POS0967 THE IMPACT OF PSORIASIS ON THE CLINICAL CHARACTERISTICS, DISEASE BURDEN AND TREATMENT PATTERNS OF PERIPHERAL SPONDYLOARTHRITIS: AN ANCILLARY ANALYSIS OF THE ASAS-perSpA STUDY

Background

Psoriasis (PsO) is one of the common extramusculoskeletal manifestations of spondyloarthritis (SpA). There is a natural overlap between peripheral SpA (pSpA) and psoriatic arthritis. However, there are several unmet needs in patients with pSpA who cannot be classified otherwise (i.e., patients without PsO and without axial involvement) due to a lack of formally approved treatment options and lack of evidence of efficacy of different drug classes in this specific population.

Objectives

To evaluate the clinical characteristics, disease burden, and treatment patterns of pSpA patients with and without PsO using data from the cross-sectional ASAS-perSpA study.

Methods

We analysed 433 patients who had a diagnosis of pSpA according to the rheumatologist’s diagnosis from the ASAS-perSpA cohort. A personal history of PsO was defined as the presence of signs of PsO on physical examination, psoriatic nail dystrophy, including onycholysis, pitting, and hyperkeratosis, or a personal history of PsO diagnosed by a dermatologist. Clinical characteristics, patient-reported outcomes and treatment patterns were compared between subgroups with and without PsO.

Results

A total of 83 patients (19.2%) had a personal history of PsO. Patients with PsO were older (48.4 vs. 43.2 years), had a longer diagnostic delay (7.4 vs. 3.5 years), a higher frequency of dactylitis (36.1 vs. 20.0%), and enthesitis (65.1 vs. 55.4%) than patients without PsO (Table 1). A longer diagnostic delay (odds ratio – OR=1.06 [95% CI 1.01-1.11]), lower HLA-B27 positivity (OR=0.31 [95% CI 0.15-0.65]), and higher frequency of enthesitis (OR=2.39 [95% CI 1.16-4.93]) were associated with the presence of PsO in the multivariable logistic regression analysis (Figure 1). Higher patient global assessment scores and lower use of bDMARD treatments were observed in patients without PsO as compared to patients with PsO.

Table 1.

Demographics and clinical characteristics of patients with pSpA according to the presence or absence of personal history of PsO

Total N=433Patients without personal history of PsO N=350Patients with personal history of PsO N=83p-valueAge, mean (SD)44.2 (14.4)43.2 (14.2)48.4 (14.5)0.005Sex (male)203/433 (46.9)167/350 (47.7)36/83 (43.4)0.541Symptom duration of SpA (years), mean (SD)10.1 (9.5)9.0 (8.8)14.4 (10.8)<0.001Diagnostic delay of SpA (years), mean (SD)4.3 (6.6)3.5 (5.9)7.4 (8.4)<0.001First- or second-degree relatives with SpA (except psoriasis)74/433 (17.1)61/350 (17.4)13/83 (15.7)0.871First- or second-degree relatives with psoriasis63/391 (16.1)29/308 (9.4)34/83 (41.0)<0.001Patients who fulfilled peripheral ASAS critieria95/433 (21.9)74/350 (21.1)21/83 (25.3)0.461Patients who fulfilled CASPAR critieria81/433 (18.7)12/350 (3.4)69/83 (83.1)<0.001Peripheral articular disease ever410/433 (94.7)335/350 (95.7)75/83 (90.4)0.059Any enthesitis in the past confirmed by specific investigations112/433 (25.9)81/350 (23.1)31/83 (37.3)0.045Current SPARCC Enthesitis Index score, mean (SD)0.4 (1.1)0.3 (0.9)0.6 (1.6)0.013Dactylitis ever100/433 (23.1)70/350 (20.0)30/83 (36.1)0.003HLA-B27 positive197/316 (62.3)179/269 (66.5)18/47 (38.3)<0.001CRP mg/L, mean (SD)13.9 (25.4)15.2 (26.9)8.5 (16.5)0.019PGA, mean (SD)4.5 (2.7)4.7 (2.7)3.9 (2.5)0.018Local injection of glucocorticoids for peripheral musculoskeletal involvement ever183/193 (94.8)156/159 (98.1)27/34 (79.4)<0.001csDMARDs ever384/433 (88.7)310/350 (88.6)74/83 (89.2)>0.999bDMARDs ever223/433 (51.5)164/350 (46.9)59/83 (71.1)<0.001bDMARDs current160/433 (37.0)119/350 (34.0)41/83 (49.4)0.011

Categorical variables were given as n/N (%)

Figure 1.

Association of demographic and clinical characteristics of pSpA with the presence of a personal history of PsO

Conclusion

The presence of skin PsO has an impact on clinical characteristics of pSpA. pSpA patients without PsO were less frequently treated with bDMARDs despite an comparable or even higher burden of the disease.

Acknowledgements

No disclosure

Disclosure of Interests

None declared

AB0809 Assessment of the Impact of Axial Spondyloarthritis on Patient’s Social Life. Results from the European Map of Axial Spondyloarthritis (EMAS)

Background

As spinal mobility becomes progressively impaired and pain levels escalate, difficulty in performing simple physical routines places a huge burden on axial spondyloarthritis (axSpA).

Objectives

The aim is to evaluate the impact of axSpA on patients’ social life and to identify the factors associated with this.

Methods

Data from 2,846 unselected patients participating in EMAS, an online survey (2017-2018) across 13 European countries, were analysed. Impact of axSpA on social life was assessed by: “Score your relationships since you have been affected by Spondylitis / Spondyloarthritis” [Much worse to much better relationships with spouse, family, friend, and neighbours], and “Please indicate the frequency with which you do the following activities since you became affected by Spondylitis/ Spondyloarthritis?” [Much less frequent to much more frequent engagement in restaurants, cultural outings, travel, and sports]. Patients who rated at least one relationship as “worse/much worse” and at least one of social activity as “less/much less frequent” were considered to have a negatively impacted social life. BASDAI (0-10), spinal stiffness (3-12), functional limitation (0-54), and mental health via the General Health Questionnaire GHQ-12 (0-12) were assessed. Univariable and multivariable binary logistic regression were used to identify variables possibly explaining negative impact on social life (n= 2,120).

Results

Mean age was 43.8±12.3 years, 61.5% female, 49.2% had a university degree, and 68.2% married. 44.9% (n= 1,205) patients had their social life negatively impacted since the onset of axSpA.

Those experiencing a negative impact on their social life were more frequently females (49.5% vs. 37.5% males, p<0.001), divorced/separated (59.5% vs. 34.4% widowed, p<0.001), and on sick leave (temporary and permanent) or unemployed (63.9%, 60.9% and 57.0% vs. 36.8% employed, p<0.001). Furthermore, those whose social life was negