.7 (-29.5,-21.8)-10.5 (-13.9,-7.0)-18.5 (-22.2,-14.7)Diff vs PBO-9.7* (-14.4,-5.0)-9.2* (-13.9,-4.5)Work productivity, N145145147147162163LSmean-20.1 (-24.1,-16.1)-22.6 (-26.8,-18.3)-19.2 (-23.1,-15.2)-25.9 (-30.0,-21.7)-10.6 (-14.4,-6.8)-17.6 (-21.7,-13.6)Diff vs PBO-9.5* (-14.8,-4.2)-8.6* (-13.9,-3.3)Non-work Activity, N242242246246245245LSmean-20.5 (-23.3,-17.7)-25.7 (-28.6,-22.7)-21.2 (-23.9,-18.4)-25.4 (-28.4,-22.5)-9.9 (-12.6,-7.1)-22.3 (-25.3,-19.4)Diff vs PBO-10.6* (-14.4,-6.8)-11.3* (-15.1,-7.5)

CI=Confidence interval

a. LSmean for each MI dataset is calculated based on an ANCOVA model for the change from baseline at W24/W52. The combined LSmean, which is the average of the LSmean, taken over all the MI datasets, is presented.

*p<0.05

Disclosure of Interests:

Jeffrey Curtis Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, and UCB, Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, and UCB, Iain McInnes Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Gilead, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Janssen, and UCB, Steve Peterson Shareholder of: Johnson & Johnson, Employee of: Janssen Global Services, LLC, Prasheen Agarwal Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Feifei Yang Shareholder of: Johnson & Johnson, Employee of: Janssen Global Services, LLC, Alexa Kollmeier Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Elizabeth C Hsia Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Chenglong Han Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, William Tillett Speakers bureau: AbbVie, Amgen, Celgene, Lilly, Janssen, Novartis, Pfizer Inc, and UCB, Consultant of: AbbVie, Amgen, Celgene, Lilly, Janssen, Novartis, MSD, Pfizer Inc, and UCB, Grant/research support from: AbbVie, Celgene, Eli Lilly, Janssen, Novartis, Pfizer Inc, and UCB, Philip J Mease Speakers bureau: Boehringer Ingelheim and GlaxoSmithKline, Grant/research support from: AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, Janssen, Novartis, Pfizer, SUN, and UCB, Proton Rahman Speakers bureau: AbbVie, Eli Lilly, Janssen, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Amgen, Bristol Myers Squibb, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, Roche, and UCB, Grant/research support from: Janssen and Novartis.

POS0405 GENETIC VARIANTS WITHIN PSORIATIC ARTHRITIS (PsA)-WEIGHTED GENES FBXL19 AND HLA-B*39 MAY SERVE AS A POTENTIAL LINK BETWEEN PsA AND OBESITY

Background:

PsA patients have been observed to have a higher body mass index (BMI) compared to individuals with a similar disease (e.g., rheumatoid arthritis) or healthy controls1. Approximately 45% of PsA patients are considered obese with BMI’s exceeding 30 kg/m2, and these patients have more severe articular disease and lower response to therapy2. A recent mendelian randomization study noted that higher BMI leads to higher risk of psoriasis when using genetic variants as instrumental variables for BMI3.

Objectives:

To determine if known PsA-weighted genetic variants are overrepresented in an obese population.

Methods:

696 samples were identified from a previous genetic study in obesity where each patient was systematically examined with BMI and other related anthropometric measures were recorded. No patients had psoriasis, inflammatory arthritis or any extra-articular manifestations of spondyloarthritis. Samples were genotyped using a PsA-weighted single nucleotide polymorphism (SNP) panel, representing genetic variants associated with PsA. The cohort consisted of 73% female with an average age of 49 years ± 15. The average BMI of the group was 35± 8 kg/m2, ranging from 17 to 67 kg/m2. The PsA SNP panel consists of 42 SNPs associated with PsA including IL23R, 5q31, PTPN22, TNFAIP3, HLA-C, TNFRSF9, LCE3A, ADAMTS9-MAGI1, HLA-B, IL13, MICA, IL12B, ZNF8816A, TRAF3IP2, KIR2DS2, FBXL19, REL, IL23R, IL23A, TNIP1, and TYK2. DNA (10ng/uL) was used to prepare a PCR, followed by SAP, and extension reaction with Agena iPLEX Pro kit using Agena MassARRAY. Quantitative trait analysis was performed to obtain the association between BMI and genotype of the 42 SNPs using a linear regression model. Bonferroni correction was used to adjust for multiple comparisons. The factors of age, gender, smoking and height also have been adjusted in the analysis (Table 1).

Table 1.

Regression analysis between BMI and 2 significant SNPs

SNPCHRAllele 1Allele 2BETASETP (Genotype Only)P (adjusted with factors)*rs31313826TC2.2270.72073.170.0015965.40E-05rs1078200116GA1.5840.43473.6440.000290.0007524Genotypes of FBXL19 and HLA-B*3905 SNPs with mean BMISNPrs3131382rs10782001GenotypesTTTCCCGGGAAASample Counts69957575324246Genotype Frequency0.00880.150.840.110.500.38Mean BMI47.1736.7335.4637.2936.3634.43SD16.076.647.127.687.406.83

*Adjusted for age, sex, height, and smoking

Results:

Linear regression analysis with and without clinical factors for the two significant SNPs are presented in Table 1. Genotypes of two SNPs (rs10782001 and rs3131382) showed a difference with BMI (Table 1). The rs10782001 variant is within FBXL19 and the average BMI in the presence of GG genotype was 37.2 vs 34.3 for the AA genotype (p=0.0007). The rs3131382 variant is within HLA-B*39:05 and the average BMI with TT genotype was 47.1 vs 35.4 for the CC genotype (p=0.00005). Both SNPs maintained significance after correction for multiple testing (p<0.001).

Conclusion:

Homozygotes for the minor allele of SNPs within HLA-B*39 and FBXL19 have shown to have an increased BMI, suggesting a potential genetic link between these genes and PsA and obesity. Interestingly, it has been recently noted that miR-26 suppresses adipocyte progenitor differentiation and fat production by targeting FBXL19, leading to possible biologic possibility regarding the link between PsA-weighted genetic variants and obesity4.

References:

[1]Bhole VM et al., Rheumatology (Oxford). 2012 Mar;51(3):552-6.

[2]Klingberg E et al., Arthritis Res Ther. 2019;21(1):17.

[3]Budu-Aggrey A et al., PLoS Med. 2019 Jan 31;16(1):e1002739.

[4]Acharya A et al., Fbxl19. Genes Dev. 2019;33(19-20):1367-1380. doi:10.1101/gad.328955.119

Disclosure of Interests:

Cassidy Welsh: None declared, Tanya Burry: None declared, Quan Li: None declared, Amanda Dohey: None declared, Dianne Codner: None declared, Vinod Chandran Speakers bureau: AbbVie, Amgen, BMS, Eli Lily, Janssen, Novartis, Pfizer, UCB, Consultant of: AbbVie, Amgen, BMS, Eli Lily, Janssen, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Amgen, Eli Lily, Employee of: Spousal Employment Eli Lilly, Dafna D Gladman Speakers bureau: AbbVie, Amgen, BMS, Eli Lily, Galapagos, Gilead, Janssen, Novartis, Pfizer, UCB, Consultant of: AbbVie, Amgen, BMS, Eli Lily, Galapagos, Gilead, Janssen, Novartis, Pfizer, UC, Grant/research support from: AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer, UCB, Darren O’Rielly: None declared, Proton Rahman Speakers bureau: Amgen, Abbott, AbbVie, BMS, Celgene, Eli Lily, Janssen, Novartis, Pfizer, Merck, UCB, Consultant of: Amgen, Abbott, AbbVie, BMS, Celgene, Eli Lily, Janssen, Novartis, Pfizer, Merck, UCB, Grant/research support from: Janssen, Novartis

POS0901 IXEKIZUMAB SHOWS A DISTINCT PATTERN OF PAIN IMPROVEMENT BEYOND INFLAMMATION IN RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS

Background:

The efficacy of ixekizumab (IXE) in biologic-naïve patients with radiographic axial spondyloarthritis (r-axSpA) has been previously presented using traditional axSpA outcome measures, such as BASDAI and ASAS.

Objectives:

In patients with active r-axSpA, to assess the analgesic efficacy of IXE as it relates to patient-reported and objective measures of inflammation.

Methods:

The Phase III COAST-V (NCT02696785) multi-center, randomized, double-blind, placebo (PBO)-controlled and active reference arm with adalimumab (ADA) trial investigated the efficacy of IXE in 341 patients (pts) with active r-axSpA for 52 weeks (W). Pts were initially randomized to IXEQ4W, IXEQ2W, PBO, and ADAQ2W. At W16, pts assigned to PBO and ADA were re-randomized to IXEQ2W or Q4W. Changes in spinal pain at night (SP-N) and spinal pain were measured at each study visit and analysed while controlling for CRP levels or mean of BASDAI questions 5 & 6 (Q5: Duration and Q6: Intensity of morning stiffness). Observed data analyses are presented for each group stratified by treatment arm and compared to PBO. In the initial analysis, pts were categorized into 2 sub-groups defined as “Sustained” and “Fluctuating” depending on: CRP <5 mg/L W4-16 vs. CRP ≥5 mg/L at any point beyond W4 between weeks 4-16 respectively. In a second analysis, pts were categorized based on BASDAI Q5/6 improvement: “Sustained” if ≥2-pt improvement W12-16 vs. “Fluctuating” if <2-pt improvement at any point beyond W12 between W12-16.

Results:

Between W0 and W16, pts treated (tx) with IXEQ4W experienced greater reduction in SP-N than pts tx with ADA, in both CRP sustained and fluctuating groups (Fig 1a). Pts in the IXEQ4W and ADA arms showed different trajectories of pain improvement in the CRP fluctuating groups. For the pts with a fluctuating CRP ≥5 mg/L, pts in IXEQ4W arm demonstrated a greater reduction in SP-N compared to pts in PBO arm (p < .001) at W16, whereas pts in ADA arm did not experience a reduction in SP-N compared to PBO (p = .416). For the pts with a sustained CRP <5mg/L, IXEQ4W and ADA treatments both significantly demonstrated reduction in SP-N compared to PBO at W16 (IXEQ4W: p = .002; ADA: p = .02), with IXEQ4W treatment showing a greater level of reduction (Fig 1a). The pts randomized to ADA and re-randomized to IXEQ2W or Q4W (ADA/IXE) experienced further improvement in SP-N. This effect was sustained over the 52-wk period (Fig 1b). The same pattern of improvement in SP-N was observed when controlling for the BASDAI Q5/6; the SP-N improvement was greater in pts with a sustained BASDAI Q5/6 compared to pts with a fluctuating BASDAI Q5/6, regardless of treatment (Table 1). In the fluctuating BASDAI Q5/6, for pts in ADA/IXE arm, further reduction of both spinal pain and SP-N were observed (Table 1).

Table 1.

Change in Pain Outcome at baseline, week 16 and week 52 by Inflammation Status as assessed by BASDAI or CRP levels for patients receiving placebo (PBO), adalimumab (ADA), and ixekizumab every 4 weeks (IXE Q4W)

Change from baselinePBOADAIXEQ4WbaselineWeek 16(as observed)Week 52PBO/IXE(as observed)baselineWeek 16(as observed)Week 52ADA/IXE(as observed)baselineWeek 16(as observed)Week 52(as observed)Spinal painBASDAI Q5/6 sustained7.54-3.33-4.657.21-4.07-4.57.4-4.52-4.94BASDAI Q5/6 fluctuating7.37-1.32-2.826.76-1.2-2.246.97-1.3-2.52CRP sustained7-1.53-1.936.83-2.9-3.67.23-3.57-4.21CRP fluctuating7.51-1.96-3.637.28-2-2.897.24-2.91-3.93Spinal pain at nightBASDAI Q5/6 sustained7.12-3.21-4.617.26-4.63-4.927.12-4.73-4.91BASDAI Q5/6 fluctuating7.05-1.15-2.886.6-1.2-2.497.03-2.17-2.92CRP sustained7.2-1.87-2.276.76-3.2-3.856.89-3.8-4.12CRP fluctuating7.04-1.69-3.67.24-2.21-3.397.35-3.68-4.38

Conclusion:

IXE reduced SP-N and spinal pain irrespective of CRP or morning stiffness. Additionally, pts treated with ADA re-randomized to IXE experienced a further reduction in SP-N and spinal pain. Collectively, these results support the additive benefits of IXE in reducing pain above measurable effects on inflammation.

Acknowledgements:

The authors would like to thank Eglantine Julle-Daniere for writing and editorial contributions

Disclosure of Interests:

Kurt de Vlam Speakers bureau: Eli Lilly, Novartis, Pfizer, Paid instructor for: Celgene, Amgen, Consultant of: Elil Lillyn Novartis, UCB, Galapagos, Sandoz, Pfizer, Grant/research support from: Celgene, Gaia Gallo Shareholder of: Eli Lilly, Employee of: Eli Lilly, Philip J Mease Speakers bureau: AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer, UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, Sun, UCB, Grant/research support from: AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, Sun, UCB, Proton Rahman Speakers bureau: AbbVie, Amgen, BMS, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, UCB, Consultant of: AbbVie, Amgen, BMS, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, UCB, Grant/research support from: Janssen, Novartis, Venkatesh Krishnan Shareholder of: Eli Lilly, Employee of: Eli Lilly, David Sandoval Shareholder of: Eli Lilly, Employee of: Eli Lilly, Chen-Yen Lin Shareholder of: Eli Lilly, Employee of: Eli Lilly, Rebecca Bolce Shareholder of: Eli Lilly, Employee of: Eli Lilly, Philip G Conaghan Consultant of: personal fees from: AbbVie, AstraZeneca, BMS, Eli Lilly, EMD Serono, Flexion Therapeutics, Galapagos, Gilead, Novartis, Pfizer

OP0230 EFFICACY AND SAFETY OF TILDRAKIZUMAB, A HIGH-AFFINITY ANTI–INTERLEUKIN-23P19 MONOCLONAL ANTIBODY, IN PATIENTS WITH ACTIVE PSORIATIC ARTHRITIS IN A RANDOMISED, DOUBLE-BLIND, PLACEBO-CONTROLLED, MULTIPLE-DOSE, PHASE 2B STUDY

Background:

Tildrakizumab (TIL), a high-affinity anti–interleukin-23p19 monoclonal antibody, is approved to treat moderate to severe plaque psoriasis and is under investigation for treatment of psoriatic arthritis (PsA).1

Objectives:

To evaluate efficacy and safety of TIL up to week (W)52 in a randomised, double-blind, placebo-controlled, multiple-dose, phase 2b study in PsA (NCT02980692).

Methods:

Patients (pts) ≥18 years with active PsA2were randomised 1:1:1:1:1 to TIL 200 mg every 4 weeks (Q4W) to W52, TIL 200 mg Q12W to W52, TIL 100 mg Q12W to W52, TIL 20 mg Q12W until W24 then TIL 200 mg Q12W to W52, or placebo (PBO) Q4W until W24 then TIL 200 mg Q12W to W52. Efficacy assessments included ACR20/50/70, 75%/90%/100% improvement in Psoriasis Area and Severity Index (PASI), proportion of pts with residual minimal disease activity (MDA) response; and mean change from baseline (BL) in HAQ-DI, Leeds Dactylitis Index (LDI, pts with BL LDI ≥1), and Leeds Enthesitis Index (LEI, pts with BL LEI ≥1) to W52. Treatment-emergent adverse events (TEAEs) were monitored.

Results:

Of 500 pts screened, 391 were randomised and received ≥1 dose of drug. Proportions of ACR20/50/70 responders were superior with TIL vs PBO through W24; after W24 rates of responses further increased for TIL 20→200 mg Q12W and PBO→200 mg Q12W through W52 (Figure 1, 2). Other efficacy results are shown in Table. Overall from BL→W24/W25→W52, 50.4%/39.9% and 2.3%/1.0% of pts experienced a TEAE and serious AE, respectively. From BL→W24, 1 case of pyelonephritis and urinary tract infection was reported in the TIL 100 mg Q12W arm and 1 case of chronic tonsillitis was reported in the TIL 20 mg→200 mg Q12W arm. During W25→W52, 1 malignancy (intraductal proliferative breast lesion) was reported with TIL 20 mg→200 mg Q12W. No deaths or major adverse cardiac events occurred.

Table.

W52 clinical efficacy

TIL 200 mg Q4Wn=78TIL 200 mg Q12Wn=79TIL 100 mg Q12Wn=77TIL 20→200 mg Q12Wn=78PBO→TIL 200 mg Q12Wn=79HAQ-DI, BLa1.0 ± 0.61.0 ±0.61.0 ± 0.71.1 ± 0.61.2 ± 0.6 W52b−0.5 ± 0.5−0.5 ± 0.6−0.5 ± 0.6−0.5 ± 0.5−0.5 ± 0.5LEI, BLa,c1.9 ± 2.01.5 ± 1.92.2 ± 2.12.2 ± 2.01.5 ± 1.9 W52b−1.3 ± 1.9−1.0 ± 1.6−1.7 ± 2.1−1.2 ± 1.8−1.2 ± 1.8LDI, BLa,d32.8 ± 32.961.3 ± 73.593.8 ± 146.571.4 ± 118.599.6 ± 170.7 W52b,d−21.4 ± 37.1−42.1 ± 76.7−41.6 ± 89.3−56.5 ± 123.4−81.5 ± 173.0 BL, W52 mediand21.8, 7.428.3, 3.232.1, 20.028.6, 034.0, 5.6MDAe56.964.445.047.142.0PASI 100e54.044.443.947.535.0PASI 90e72.080.658.555.050.0PASI 75e82.094.482.975.067.5

aBL mean ± SD.bMean change from BL ± SD.cPts with BL LEI ≥1 will be presented at EULAR.dPts with BL LDI ≥1 (n = 27, 21, 21, 19, 25) using nonresponder imputation.e% at W52

Missing data not imputed.

SD, standard deviation.

Conclusion:

TIL was well tolerated and improved joint and skin manifestations of PsA through W52.

References:

[1]Reich, et al.Lancet2017;390:276−88.

[2]Taylor, et al.Arthritis Rheum2006;54:2665–73.

Disclosure of Interests:

Philip J Mease Grant/research support from: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – grant/research support, Consultant of: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – consultant, Speakers bureau: Abbott, Amgen, Biogen Idec, BMS, Eli Lilly, Genentech, Janssen, Pfizer, UCB – speakers bureau, Saima Chohan Employee of: Partner/physician at Arizona Arthritis and Rheumatology Associates, Ferran J García Fructuoso Grant/research support from: AbbVie, Eli Lilly, Gedeon Richter, MedImmune, Nichi-Iko, Pfizer, Sanofi-Aventis, Takeda, and UCB, Consultant of: AbbVie, Eli Lilly, Gedeon Richter, MedImmune, Nichi-Iko, Pfizer, Sanofi-Aventis, Takeda, and UCB, Speakers bureau: AbbVie, Eli Lilly, Gedeon Richter, MedImmune, Nichi-Iko, Pfizer, Sanofi-Aventis, Takeda, and UCB, Alice B Gottlieb Grant/research support from:: Research grants, consultation fees, or speaker honoraria for lectures from: Pfizer, AbbVie, BMS, Lilly, MSD, Novartis, Roche, Sanofi, Sandoz, Nordic, Celltrion and UCB., Consultant of:: Research grants, consultation fees, or speaker honoraria for lectures from: Pfizer, AbbVie, BMS, Lilly, MSD, Novartis, Roche, Sanofi, Sandoz, Nordic, Celltrion and UCB., Speakers bureau:: Research grants, consultation fees, or speaker honoraria for lectures from: Pfizer, AbbVie, BMS, Lilly, MSD, Novartis, Roche, Sanofi, Sandoz, Nordic, Celltrion and UCB., Michael E Luggen Grant/research support from: AbbVie; Amgen; Eli Lilly; Genentech; Nichi-Iko; Novartis; Pfizer; R-Pharm; and Sun Pharmaceutical Industries, Inc., Consultant of: AbbVie; Amgen; Eli Lilly; Genentech; Nichi-Iko; Novartis; Pfizer; R-Pharm; and Sun Pharmaceutical Industries, Inc., Speakers bureau: AbbVie; Amgen; Eli Lilly; Genentech; Nichi-Iko; Novartis; Pfizer; R-Pharm; and Sun Pharmaceutical Industries, Inc., Proton Rahman Grant/research support from: Janssen and Novartis, Consultant of: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, and Pfizer., Speakers bureau: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, Pfizer, Siba P Raychaudhuri Grant/research support from: AbbVie; Janssen; Novartis, Pfizer; Sun Pharmaceutical Industries, Inc, Consultant of: Amgen; Eli Lilly; Janssen; Novartis and Pfizer, Richard C Chou Consultant of: Sun Pharmaceutical Industries, Inc, Alan M Mendelsohn Shareholder of: Johnson and Johnson, Employee of: Sun Pharmaceutical Industries, Inc, Stephen Rozzo Employee of: Sun Pharmaceutical Industries, Inc, Ana-Maria Orbai Grant/research support from: Abbvie, Eli Lilly and Company, Celgene, Novartis, Janssen, Horizon, Consultant of: Eli Lilly; Janssen; Novartis; Pfizer; UCB. Ana-Maria Orbai was a private consultant or advisor for Sun Pharmaceutical Industries, Inc, not in her capacity as a Johns Hopkins faculty member and was not compensated for this service.

OP0050 ADALIMUMAB INTRODUCTION VERSUS METHOTREXATE DOSE ESCALATION IN PATIENTS WITH INADEQUATELY CONTROLLED PSORIATIC ARTHRITIS: RESULTS FROM RANDOMIZED PHASE 4 CONTROL STUDY

Background:

Methotrexate (MTX) is often used as first-line therapy for patients (pts) with psoriatic arthritis (PsA) despite limited efficacy and data on appropriate dosage. Minimal Disease Activity (MDA) is suggested as an optimal treat-to-target outcome. Biologic disease-modifying antirheumatic drugs (bDMARDs) have demonstrated improved outcomes (including MDA rates) over MTX. However, more data are needed to define the optimal timing of bDMARD initiation and characterize efficacy of MTX dose escalation, to achieve optimal outcomes.

Objectives:

To compare achievement of MDA between adding adalimumab (ADA) vs escalating MTX dose in PsA pts with inadequate disease control after initial MTX therapy.

Methods:

The open-label, 2-part CONTROL study enrolled bDMARD-naive adult pts with active PsA (not in MDA at screening and ≥3 tender and ≥3 swollen joints) despite MTX 15 mg every wk (ew) for ≥4 wks. Pts were randomized to ADA 40 mg every other wk + MTX 15 mg (ADA+MTX) or escalated MTX to 20–25 mg ew or highest tolerable dose during 16-wk part 1 (Fig 1). The primary endpoint was achievement of MDA, defined as fulfilling ≥5 of the 7 criteria: tender joint count 68 (TJC68) ≤1, swollen joint count 66 (SJC66) ≤1, Psoriasis Area Severity Index (PASI) ≤1 or body surface area (BSA) ≤3%, pt’s pain (visual analogue scale [VAS] 0–100) ≤15, Pt’s Global Assessment of disease activity (PtGA) VAS ≤20, Health Assessment Questionnaire Disability Index (HAQ-DI) ≤0.5 and tender entheseal points (0–8) ≤1. Key secondary efficacy endpoints were achievement of ACR20 and PASI75 and change from baseline in HAQ-DI and Leeds Enthesitis Index (LEI) at wk 16.

Results:

Overall, 246 pts were randomized; 245 received treatment (ADA+MTX, n=123; escalated MTX, n=122); 117 (95%) pts and 110 (90%) pts, respectively, completed part 1. Baseline characteristics were similar between groups (Table). During part 1, the average dose of MTX was 21.8 mg/wk (55% on oral MTX) in the escalated MTX group. Significantly higher proportion of pts in ADA+MTX (42%) vs escalated MTX (13%) group achieved MDA at wk 16 (non-responder imputation [NRI]; difference [95% CI] 28% [18%–39%];P<0.001;Fig 2). Observed case analysis confirmed the NRI analysis. Lower MDA rates at wk 16 were observed in the escalated MTX arm regardless of prior MTX duration (Fig 2). Significant improvements in key secondary endpoints were also observed with ADA+MTX vs escalated MTX (allP<0.05;Fig 2). In part 1, the proportion of patients with adverse events was similar between groups (ADA+MTX, 62% vs escalated MTX, 57%); no opportunistic infections, tuberculosis, malignancies, or deaths were reported during part 1.

Conclusion:

A significantly higher proportion of pts achieved MDA at wk 16 after introducing ADA compared with escalating MTX dose; higher rates were observed regardless of prior MTX duration. Significantly higher responses in musculoskeletal, skin, and quality of life measures were observed with ADA+MTX vs escalated MTX. No new safety signals with ADA were identified in this pt population.

Table 1.

Baseline Demographics

Characteristics, mean (SD)ADA+MTXn=123Escalated MTXn=122Female, n (%)64 (52.0)59 (48.4)Age, y51.4 (12.2)48.8 (12.7)BSA >3%, n (%)74 (60.2)78 (63.9)Pt pain63.7 (19.5)62.3 (20.9)PtGA65.0 (19.9)62.9 (20.9)HAQ-DI1.2 (0.6)1.2 (0.7)LEI + plantar count3.5 (2.1)3.5 (2.1)

Disclosure of Interests:

Laura C Coates: None declared, William Tillett Grant/research support from: AbbVie, Celgene, Eli Lilly, Janssen, Novartis, Pfizer Inc, UCB, Consultant of: AbbVie, Amgen, Celgene, Lilly, Janssen, Novartis, MSD, Pfizer Inc, UCB, Speakers bureau: AbbVie, Amgen, Celgene, Lilly, Janssen, Novartis, Pfizer Inc, UCB, Maria Antonietta D’Agostino Consultant of: AbbVie, BMS, Novartis, and Roche, Speakers bureau: AbbVie, BMS, Novartis, and Roche, Proton Rahman Grant/research support from: Janssen and Novartis, Consultant of: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, and Pfizer., Speakers bureau: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, Pfizer, Frank Behrens Grant/research support from: Pfizer, Janssen, Chugai, Celgene, Lilly and Roche, Consultant of: Pfizer, AbbVie, Sanofi, Lilly, Novartis, Genzyme, Boehringer, Janssen, MSD, Celgene, Roche and Chugai, Philip G Conaghan Consultant of: AbbVie, BMS, Eli Lilly, EMD Serono, Flexion Therapeutics, Galapagos, GSK, Novartis, Pfizer, Speakers bureau: AbbVie, Eli Lilly, Novartis, Pfizer, Erin McDearmon-Blondell Shareholder of: AbbVie, Employee of: AbbVie, Xianwei Bu Shareholder of: AbbVie, Employee of: AbbVie, Liang Chen Shareholder of: AbbVie, Employee of: AbbVie, Mudra Kapoor Shareholder of: AbbVie, Employee of: AbbVie, Philip J Mease Grant/research support from: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – grant/research support, Consultant of: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – consultant, Speakers bureau: Abbott, Amgen, Biogen Idec, BMS, Eli Lilly, Genentech, Janssen, Pfizer, UCB – speakers bureau

THU0396 IMPACT OF IXEKIZUMAB ON WORK PRODUCTIVITY IN PATIENTS WITH ANKYLOSING SPONDYLITIS: RESULTS FROM THE COAST-V AND COAST-W TRIALS AT 52 WEEKS

Background:

Patients with ankylosing spondylitis (AS) are burdened with decreased work productivity.1Ixekizumab (IXE), a high-affinity monoclonal antibody selectively targeting interleukin-17A, has been shown to improve disease signs and symptoms in 2 phase 3 trials assessing patients with active AS.2, 3

Objectives:

This study investigated the effect of IXE treatment for 52 weeks on work productivity and activity impairment as measured by absenteeism, presenteeism, overall work impairment, and activity impairment in patients with active AS.

Methods:

COAST-V (NCT02696785) and COAST-W (NCT02696798) were phase 3, multicenter, randomized, double-blind, placebo (PBO)-controlled (COAST-V active-controlled with adalimumab) trials investigating the efficacy of IXE every 4 weeks (Q4W) and every 2 weeks (Q2W) in 341 patients with active AS naïve to biologic disease-modifying antirheumatic drugs (bDMARDs; COAST-V) and in 316 patients who were inadequate responders or intolerant to 1 or 2 tumor necrosis factor inhibitors (TNFi; COAST-W). Patients receiving PBO were switched to IXE Q4W or Q2W at Week 16; patients receiving adalimumab (ADA) were switched to IXE Q4W or Q2W at Week 20. Data for IXE Q4W and Q2W were combined for PBO/IXE and ADA/IXE groups. Changes from baseline in work productivity were measured for those reporting full- or part-time work at Weeks 16 and 52 with the Work Productivity and Activity Impairment (WPAI) Questionnaire for Spondyloarthritis.

Results:

Compared to bDMARD-naïve patients (COAST-V), TNFi-experienced patients (COAST-W) were slightly older, had longer disease duration, reported less paid employment, and had greater scores for impaired work productivity, signifying more severe baseline disease. At Week 16, bDMARD-naïve patients treated with IXE Q4W or Q2W had significant improvements in activity impairment compared to placebo (p<0.01); TNFi-experienced patients treated with IXE Q4W or Q2W had significant improvements in presenteeism (p<0.05) and overall work impairment (p<0.05; Figure). TNFi-experienced patients treated with IXE Q2W also had significant improvement in activity impairment at Week 16 (p<0.05; Figure). Improvements were sustained through Week 52 (Figure).

Conclusion:

Both bDMARD-naïve and TNFi-experienced patients with AS receiving IXE had greater improvements in aspects of work productivity compared to placebo. Improvements were sustained through Week 52.

References:

[1]Boonen, van der Linden. (2006).J Rheumatol Suppl.78:4-11.

[2]Van der Heijde, et al. (2018)Lancet. 392(10163):2441-51.

[3]Deodhar, et al. (2019)Arthritis Rheumatol.71(4):599-611.

Disclosure of Interests:

Helena Marzo-Ortega Grant/research support from: Janssen, Novartis, Consultant of: Abbvie, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, UCB, Speakers bureau: Abbvie, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, Takeda, UCB, Philip J Mease Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Janssen, Eli Lilly, Novartis, Pfizer, Sun Pharma, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Janssen, Eli Lilly, Galapagos, Gilead, Novartis, Pfizer, Sun Pharma, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Genentech, Janssen, Novartis, Pfizer, UCB Pharma, Proton Rahman Grant/research support from: Janssen and Novartis, Consultant of: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, and Pfizer., Speakers bureau: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, Pfizer, Victoria Navarro-Compán Consultant of: Abbvie, Lilly, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Lilly, Novartis, Pfizer, UCB, Vibeke Strand Consultant of: AbbVie, Amgen, Biogen, Celltrion, Consortium of Rheumatology Researchers of North America, Crescendo Bioscience, Eli Lilly, Genentech/Roche, GlaxoSmithKline, Hospira, Janssen, Merck, Novartis, Pfizer, Regeneron Pharmaceuticals, Inc., Sanofi, UCB, Maxime Dougados Grant/research support from: AbbVie, Eli Lilly, Merck, Novartis, Pfizer and UCB Pharma, Consultant of: AbbVie, Eli Lilly, Merck, Novartis, Pfizer and UCB Pharma, Speakers bureau: AbbVie, Eli Lilly, Merck, Novartis, Pfizer and UCB Pharma, Bernard Combe Grant/research support from: Novartis, Pfizer, Roche-Chugai, Consultant of: AbbVie; Gilead Sciences, Inc.; Janssen; Eli Lilly and Company; Pfizer; Roche-Chugai; Sanofi, Speakers bureau: Bristol-Myers Squibb; Gilead Sciences, Inc.; Eli Lilly and Company; Merck Sharp & Dohme; Pfizer; Roche-Chugai; UCB, James Cheng-Chung Wei Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Novartis, Pfizer Inc, UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Chugai, Eisai, Janssen, Novartis, Pfizer Inc, Sanofi-Aventis, UCB Pharma, Xenofon Baraliakos Grant/research support from: Grant/research support from: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Consultant of: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Speakers bureau: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Theresa Hunter Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, David Sandoval Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Xiaoqi Li Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Baojin Zhu Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Louis Bessette Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Sanofi, Atul Deodhar Grant/research support from: AbbVie, Eli Lilly, GSK, Novartis, Pfizer, UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB

Figure.

Changes from baseline in Overall Work Impairment in A) bDMARD-naïve (COAST-V) and B) TNFi-experienced (COAST-W) patients and Activity Impairment in C) bDMARD-naïve and D) TNFi-experienced patients.

SAT0638-HPR CHARACTERIZING THE IMPACT OF AXIAL SPONDYLOARTHRITIS ON DAILY LIFE: GENDER AND PATIENT-REPORTED OUTCOMES ASSOCIATED WITH FUNCTIONAL LIMITATION IN CANADA. RESULTS FROM THE IMAS SURVEY

Background:

Understanding the most limiting daily activities reported by patients is important for a holistic healthcare approach.

Objectives:

To evaluate the degree of functional limitation on daily activities and its association with PROs in Canada.

Methods:

The International Map of Axial Spondyloarthritis (IMAS) is a cross-sectional online survey of non-selected patients with self-reported axSpA conducted in 22 countries and endorsed by the Axial Spondyloarthritis International Federation. IMAS captures the patients’ perspective of the burden of axSpA. The Canadian adaptation included a review of the survey by an advisory board of axSpA patients and a national steering committee composed of the Canadian Spondylitis Association, rheumatologists and axSpA patients. Canadian participants were recruited from 2018 to 2019. Socio-demographics variables, BASDAI and mental health (GHQ-12) data were collected. Degree of functional limitation in 18 daily activities was evaluated using a 3-point Likert scale. Bivariate analysis was performed to assess activities associated with poorer BASDAI and mental health status.

Table 1.

BASDAI and mental health (GHQ-12)- impact on daily activities (N = 542)

BASDAIMean ± SDGHQ-12Mean ± SDLow limitationMedium + High Limitationp-valueLow limitationMedium + High Limitationp-valueDressing / undressing5.5 ± 2.06.4 ± 4.4<.001*4.4 ± 3.85.7 ±4.0.007*Washing / personal grooming5.6 ±2.06.3 ± 2.0.002*4.7 ± 4.15.6 ± 4.1.099Taking a bath / shower5.6 ±2.06.6 ±1.8<.001*4.2 ± 4.05.9 ± 4.0.002*Tying shoe laces5.4 ± 2.06.1 ± 2.0.005*4.3 ± 3.85.2 ± 4.1.044*Walking / getting around the house5.5 ± 2.06.4 ± 1.9<.001*4.2 ± 3.95.6 ± 4.1.005*Stair climbing5.1 ±1.96.3 ±1.8<.001*3.4 ± 3.45.4 ± 4.0<.001*Lying down / getting up from bed5.2 ± 2.06.3 ± 1.9<.001*3.6 ± 3.65.5 ± 4.1<.001*Going to the toilet5.4 ± 2.06.7 ± 1.9<.001*4.3 ± 4.25.6 ± 3.9.024*Shopping5.6 ± 1.86.2 ± 1.9.003*4.1 ± 3.75.3 ± 4.1.025*Cooking5.6 ± 1.96.3 ± 1.8.008*3.7 ± 3.65.8 ±4.2<.001*Eating5.9 ± 2.16.9 ± 1.9.024*5.0 ± 4.45.8 ± 3.9.282Housework / cleaning4.9 ± 2.06.0 ± 1.8<.001*3.7 ± 3.64.8 ± 4.0.021*Walking down the street5.4 ± 1.96.1 ± 2.0.005*4.4 ± 3.85.1 ± 4.1.228Using public transportation5.6 ± 1.96.1 ± 1.9.1804.4 ± 4.05.3 ± 4.0.155Driving5.5 ± 2.06.1 ± 2.1.021*4.2 ± 3.95.3 ± 4.2.050Doing physical exercise4.7 ± 2.15.8 ± 1.9<.001*3.4 ± 3.74.7 ± 4.0.002*Engaging in intimate relations5.2 ± 1.96.0 ±1.9<.0014.0 ± 3.85.1 ± 4.0.015*Caring for children / grandchildren5.2 ± 1.96.0 ± 2.0.0033.7 ± 3.85.2 ± 4.1.005

* p≤.05

Results:

542 axSpA patients participated. Mean age was 44.3±13.9 years and 63% were female. Mean BASDAI was 5.3±2.1, mean GHQ-12 score was 4.0±3.8 and 50% were on biologics. 94% reported ≥1 limitation in daily activities, of which physical exercise (30%), house cleaning (22%), intimacy (21%) and stair climbing (21%) were most commonly severely impacted (high limitation). Women reported significantly higher limitations in house cleaning, stair climbing, driving, moving around the house and caring for young children (p<.05 for all activities vs men). Compared with low limitation, medium–high limitation in most activities was significantly associated with higher disease activity and worsened mental health for the overall population (Table 1).

Conclusion:

Canadian axSpA patients, particularly women, are limited in daily life activities beyond those captured by other validated scales. Strong association between functional limitation, disease activity and mental health emphasizes the need for holistic evaluation of axSpA patients.

Disclosure of Interests:

Proton Rahman Grant/research support from: Janssen and Novartis, Consultant of: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, and Pfizer., Speakers bureau: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, Pfizer, Marco Garrido-Cumbrera: None declared, Sherry Rohekar: None declared, Michael Mallinson: None declared, Gerald Major: None declared, Algis Jovaisas: None declared, Nigil Haroon: None declared, Wendy Gerhart: None declared, Artur J. deBrum Fernandes: None declared, Martin Cohen: None declared, Jon Chan: None declared, Patrick Leclerc Employee of: Novartis, Julie Schneiderman Employee of: Novartis, Robert Inman: None declared

SAT0414 THE PERFORMANCE OF A MULTI-MARKER GENETIC TEST TO IDENTIFY PATIENTS WITH PSORIATIC ARTHRITIS AMONG PSORIASIS PATIENTS

Background:

Improved understanding of the complex genetic architecture of psoriatic arthritis (PsA) along with the reduction in the cost of genetic testing provide an opportunity to assess the application of genetic testing for PsA diagnosis in clinical setting.

Objectives:

The study aimed to assess the performance of the multi-SNP genetic test in predicting a clinical diagnosis of PsA by a rheumatologist among psoriasis patients with musculoskeletal symptoms.

Methods:

328 patients with psoriasis and musculoskeletal symptoms that were referred to a rapid access clinic for suspected PsA were enrolled. Patients with a prior diagnosis of PsA were excluded. A rheumatologist evaluated all patients and classified them as “PsA” or “not PsA”. All patients who were classified as not PsA at baseline were reassessed 1 year later to determine whether they have developed PsA. We tested 2 outcomes: 1) diagnosis of PsA at baseline; and 2) diagnosis of PsA at baseline or at 1 year. A custom multi-SNP genetic assay was genotyped on a MassARRAY system (Agena Biosciences). The custom PsA weighted genetic panel included 42 variants in or near 20 genes based on genome-wide significance in PsA studies. We tested the ability of each genetic maker individually to predict PsA using logistic regression models adjusted for age and sex. Machine-learning methods including logistic regression, naïve bayes and random forest were used to identify the optimal prediction model. Age and sex were included in the prediction models.

Results:

78 patients were classified as PsA (PsA-baseline) and the remaining 250 patients as not PsA. After 1 year, 17 additional patients developed PsA resulting in 95 patients with PsA at 1 year (PsA-1 year). The association between the tested SNPs and PsA is shown in Table 1. 5 SNPs located at LCE3A (rs10888503), TNIP1 (rs146571698) and IL-23R (rs4655683, rs2201841 and rs12044149) were associated with PsA-baseline or PsA-1 year (all p<0.05). Of the three machine-learning methods used, logistic regression was found to have the best prediction properties (highest AUC). Overall, the performance of prediction models to classify patients as PsA was modest (see Table 2). The AUC, sensitivity and specificity of the models to predict PsAat baselinewere: 0.62, 0.15, 0.97, respectively andat 1 year: 0.62, 0.15, 0.94.

Table 1.

The association between (selected top markers)

ChromSNPGenePsA diagnosis at baseline (N=78)PsA diagnosis at 1 year (N=95)OR95% CIP valueOR95% CIP value1rs10888503LCE3A1.781.21, 2.620.0031.521.06, 2.170.026rs12191877HLA-C0.520.31, 0.890.0170.630.39, 1.010.0576rs2894207HLA-C*60.570.35, 0.930.0250.620.39, 0.990.0456rs13214872HLA-C0.570.34, 0.960.0350.650.41, 1.050.0786rs12189871HLA-C0.550.30, 1.010.0550.680.40, 1.170.1696rs4406273HLA-C0.570.32, 1.020.0570.670.40, 1.120.1225rs146571698TNIP12.030.97, 4.240.0612.071.02, 4.180.0441rs4655683IL-23R1.420.97, 2.080.0691.521.06, 2.170.0221rs2201841IL-23R0.720.50, 1.050.0870.680.48, 0.960.0541rs12044149IL-23R1.340.88,2.060.1671.601.07, 2.390.021Table 2.

Performance of the genetic assay in predicting PsA

2A. Prediction of PsA at baseline (N=78)MethodTPTNFPFNAccuracySensitivitySpecificityAUCLogistic Regression122428660.770.150.970.62Naïve Bayes2720347510.700.350.810.61Random Forest1423713640.770.180.950.562B. Prediction of PsA at 1 year (N=95)MethodTPTNFPFNAccuracySensitivitySpecificityAUCLogistic Regression1521815800.710.150.940.62Naïve Bayes2120330740.680.220.870.62Random Forest1620429790.670.170.880.55

Conclusion:

Despite the association of several genetic markers with PsA, genetic testing has marginal effect on predicting a diagnosis of PsA among patients with psoriasis and musculoskeletal symptoms.

Disclosure of Interests:

Lihi Eder Grant/research support from: Abbvie, Lily, Janssen, Amgen, Novartis, Consultant of: Janssen, Speakers bureau: Abbvie, Lily, Janssen, Amgen, Novartis, Quan Li: None declared, Dana Jerome: None declared, Chandra Farrer: None declared, Tanya Burry: None declared, Proton Rahman Grant/research support from: Janssen and Novartis, Consultant of: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, and Pfizer., Speakers bureau: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, Pfizer

AB0756 GUSELKUMAB IMPROVED WORK PRODUCTIVITY AND DAILY ACTIVITY IN PATIENTS WITH PSORIATIC ARTHRITIS: RESULTS FROM A PHASE 3 TRIAL

Background:

DISCOVER 2 (DISC 2) is a Phase 3 trial of anti-IL-23-specific mAb guselkumab (GUS) in psoriatic arthritis (PsA) pts, who experience impaired physical function, resulting in disability, work productivity loss, and economic consequences.1

Objectives:

To evaluate the effect of GUS on impaired work productivity and daily activity in DISC 2 using the Work Productivity and Activity Impairment Questionnaire: Psoriatic Arthritis (WPAI-PsA).

Methods:

Bio-naïve adults with active PsA despite nonbiologic DMARDs &/or NSAIDs received subcutaneous GUS 100 mg every (q) 4 weeks (W); GUS 100 mg W0, W4, q8W; or placebo (PBO). WPAI-PsA assesses, due to PsA over the previous week, work time missed (absenteeism), impairment while working (presenteeism), and impaired overall work productivity (absenteeism + presenteeism) and daily activity. Percentage change from baseline was analyzed for WPAI-PsA domains using mixed-effect model repeated measure (MMRM). Indirect savings from improved overall work productivity were estimated with 2018 US mean yearly wage estimate (all occupations).2

Results:

At Week 24, impaired overall work productivity and daily activity were improved 20-22% in GUS-treated and 10-11% in PBO-treated pts (Table). Potential yearly indirect savings from improved overall work productivity was $10,242 with GUS q8W and $10,404 with GUS q4W vs $5,648 with PBO; $4,594 and $4,756 difference, respectively.

Conclusion:

Improvement in overall work productivity and daily activity was greater with GUS versus PBO among pts with moderate-to-severe PsA, resulting in potential annual incremental economic gains.

References:

[1]Tillett W et al. Rheumatol (Oxford). 2012;51:275–283.

[2]US Bureau of Labor Statistics. May 2018 National Occupational Employment and Wage Estimates United States.https://www.bls.gov/oes/current/oes_nat.htm#00-000

Table.

Model-based estimates of mean change from baseline in WPAI-PsA domains

% change from baselinePBOGUS 100 mg q8WGUS 100 mg q4WW16W24W16W24W16W24Work time missed (absenteeism), n155152141145145143LSMean-4.6 (-7.2,-1.9)-3.5 (-6.4,-0.6)-3.5 (-6.2,-0.7)-3.1 (-6.1,-0.1)-4.7 (-7.4,-2.0)-3.8 (-6.8,-0.8)LSMean diff1.1 (-2.6,-4.8)*0.4 (-3.7,4.5)*-0.2 (-3.9,3.5)*-0.3 (-4.4,3.8)*Impairment while working (presenteeism), n131130125129133130LSMean-10.3 (-13.9,-6.7)-10.2 (-13.7,-6.7)-16.1 (-19.7,-12.4)-19.4 (-22.9,-15.9)-15.1 (-18.7,-11.5)-19.5 (-23.0,-16.0)LSMean diff-5.8 (-10.8,-0.8)†-9.2 (-14.0,-4.4)‡-4.8 (-9.7,0.1)*-9.3 (-14.1,-4.5)‡Overall work productivity impairment (absenteeism + presenteeism), n131130125129133130LSMean-11.2 (-15.0,-7.5)-10.9 (-14.6,-7.1)-15.9 (-19.7,-12.2)-19.7 (-23.4,-16.0)-15.8 (-19.5,-12.1)-20.0 (-23.7,-16.3)LSMean diff-4.7 (-9.9,0.5)*-8.8 (-14.0,-3.7)‡-4.6 (-9.7,0.5)*-9.2 (-14.3,-4.0)‡Daily activity impairment, n244244247246243245LSMean-10.6 (-13.3,-7.9)-10.3 (-13.1,-7.6)-17.1 (-19.8,-14.4)-21.5 (-24.2,-18.7)-17.0 (-19.7,-14.3)-20.5 (-23.2,-17.7)LSMean diff-6.5 (-10.2,-2.8)‡-11.1 (-15.0,-7.4)‡-6.5 (-10.2,-2.7)‡-10.2 (-14.0,-6.4)‡

Data are % (95% CI)

*p>0.05, †p<0.05,‡p<0.001

LSmeans, p values based on MMRM

LSmean diffs, p values vs PBO

Acknowledgments:

None

Disclosure of Interests:

Jeffrey Curtis Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, UCB, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, UCB, Iain McInnes Grant/research support from: Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Janssen, and UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Gilead, Janssen, Novartis, Pfizer, and UCB, Proton Rahman Grant/research support from: Janssen and Novartis, Consultant of: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, and Pfizer., Speakers bureau: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, Pfizer, William Tillett Grant/research support from: AbbVie, Celgene, Eli Lilly, Janssen, Novartis, Pfizer Inc, UCB, Consultant of: AbbVie, Amgen, Celgene, Lilly, Janssen, Novartis, MSD, Pfizer Inc, UCB, Speakers bureau: AbbVie, Amgen, Celgene, Lilly, Janssen, Novartis, Pfizer Inc, UCB, Philip J Mease Grant/research support from: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – grant/research support, Consultant of: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – consultant, Speakers bureau: Abbott, Amgen, Biogen Idec, BMS, Eli Lilly, Genentech, Janssen, Pfizer, UCB – speakers bureau, Alexa Kollmeier Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Elizabeth C Hsia Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Bei Zhou Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Prasheen Agarwal Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Steve Peterson Employee of: Janssen Research & Development, LLC, Chenglong Han Employee of: Janssen Research & Development, LLC

FRI0359 INTEGRATED SAFETY RESULTS OF TWO PHASE-3 TRIALS OF GUSELKUMAB IN PATIENTS WITH PSORIATIC ARTHRITIS THROUGH THE PLACEBO-CONTROLLED PERIODS

Background:

DISCOVER 1 & 2 are phase 3 psoriatic arthritis (PsA) trials investigating guselkumab (GUS), an IL-23 inhibitor that specifically binds the IL-23p19 subunit. In both studies, GUS showed significant improvement vs placebo (PBO) through week (W) 24 in the PBO-controlled period.1,2

Objectives:

To present integrated safety results of DISC 1 & 2 through the PBO-controlled periods.

Methods:

Adult patients (pts) with active PsA despite standard therapy were enrolled. All pts were biologic-naïve, except ~30% in DISC 1 with previous exposure to 1-2 TNF inhibitors. Pts were randomized to SC GUS 100 mg Q4W; GUS 100 mg at W0, W4, then Q8W; or PBO. Adverse events (AEs) and lab results were analyzed from pooled data.

Results:

The rates of pts experiencing ≥1 AE, serious AE, infection, serious infection, and discontinuation due to an AE were similar between GUS and PBO (Table 1). There were 2 deaths, 3 malignancies, 2 Major Adverse Cardiac Events (MACE), and no opportunistic infections (treatment group not shown to prevent unblinding). Among the AEs reported by ≥5% pts in any group (Table 1), nasopharyngitis and elevated serum hepatic aminotransferases were more common with GUS vs PBO. Laboratory ALT and AST elevations were mostly mild, transient, and not associated with significant bilirubin elevation. There was a trend to decreased neutrophil count (mostly Grade 1, transient, and not associated with infection) with GUS vs PBO (Table 2). Low rates of injection-site reactions were seen with GUS vs PBO. Anti-drug antibody development was also low (Table 1).

Table 1.

Patient Reported AEs, n (%)

GUS100 mgQ8WGUS100 mgQ4WPBON375373372≥1 AE182 (48.5)182 (48.8)176 (47.3)≥1 Serious AE7 (1.9)8 (2.1)12 (3.2)Discontinuation due to AE5 (1.3)8 (2.1)7 (1.9)≥1 Infection73 (19.5)80 (21.4)77 (20.7)≥1 Serious infection1 (0.3)3 (0.8)3 (0.8)≥1 Opportunistic Infection (including Candida)000Active Tuberculosis000≥1 Injection-site reaction5 (1.3)4 (1.1)1 (0.3)Anti-GUS antibody +, n/N (%)6/373 (1.6)9/371 (2.4)--AEs* reported by ≥5% of patients in any treatment groupNasopharyngitis26 (6.9)19 (5.1)17 (4.6)Upper respiratory tract infection13 (3.5)23 (6.2)17 (4.6)Increased ALT23 (6.1)28 (7.5)14 (3.8)Increased AST23 (6.1)14 (3.8)9 (2.4)

*Medical Dictionary for Regulatory Activities (MedDRA) preferred term

Table 2.

Lab Results*

GUS100 mgQ8WGUS100 mgQ4WPBON373371370ALT Increased (%)Grade 128.235.030.121.12.71.43-40.81.10.8Neutrophil Count Decreased (%)Grade 15.65.93.221.61.60.83-400.30.3

*NCI toxicity grade

ALT=Alanine aminotransferase

Conclusion:

GUS was safe and well tolerated through the PBO-controlled period in 2 randomized, phase 3 trials of patients with active PsA. There were no meaningful safety differences between the Q8W and Q4W groups, no significant safety issues identified when comparing GUS to PBO, and no safety signals with regards to infections, malignancy, and MACE. The safety profile of GUS Q4W and Q8W in PsA pts was generally consistent with that in the Phase 3 trials of GUS Q8W for psoriasis.3,4

References:

[1]Deodhar et al. ACR 2019 (#807). Arth Rheum 2019;71 S10:1386

[2]Mease et al. ACR 2019 (#L13). Arth Rheum 2019;71 S10:5247

[3]Blauvelt et al. J Am Acad Derm 2017;76:405

[4]Reich et al. J Am Acad Derm 2017;76:418

Acknowledgments:

None

Disclosure of Interests:

Proton Rahman Grant/research support from: Janssen and Novartis, Consultant of: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, and Pfizer., Speakers bureau: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, Pfizer, Christopher T. Ritchlin Grant/research support from: UCB Pharma, AbbVie, Amgen, Consultant of: UCB Pharma, Amgen, AbbVie, Lilly, Pfizer, Novartis, Gilead, Janssen, Philip Helliwell: None declared, Wolf-Henning Boehncke Grant/research support from: Janssen Research & Development, LLC, Consultant of: Janssen, Philip J Mease Grant/research support from: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – grant/research support, Consultant of: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – consultant, Speakers bureau: Abbott, Amgen, Biogen Idec, BMS, Eli Lilly, Genentech, Janssen, Pfizer, UCB – speakers bureau, Alice B Gottlieb Grant/research support from:: Research grants, consultation fees, or speaker honoraria for lectures from: Pfizer, AbbVie, BMS, Lilly, MSD, Novartis, Roche, Sanofi, Sandoz, Nordic, Celltrion and UCB., Consultant of:: Research grants, consultation fees, or speaker honoraria for lectures from: Pfizer, AbbVie, BMS, Lilly, MSD, Novartis, Roche, Sanofi, Sandoz, Nordic, Celltrion and UCB., Speakers bureau:: Research grants, consultation fees, or speaker honoraria for lectures from: Pfizer, AbbVie, BMS, Lilly, MSD, Novartis, Roche, Sanofi, Sandoz, Nordic, Celltrion and UCB., Shelly Kafka Employee of: Janssen Scientific Affairs, LLC, Alexa Kollmeier Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Elizabeth C Hsia Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Xie L Xu Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, May Shawi Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Shihong Sheng Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Prasheen Agarwal Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Bei Zhou Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Paraneedharan Ramachandran Employee of: Janssen Research & Development, LLC, Iain McInnes Grant/research support from: Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Janssen, and UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Gilead, Janssen, Novartis, Pfizer, and UCB

SAT0629-HPR FACTORS ASSOCIATED WITH USE OF BIOLOGICAL THERAPIES FOR AXIAL SPONDYLOARTHRITIS IN CANADA. RESULTS FROM THE IMAS SURVEY

Background:

Biologics have revolutionized the treatment of axial spondyloarthritis (axSpA). However, there is limited knowledge about factors associated with their use in Canada.

Objectives:

To evaluate sociodemographic, healthcare and patient-reported outcomes (PROs) associated with the use of biologics in Canadian axSpA patients.

Methods:

The International Map of Axial Spondyloarthritis (IMAS) is a cross-sectional online survey of non-selected patients with self-reported axSpA, conducted in 21 countries and endorsed by the Axial Spondyloarthritis International Federation (ASIF). IMAS captures the patients’ perspective of the burden of axSpA. The Canadian adaptation included a review of the survey by an advisory board of axSpA patients and a national steering committee composed of the Canadian Spondylitis Association, rheumatologists and patients. Participants were recruited between August 2018 and February 2019. Sociodemographic and healthcare-related variables, as well as PROs (disease activity [BASDAI, 0–10], spinal stiffness [3–12], functional limitation [0–54] and psychological distress [GHQ-12]) were collected. Respondents were divided in 2 groups 1) biologic and 2) NSAIDs or no treatment, based on reported pharmacologic treatments. Statistical analyses were performed to assess associations between variables and biologic use (bivariate) and the relative weight of these associations (multivariate).

Results:

542 axSpA patients were recruited. Mean age was 44.3±13.9 years, 63.1% were female, 66.4% married and 81.0% educated to university/college level. 22.8% of patients lived >50 km from their rheumatologist. Mean BASDAI was 5.3±2.1 and mean GHQ-12 score (mental health) was 4.0±3.8. Nearly half (49.6%) were currently on a biologic. Reported incidence of side effects was lower for patients having biologics (42.5%) vs. a NSAIDs (53.7%) as part of their treatment armamentarium. Only 15.7% of patients had discontinued biologic therapy, the main reasons for withdrawal being physician recommendation (50%), side effects (50%) and personal choice (34%). Variables associated with biologic use included: membership of a patient support group (p<0.001), non-manual work (p=0.008), higher income level (p=0.039), having a combination of public and private insurance schemes (p<0.001) and diagnosis by a rheumatologist (p<0.001). Associated PROs were spinal stiffness (p=0.011) and diagnostic delay (p=0.030). In the multivariate analysis, all variables except income and diagnostic delay were associated with biologic use (Table 1).

Table 1.

Analysis of sociodemographic and clinical variables in relation to pharmacologic treatment

VariableUnivariate linear regressionMultivariate stepwise linear regressionB95% CIB95% CIIncome level0.0011.000–1.000NANAEmployment—manual worker–0.7610.266–0.822–0.8380.228–0.820Member of a patient support group0.9371.797–3.6281.1161.754–5.309Health insurance scheme—combination0.2091.162–1.3070.2151.132–1.357Diagnostic delay0.0090.993–1.026NANASpinal Stiffness (3–12)0.0991.022–1.1930.2201.090–1.424Diagnosed by rheumatologist0.5351.412–2.0670.3351.041–1.877

B, B coefficient; NA, [not applicable]

Conclusion:

Canadian axSpA patients with greater social status, disease awareness, and insurance options are more likely to receive biologic therapy. Furthermore, Canadian physicians are more inclined to prescribe biologics to patients with increased spinal stiffness.

Disclosure of Interests:

Robert Inman: None declared, Marco Garrido-Cumbrera: None declared, Jon Chan: None declared, Martin Cohen: None declared, Artur J. deBrum Fernandes: None declared, Wendy Gerhart: None declared, Nigil Haroon: None declared, Algis Jovaisas: None declared, Gerald Major: None declared, Michael Mallinson: None declared, Sherry Rohekar: None declared, Patrick Leclerc Employee of: Novartis, Julie Schneiderman Employee of: Novartis, Proton Rahman Grant/research support from: Janssen and Novartis, Consultant of: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, and Pfizer., Speakers bureau: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, Pfizer

SAT0359 THE ASSOCIATION BETWEEN IMAGING SUB-PHENOTYPES OF PSORIATIC ARTHRITIS AND GENE EXPRESSION PROFILES

Background:

Heterogeneity is a hallmark of psoriatic arthritis (PsA), which is reflected in diverse clinical, imaging and molecular features that may reflect disease course and response to treatment. We hypothesized that specific molecular pathways underlie the various manifestations of PsA.

Objectives:

To create a model for accurate and biologically meaningful sub-phenotyping of PsA using imaging and molecular data. Specifically, we aimed to identify imaging sub-phenotypes in patients with PsA and determine their association with whole blood mRNA expression markers.

Methods:

55 patients with PsA ready to initiate treatment for active disease were prospectively recruited. An ultrasound assessment of the extent of musculoskeletal inflammation in 64 joints, 34 tendons and 16 entheses was performed. Sonographic inflammation (in greyscale and Doppler) of the following domains was graded for: a) synovitis; b) peri-tendonitis; c) tenosynovitis; and d) enthesitis. A global inflammatory score was calculated for each tissue domain. Peripheral blood was profiled with RNAseq, and gene expression data were obtained. Analyses were performed in two stages: 1) Unsupervised cluster analysis was performed using hierarchial and k-means to define imaging sub-phenotypes in PsA that reflected the predominant tissue involved; 2) Principal component analysis with ellipses was used to determine the association between imaging-defined clusters and peripheral blood gene expression profile.

Results:

The patients could be divided into 3 groups based on unsupervised hierarchical and k-means clustering of images indicating the predominant involved tissue (Figure 1): 1) Enthesitis predominant (N=13 [24%]); 2) Peri-tendonitis predominant (N=11 [20%]); 3); Synovitis predominant (N=31 [56%]). Patients in the synovitis predominant group had more nail involvement, while those in the peri-tendonitis group had the highest number of clinically active joints (Table 1). Unsupervised clustering of gene expression data identified three clusters that partially overlapped with the imaging clustering (Figure 2). Overall, 344 genes were differentially expressed (p<0.05) in two of the three comparisons between the imaging clusters.

Table 1.

Clinical Features by Imaging Clustering

VariableEnthesitis predominantcluster(N=13)Peritendonitis predominant cluster(N=11)Synovitis predominant cluster(N=31)Age (years)47 (14)49 (16)45 (20)Sex: Female8 (61.5%)5 (45.5%)15 (48.4%)PsA duration (years)1.2 (1.5)1.6 (11.5)0.8 (3.7)BMI29.4 (6.8)25 (8.1)26.1 (8.4)Nail lesions3 (23.1%)5 (45.5%)17 (54.8%)PASI1.2 (2.7)1.2 (3.2)2.8 (7.8)Tender joint count6 (9)11 (5)3 (6)Swollen joint count2 (6)10 (7)3 (6)Dactylitis3 (23.1%)4 (36.4%)7 (22.6%)Enthesitis count3 (3)1 (4)0 (2)Enthesitis12 (92.3%)7 (63.6%)15 (48.4%)hsCRP2.9 (8.8)8.5 (21.5)3.6 (9.4)

Median (IQ range) and frequencies (%)

Bolded=Statistically different between the 3 groups (p<0.05)

Conclusion:

We identified three different imaging clusters based on the predominant tissue involved in patients with active PsA. Distinct gene expression profiles may underlie these imaging clusters seen in PsA.

Acknowledgments:

The study was supported by a Discovery Grant from the National Psoriasis Foundation.

Disclosure of Interests:

Lihi Eder Grant/research support from: Abbvie, Lily, Janssen, Amgen, Novartis, Consultant of: Janssen, Speakers bureau: Abbvie, Lily, Janssen, Amgen, Novartis, Quan Li: None declared, Sara Rahmati: None declared, Iris Eshed: None declared, Proton Rahman Grant/research support from: Janssen and Novartis, Consultant of: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, and Pfizer., Speakers bureau: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, Pfizer, Igor Jurisica Grant/research support from: IBM, Vinod Chandran Grant/research support from: Abbvie, Celgene, Consultant of: Abbvie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lily, Janssen, Novartis, Pfizer, UCB, Employee of: Spouse employed by Eli Lily

SAT0421 GUSELKUMAB DEMONSTRATED AN INDEPENDENT TREATMENT EFFECT ON FATIGUE AFTER ADJUSTMENT FOR CLINICAL RESPONSE (ACR20) IN PATIENTS WITH PSORIATIC ARTHRITIS: RESULTS FROM PHASE-3 TRIALS DISCOVER 1 & 2

Background:

DISCOVER 1 and 2 are phase-3 trials of guselkumab (GUS, a monoclonal antibody that specifically binds the p19-subunit of IL-23) in patients with psoriatic arthritis (PsA). In both trials, treatment with GUS led to significantly more improvement than placebo (PBO) in the primary endpoint (ACR20) as well as in other measures of arthritis and psoriasis at week (W) 24.1,2

Objectives:

To evaluate the effect of GUS on fatigue in DISC 1 & 2 using the patient reported outcome (PRO) FACIT-Fatigue, which has demonstrated content validity and strong psychometric properties in clinical trials.3

Methods:

DISC 1 & 2 enrolled patients with active PsA, despite nonbiologic DMARDS and/or NSAIDS, who were mostly biologic naïve except for ~30% of patients in DISC 1 who had received 1-2 TNFi. Patients were randomized (1:1:1) in a blinded fashion to subcutaneous GUS 100 mg at W0 and W4 then every (q) 8W, to GUS 100 mg q4W, or to matching PBO. Concomitant treatment with select non-biologic DMARDS, oral corticosteroids, and NSAIDs was allowed. The FACIT-Fatigue is a 13-item PRO instrument assessing fatigue and its impact on daily activities and function over the past seven days, with a total score ranging from 0 to 52, higher score denoting less fatigue. A change of ≥4 points is identified as clinically meaningful.3Change from baseline in FACIT-Fatigue was analyzed using MMRM (Figure). Independence of treatment effect on FACIT-Fatigue from effect on ACR20 was assessed using Mediation Analysis4(Table) to estimate the natural direct effect (NDE) and natural indirect effect (NIE) mediated by ACR20 response.

Results:

At baseline in DISC 1 & 2, the mean FACIT-fatigue scores (SD) were 30.4 (10.4) and 29.7 (9.7), respectively, indicating moderate to severe fatigue. In both DISCOVER 1 & 2 trials, treatment with GUS led to improvements in FACIT-Fatigue scores compared with PBO as early as W8 (Figure). 54%-63% of GUS patients compared with 35%-46% of PBO patients achieved clinically meaningful improvement (≥4 points) in FACIT-Fatigue (P≤0.003). Mediation analysis revealed that the independent treatment effects on fatigue after adjustment for ACR20 response (Natural Direct Effect [NDE], Table) were 12-36% in the q8W GUS dosing group and 69% -70% in the q4W GUS group.

Conclusion:

In 2 phase-3 trials, treatment with GUS of patients with active PsA led to significant improvements compared to PBO in fatigue, including substantial effects on FACIT-Fatigue that were independent of the effects on ACR 20, especially for the q4W dosing group.

References:

[1]Deodhar et al. ACR 2019. Abstract #807. Arthr Rheumatol. 2019;71 S10: 1386

[2]Mease et al. ACR 2019. Abstract # L13. Arthr Rheumatol. 2019;71 S10:5247

[3]Cella et al. Journal of Patient-Reported Outcomes. 2019;3:30

[4]Valeri et al. Psychologic Meth. 2013;18:137

Table.

Mediation Analysis of the Effect of ACR 20 Response on Change from Baseline in FACIT-Fatigue Score at Week 24

EffectGUS 100 mg q8W vs. PBOEstimate (95% CI)GUS 100 mg q4W vs. PBOEstimate (95% CI)DISCOVER 1NDE0.36 (-1.7, 2.4)2.60 (0.6, 4.5)*NIE2.75 (1.4, 4.3)*1.20 (0.3, 2.3)*Total Effect3.12 (1.0, 5.2)*3.79 (1.9, 5.4)*Proportion Independent11.7%68.5%Proportion Mediated88.3%31.5%DISCOVER 2NDE1.44 (-0.1, 3.0)2.49 (1.0, 4.1)*NIE2.53 (1.6, 3.6)*1.09 (0.4, 1.9)*Total Effect3.97 (2.4, 5.5)*3.58 (2.1, 5.0)*Proportion Independent36.3%69.7%Proportion Mediated63.7%30.3%

*P vs placebo<0.02

NDE=Natural Direct Effect (effect on FACIT-F beyond effect on ACR20), NIE=Natural Indirect Effect (effect on FACIT-F mediated by ACR20)

Mediation analysis4used linear and logistics regression models with Bootstrapping method

Acknowledgments:

None

Disclosure of Interests:

Philip Helliwell: None declared, Proton Rahman Grant/research support from: Janssen and Novartis, Consultant of: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, and Pfizer., Speakers bureau: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, Pfizer, Atul Deodhar Grant/research support from: AbbVie, Eli Lilly, GSK, Novartis, Pfizer, UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB, Alexa Kollmeier Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Elizabeth C Hsia Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Bei Zhou Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Xiwu Lin Employee of: Janssen Research & Development, LLC, Chenglong Han Employee of: Janssen Research & Development, LLC, Philip J Mease Grant/research support from: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – grant/research support, Consultant of: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – consultant, Speakers bureau: Abbott, Amgen, Biogen Idec, BMS, Eli Lilly, Genentech, Janssen, Pfizer, UCB – speakers bureau

THU0384 IMPACT OF IXEKIZUMAB ON WORK PRODUCTIVITY IN NON-RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS PATIENTS: RESULTS FROM THE COAST-X TRIAL AT 52 WEEKS

Background:

Patients with non-radiographic axial spondyloarthritis (nr-axSpA) experience impairments in health-related quality of life comparable to those seen in ankylosing spondylitis, including impacts on work productivity. Ixekizumab (IXE) is a high-affinity monoclonal antibody that selectively targets interleukin-17A and effectively treats axial spondyloarthritis.1,2,3

Objectives:

This analysis evaluated the effect of IXE treatment for 52 weeks on work productivity and activity impairment as measured by absenteeism, presenteeism, overall work impairment, and activity impairment in patients with active nr-axSpA.

Methods:

COAST-X (NCT02757352) was a phase 3, multicenter, randomized, double-blind, placebo-controlled, parallel-group outpatient study investigating the efficacy and safety of 80 mg IXE every 2 weeks (Q2W) and every 4 weeks (Q4W) compared to placebo (PBO) in 303 patients naïve to biologic disease-modifying anti-rheumatic drugs with active nr-axSpA during a 52-week treatment period. From Weeks 16 through 44, if patients’ disease activity required escalation of treatment at investigator discretion, patients were switched to open-label IXE Q2W or subsequent tumor necrosis factor inhibitor treatment. Analysis was performed for the intent-to-treat population, which included data up to the time of biologic switching. Patients who switched to open-label IXE were considered non-responders. Changes from baseline in work productivity were measured for patients reporting full- or part-time work at Weeks 16 and 52 with the Work Productivity and Activity Impairment (WPAI) Questionnaire for Spondyloarthritis and analyzed with an analysis of covariance model including treatment, geographic region, screening magnetic resonance imaging and C-reactive protein level status, and baseline value as factors. Missing data was imputed using the modified baseline observation carried forward.

Results:

A majority of patients (63.5–65.7%) reported part-time or full-time paid work at baseline, with baseline scores for presenteeism and overall work activity slightly higher for patients in the PBO arm (p<0.05). Patients treated with IXE Q4W had significantly greater improvement than PBO in activity impairment at Weeks 16 (p=0.003) and 52 (p=0.004), presenteeism at Weeks 16 (p=0.007) and 52 (p=0.003), and overall work impairment at Weeks 16 (p=0.014) and 52 (p=0.005; Figure). Patients treated with IXE Q2W had significantly greater improvement than PBO in activity impairment at Weeks 16 (p=0.007) and 52 (p=0.006; Figure). Patients treated with either IXE regimen had numeric improvements in all WPAI measures compared to those receiving PBO at Weeks 16 and 52 (Figure).

Conclusion:

Patients with nr-axSpA treated with either IXE regimen had significant improvements in activity impairment compared to PBO. Patients receiving IXE Q4W also had significant improvements in presenteeism and overall work impairment.

References:

[1]Sieper, et al. (2016)Clin Exp Rheumatol.34(6):975-83.

[2]Van der Heijde, et al. (2018)Lancet. 392(10163):2441-51.

[3]Deodhar, et al. (2019)Arthritis Rheumatol.71(4):599-611.

Figure.

Changes from baseline in A) Absenteeism, B) Presenteeism, C) Overall Work Impairment, and D) Activity Impairment.

Disclosure of Interests:

Atul Deodhar Grant/research support from: AbbVie, Eli Lilly, GSK, Novartis, Pfizer, UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB, Philip J Mease Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Janssen, Eli Lilly, Novartis, Pfizer, Sun Pharma, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Janssen, Eli Lilly, Galapagos, Gilead, Novartis, Pfizer, Sun Pharma, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Genentech, Janssen, Novartis, Pfizer, UCB Pharma, Lianne S. Gensler Grant/research support from: Pfizer, Novartis, UCB, Consultant of: AbbVie, Eli Lilly, GSK, Novartis, UCB, Proton Rahman Grant/research support from: Janssen and Novartis, Consultant of: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, and Pfizer., Speakers bureau: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, Pfizer, Victoria Navarro-Compán Consultant of: Abbvie, Lilly, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Lilly, Novartis, Pfizer, UCB, Helena Marzo-Ortega Grant/research support from: Janssen, Novartis, Consultant of: Abbvie, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, UCB, Speakers bureau: Abbvie, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, Takeda, UCB, Theresa Hunter Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, David Sandoval Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Andris Kronbergs Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Baojin Zhu Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Ann Leung: None declared, Vibeke Strand Consultant of: AbbVie, Amgen, Biogen, Celltrion, Consortium of Rheumatology Researchers of North America, Crescendo Bioscience, Eli Lilly, Genentech/Roche, GlaxoSmithKline, Hospira, Janssen, Merck, Novartis, Pfizer, Regeneron Pharmaceuticals, Inc., Sanofi, UCB

OP0305 RHO-GTPASE PATHWAYS MAY DIFFERENTIATE RESPONDER AND NON-RESPONDERS TO TUMOUR NECROSIS FACTOR INHIBITOR (TNFI) AND INTERLEUKIN-17A INHIBITOR (IL-17AI) THERAPY IN PSORIATIC ARTHRITIS (PSA)

Background:

In PsA there is a pressing need to develop a coherent strategy for identifying initial and subsequent biologic responders. PsA patients present substantial heterogeneity in response to biologics, and molecular subtyping will help to identify the right patient for the right treatment.

Objectives:

To identify transcript profiles (biomarkers) that will select TNFi and IL-17Ai responders in PsA using baseline CD4+ cells; and elucidate novel signaling pathways relevant to biologic disease modifying antirheumatic drug (bDMARD) response using a systems biology approach.

Methods:

Consenting patients initiating TNFi agents (20 patients) or IL-17Ai agents (20 patients) with moderate-to-severe PsA were assessed with a comprehensive standardized protocol at baseline and at 3 months. Responder to bDMARDs was defined by Disease Activity index for PSoriatic Arthritis (DAPSA) score of less than 14 (low disease activity). Global transcript profiling was performed on all patients prior to initiation of and 3 months post bDMARDs. We mapped RNA-seq reads to the hg19 reference genome using STAR and quantified transcripts with Cufflinks. The transcripts per million (TPM) values were log-transformed for statistical analyses

Results:

The demographics of PsA patients for both treatment groups are presented (Table 1). Differentially expressed genes (DEGs) were identified using the limma tool for TNFi and IL-17Ai responders and non-responders (Figure 1) as well as DEGs that differentiated TNFi from IL-17Ai response and non-response. Integration of differential gene expression data with tissue-specific protein-protein interactions (IID version 2018-11) identified 117 and 132 DEGs between responders and non-responders to TNFi and IL-17Ai treatments, respectively. Comprehensive pathway enrichment analysis of these genes using pathDIP (v 4.1) revealed 576 (out of 5380) pathways enriched in 117 DEGs between responders and non-responders to TNFi, and 125 pathways enriched in 132 DEGs between responders and non-responders to IL-17Ai. Interestingly, while these two gene lists share only 17 genes, they have 79 enriched pathways in common suggesting potential effect of two different treatments on similar pathways but through different pathway members (Figure 2). Moreover, it suggests potential importance of the 17 shared genes in association with these pathways. Most of these pathways are related to innate and adaptive immune system, and to “osteoclast differentiation”. Among 46 pathways specific to response to IL-17Ai, multiple Rho-GTPase-related pathways were identified. It has been shown that experimental inhibition of ROCK2, a target of Rho-GTPase family is effective in psoriatic disease through regulation of IL-17/23/10, but not IL-6 and TNFα.

Table 1.

Demographics of psoriatic arthritis (PsA) patients.

IL-17AiTNFiNumber of PsA patients2020Gender (% female)55%75%Mean Age (Years)55.9 (9.5)56.8 (7.9)Mean Disease Duration (Years)10.4 (6.9)7.3 (7.9)Mean DAPSA baseline38.8 (17.5)45.6 (28.9)Responders (%) (DAPSA <14)35%65%Biologic naïve (%)40%60%Figure 1.

PCA plots illustrating that DEGs of CD4+ cells can differentiate responders from non-responders when treated with:A.IL-17Ai; andB.TNFi.

Figure 2.

Over-represented terms in significantly enriched pathways considering DEGs between:A.IL-17i responders and non-responders (125 pathways);B.TNFi responders and non-responders (576 pathways).

Conclusion:

Integration of cell-specific transcriptomic data with protein networks represents a very promising strategy for identifying biologic responders and pathways involved in predicting response that may have identified the Rho-GTP pathway as a potential marker to guide the choice of biologic agents for individual patients.

Disclosure of Interests:

Sara Rahmati: None declared, Darren O’Rielly: None declared, Quan Li: None declared, Dianne Codner: None declared, Amanda Dohey: None declared, Kari Jenkins: None declared, Igor Jurisica Grant/research support from: IBM, Dafna D Gladman Grant/research support from: AbbVie, Amgen Inc., BMS, Celgene Corporation, Janssen, Novartis, Pfizer, UCB – grant/research support, Consultant of: AbbVie, Amgen Inc., BMS, Celgene Corporation, Janssen, Novartis, Pfizer, UCB – consultant, Vinod Chandran Grant/research support from: Abbvie, Celgene, Consultant of: Abbvie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lily, Janssen, Novartis, Pfizer, UCB, Employee of: Spouse employed by Eli Lily, Proton Rahman Grant/research support from: Janssen and Novartis, Consultant of: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, and Pfizer., Speakers bureau: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, Pfizer

AB0801 EFFECTS OF GUSELKUMAB, A MONOCLONAL ANTIBODY THAT SPECIFICALLY BINDS TO THE P19-SUBUNIT OF INTERLEUKIN-23, ON DACTYLITIS AND ENTHESITIS IN PATIENTS WITH ACTIVE PSORIATIC ARTHRITIS: POOLED RESULTS THROUGH WEEK 24 FROM TWO PHASE 3 STUDIES

Background:

Guselkumab (GUS), a novel monoclonal antibody that specifically binds to the p19-subunit of IL-23, demonstrated efficacy in the Ph 3 DISCOVER-1 (D1) & DISCOVER-2 (D2) trials of pts with active psoriatic arthritis (PsA).1,2Dactylitis & enthesitis, key PsA clinical manifestations, can be difficult to treat and may portend more significant disease burden.3,4

Objectives:

In pts with dactylitis or enthesitis at baseline, assess: 1) changes in symptoms over time and 2) relationships between improvements in dactylitis or enthesitis and other PsA domains.

Methods:

Adults with active PsA despite standard therapies were eligible for D1 & D2. Approx. 30% of D1 pts previously received 1-2 TNF inhibitors; D2 pts were biologic-naïve. Pts were randomized 1:1:1 to GUS 100mg Q4W; GUS 100mg at W0, W4, Q8W; or PBO. Independent assessors evaluated dactylitis (total score: 0-60) & enthesitis (Leeds Enthesitis Index [LEI]; total score 0-6). Dactylitis and enthesitis findings through W24 were prespecified to be pooled across D1 & D2. P-values are unadjusted. We assessed changes in dactylitis and LEI scores over time (ANCOVA); associations between dactylitis or enthesitis resolution and ACR/PASI responses at W24 (Chi-square); and correlations between dactylitis or LEI and HAQ-DI/SF-36 change scores at W24 (Spearman’s correlation). AEs through W24 were reported.1,2

Results:

At W0, 42% of pooled D1+D2 pts had dactylitis; 65% had enthesitis. GUS improved dactylitis and LEI scores vs PBO at W8, W16, W24. GUS vs PBO differences were significant for dactylitis changes at W16 & W24 and LEI changes at W8 (Q4W only), W16 & W24; no dose response was observed (Fig). Rates of dactylitis or enthesitis resolution by W24 were consistently significantly (p<0.001) associated with ACR20/50/70 and PASI75/90 response (Table). In GUS-treated pts at W24, significant correlations were observed between dactylitis change scores and PASI (p<0.001 Q4W; p=0.006 Q8W) and SF-36 MCS (p=0.038 Q4W; p=0.003 Q8W) changes, and between LEI and HAQ-DI change scores (p<0.001 Q4W; p=0.005 Q8W). No consistent correlations/associations were observed between dactylitis or LEI scores and other clinical outcomes.

Conclusion:

In PsA pts with dactylitis or enthesitis at W0, GUS improved dactylitis or LEI scores vs PBO by W8; treatment differences were significant at W16 & W24. Resolution of dactylitis or enthesitis was significantly associated with clinically meaningful improvements in PsA joint & skin symptoms. Improved dactylitis scores correlated with improved skin symptoms and mental health; improved LEI scores correlated with improved physical function.

References:

[1]Deodhar A (A#807),

[2]Mease P (A#L13), Arthritis Rheumatol 2019;71(suppl 10);

[3]DOI: 10.1186/s13075-017-1399-5;4DOI: 10.1016/j.semarthrit.2018.02.002

Table.

Pooled DISCOVER-1&2: associations between dactylitis/enthesitis resolution and joint/skin response

ACR20ACR50ACR70PASI75aPASI90aDactylitis resolutionbN%pts%pts%ptsN%pts%pts Q4W37355*34*16*12178*55* Q8W37553*31*16*11680*65* PBO37226*12*5*11519*10*Enthesitis resolutionc Q4W24334*31*11*18782*63* Q8W23040*7*12*16277*62* PBO25514*13*5*18219*9*

* p < 0.001 (Chi-square)

aIn pts with ≥3% BSA psoriasis & IGA ≥2 at W0

bIn pts with D at W0

cIn pts with E at W0

Acknowledgments:

None

Disclosure of Interests:

Dennis McGonagle Grant/research support from: Janssen Research & Development, LLC, Iain McInnes Grant/research support from: Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Janssen, and UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Gilead, Janssen, Novartis, Pfizer, and UCB, Atul Deodhar Grant/research support from: AbbVie, Eli Lilly, GSK, Novartis, Pfizer, UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB, Georg Schett Speakers bureau: AbbVie, BMS, Celgene, Janssen, Eli Lilly, Novartis, Roche and UCB, Philip J Mease Grant/research support from: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – grant/research support, Consultant of: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – consultant, Speakers bureau: Abbott, Amgen, Biogen Idec, BMS, Eli Lilly, Genentech, Janssen, Pfizer, UCB – speakers bureau, May Shawi Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Shelly Kafka Employee of: Janssen Scientific Affairs, LLC, Chetan Karyekar Shareholder of: Johnson & Johnson, Consultant of: Janssen, Employee of: Janssen Global Services, LLC. Previously, Novartis, Bristol-Myers Squibb, and Abbott Labs., Alexa Kollmeier Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Elizabeth C Hsia Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Xie L Xu Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Shihong Sheng Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Prasheen Agarwal Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Bei Zhou Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Christopher T. Ritchlin Grant/research support from: UCB Pharma, AbbVie, Amgen, Consultant of: UCB Pharma, Amgen, AbbVie, Lilly, Pfizer, Novartis, Gilead, Janssen, Proton Rahman Grant/research support from: Janssen and Novartis, Consultant of: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, and Pfizer., Speakers bureau: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, Pfizer

FRI0286 IXEKIZUMAB TREATMENT IMPROVES FATIGUE, SPINAL PAIN, STIFFNESS, AND SLEEP IN PATIENTS WITH NON-RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS

Background:

Common symptoms of axial spondyloarthritis (axSpA) include fatigue, spinal pain, stiffness, and sleep problems, which can impair health-related quality of life. Ixekizumab (IXE) treatment shows efficacy in active non-radiographic axSpA (nr-axSpA).1

Objectives:

To assess fatigue, spinal pain, stiffness, and sleep with IXE treatment versus (vs) placebo (PBO) in patients (pts) with active nr-axSpA up to 16 and 52 weeks (wks).

Methods:

In COAST-X, pts with active nr-axSpA were randomized to 52 wks of double-blind IXE 80 mg once every 4 wks (Q4W) or 2 wks (Q2W), or PBO. Data were collected from baseline to Wk 52.

Results:

At Wk 16, IXE Q4W significantly improved fatigue, spinal pain, and stiffness, and IXE Q2W improved spinal pain, spinal pain at night, and stiffness vs PBO (Table). At Wk 52, IXE Q4W significantly improved stiffness, and IXE Q2W improved spinal pain, spinal pain at night, and stiffness vs PBO. Numeric improvements in sleep were not significant vs PBO. Wk 1, and up to Wk 16, IXE Q4W and Q2W significantly reduced spinal pain and stiffness vs PBO; stiffness was significantly reduced vs PBO up to Wk 52 (Figure).

Least squares mean (standard error) change from BL-ITT population (mixed-effect model of repeated measures)

MeasureTimepointPBO N=105IXE Q4W N=96IXE Q2W N=102Spinal painaWk 16-1.45 (0.244)-2.35 (0.248)*-2.59 (0.244)†Wk 52-2.29 (0.350)-2.92 (0.305)-3.32 (0.304)*Spinal pain at nightaWk 16-1.71 (0.262)-2.43 (0.267)-2.79 (0.263)*Wk 52-2.25 (0.358)-3.04 (0.312)-3.58 (0.311)*BASDAI-stiffnessb,cWk 16-1.44 (0.242)-2.44 (0.246)*-2.89 (0.242)†Wk 52-1.94 (0.332)-3.15 (0.290)*-3.48 (0.289)†Fatigue severity NRSdWk 16-1.4 (0.24)-2.1 (0.24)*-1.9 (0.24)Wk 52-2.1 (0.38)-2.6 (0.32)-2.7 (0.32)Sleep disturbanceeWk 16-2.3 (0.45)-2.0 (0.45)-2.5 (0.45)Wk 52-2.9 (0.63)-3.6 (0.52)-3.6 (0.53)Pt Global Assessment of Disease ActivityfWk 16-1.30 (0.246)-2.32 (0.251)*-2.64 (0.247)†Wk 52-1.81 (0.378)-2.77 (0.320)-3.30 (0.321)*

*P<.05 vs PBO;†P≤.001 vs PBO. ITT population: all randomized pts. Pts needing rescue treatment after Wk 16 per investigator could switch to open-label IXE Q2W; observations at visits thereafter not included in analyses. BL values similar across treatments. Numerical improvements in BASDAI-fatigue not significant vs PBO.

aScored 0 (no pain) to 10 (most severe pain) on NRS

bMean score BASDAI questions 5 (intensity) and 6 (duration)

cScored 1–10 on NRS

dScored 0 (no fatigue) to 10 (as bad as you can imagine)

eJenkins Sleep Evaluation Questionnaire scored 0 to 20: each of 4 items scored 0 (0 days) to 5 (22–30 days)

fScored 0 (not active) to 10 (very active) on NRS

BASDAI=Bath Ankylosing Spondylitis Disease Activity IndexBL=baselineITT=intent-to-treatIXE=ixekizumabN=number of pts in ITT populationNRS= numeric rating scalePBO=placebopt=patientQ2W=every 2 wksQ4W=every 4 wksvs=versuswk=week

Conclusion:

IXE Q4W and/or Q2W significantly improved spinal pain, spinal pain at night, and stiffness vs PBO at 16 and 52 wks in pts with nr-axSpA. IXE Q4W also improved fatigue at 16 wks in these pts. Numerical improvements in sleep were not significant vs PBO.

References:

[1]Deodhar A, et al. Lancet. 2019

Disclosure of Interests:

Philip J Mease Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Janssen, Eli Lilly, Novartis, Pfizer, Sun Pharma, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Janssen, Eli Lilly, Galapagos, Gilead, Novartis, Pfizer, Sun Pharma, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Genentech, Janssen, Novartis, Pfizer, UCB Pharma, Atul Deodhar Grant/research support from: AbbVie, Eli Lilly, GSK, Novartis, Pfizer, UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB, Proton Rahman Grant/research support from: Janssen and Novartis, Consultant of: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, and Pfizer., Speakers bureau: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, Pfizer, Helena Marzo-Ortega Grant/research support from: Janssen, Novartis, Consultant of: Abbvie, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, UCB, Speakers bureau: Abbvie, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, Takeda, UCB, Vibeke Strand Consultant of: AbbVie, Amgen, Biogen, Celltrion, Consortium of Rheumatology Researchers of North America, Crescendo Bioscience, Eli Lilly, Genentech/Roche, GlaxoSmithKline, Hospira, Janssen, Merck, Novartis, Pfizer, Regeneron Pharmaceuticals, Inc., Sanofi, UCB, Theresa Hunter Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, David Adams Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, David Sandoval Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Andris Kronbergs Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Baojin Zhu Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Ann Leung: None declared, Soyi Liu Leage Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Victoria Navarro-Compán Consultant of: Abbvie, Lilly, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Lilly, Novartis, Pfizer, UCB

SAT0402 EFFICACY AND SAFETY OF GUSELKUMAB, A MONOCLONAL ANTIBODY SPECIFIC TO THE P19-SUBUNIT OF INTERLEUKIN-23, THROUGH WEEK 52 OF A PHASE 3, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED STUDY CONDUCTED IN BIOLOGIC-NAÏVE PATIENTS WITH ACTIVE PSORIATIC ARTHRITIS

Background:

Guselkumab (GUS), a monoclonal antibody that specifically binds to the p19-subunit of IL-23, is approved to treat psoriasis. Through Week24 (W24) of the Ph3, double-blind, placebo (PBO)-controlled trial in biologic-naïve pts with active PsA (DISCOVER-2), GUS every 4 or 8 weeks (Q4W or Q8W) demonstrated efficacy for joint & skin symptoms and inhibition of structural damage progression (Q4W), and was well tolerated.

Objectives:

Assess GUS efficacy and safety through W52.

Methods:

Biologic-naïve adults with active PsA (≥5 swollen+≥5 tender joints; CRP ≥0.6mg/dL) were randomized (1:1:1) to GUS 100 mg Q4W; GUS 100 mg at W0, W4, Q8W; or PBO. At W24, PBO pts crossed over to GUS 100 mg Q4W (PBO X Q4W). ACR response rates at W52, based on nonresponder imputation (NRI) for missing data and as observed in pts who continued study agent at W24, are shown. Observed data for additional endpoints, including PsA-modified van der Heijde Sharp (vdH-S) scores derived from blinded radiographic images collected at W0, W24, W52 (or at d/c) and scored in a new Read Campaign, are shown.

Results:

712/739 (96.3%) randomized & treated pts continued study agent at W24; 689/739 (93.2%) completed Wk52. NRI ACR20 response rates continued to increase after W24, and at W52 were 70.6% for GUS Q4W and 74.6% for GUS Q8W (Fig 1A). Similar response patterns were observed for the more stringent ACR50/70 criteria (Fig 1C,E). Observed ACR (Fig, 1B,D,F), IGA, PASI & MDA/VLDA responses; dactylitis & enthesitis resolution; and mean improvements in HAQ-DI and SF-36 PCS/MCS scores were also sustained through W52 in pts receiving Q4W & Q8W; W52 data for PBO X Q4W pts were generally consistent with other GUS-treated pts (Fig 1, Table 1). Changes in vdH-S scores were similar for W24-52 (0.62) and W0-24 (0.46) for Q4W; less radiographic progression occurred from W24-52 v W0-24 for Q8W (0.23 v 0.73) & PBO X Q4W (0.25 v 1.00). In 731 GUS-treated pts, 4.2% had SAEs; 1.2% had serious infections; no pt died; and no pt had IBD, opportunistic infections or active TB, or anaphylactic or serum sickness-like reactions.

Table 1.

Observed Efficacy1

GUSQ4WGUSQ8WPBO X(W0-24)GUS Q4W(W24-52)Data are % unless otherwise statedW24W52W24W52W24W52Dactylitis at W0,n1161111071059593Resolution68.181.160.781.941.178.5Enthesitis at W0,n165160151148172168Resolution45.560.057.665.532.667.3≥3% BSA psoriasis, IGA ≥2 at W0,n176173172170176172IGA 0/1 + ≥2-grade decrease71.084.472.177.119.984.3PASI7581.891.980.888.823.388.4PASI9063.681.570.377.110.276.7PASI10046.661.346.554.72.855.2HAQ-DI,n234229238234237230Mean change-0.4-0.5-0.4-0.5-0.2-0.4SF-36 scores,n (mean change)234229238234237230Physical Component - PCS7.29.07.89.53.88.1Mental Component - MCS4.14.14.54.52.24.3MDA/VLDA, n234228238234238231MDA19.736.826.532.96.331.6VLDA5.112.224.6317.11.36.9

1Randomized pts still on study agent at W24;2N=229;3N=237

Conclusion:

In biologic-naïve pts with active PsA, GUS elicited sustained improvements in joint & skin symptoms; inhibition of radiographic progression & improvements in physical function, quality of life & composite indices through W52. GUS safety in PsA was similar at W241& W52 and consistent with GUS safety in psoriasis.

References:

[1]Mease P (A#L13), Arthritis Rheumatol 2019;71(suppl 10)

Acknowledgments:

None

Disclosure of Interests:

Iain McInnes Grant/research support from: Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Janssen, and UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Gilead, Janssen, Novartis, Pfizer, and UCB, Proton Rahman Grant/research support from: Janssen and Novartis, Consultant of: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, and Pfizer., Speakers bureau: Abbott, AbbVie, Amgen, BMS, Celgene, Lilly, Janssen, Novartis, Pfizer, Alice B Gottlieb Grant/research support from:: Research grants, consultation fees, or speaker honoraria for lectures from: Pfizer, AbbVie, BMS, Lilly, MSD, Novartis, Roche, Sanofi, Sandoz, Nordic, Celltrion and UCB., Consultant of:: Research grants, consultation fees, or speaker honoraria for lectures from: Pfizer, AbbVie, BMS, Lilly, MSD, Novartis, Roche, Sanofi, Sandoz, Nordic, Celltrion and UCB., Speakers bureau:: Research grants, consultation fees, or speaker honoraria for lectures from: Pfizer, AbbVie, BMS, Lilly, MSD, Novartis, Roche, Sanofi, Sandoz, Nordic, Celltrion and UCB., Elizabeth C Hsia Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Alexa Kollmeier Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Xie L Xu Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Ramanand A Subramanian Employee of: Janssen Research & Development, LLC, Prasheen Agarwal Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Shihong Sheng Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Yusang Jiang: None declared, Bei Zhou Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Désirée van der Heijde Consultant of: AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Cyxone, Daiichi, Eisai, Eli-Lilly, Galapagos, Gilead Sciences, Inc., Glaxo-Smith-Kline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, UCB Pharma; Director of Imaging Rheumatology BV, Philip J Mease Grant/research support from: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – grant/research support, Consultant of: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – consultant, Speakers bureau: Abbott, Amgen, Biogen Idec, BMS, Eli Lilly, Genentech, Janssen, Pfizer, UCB – speakers bureau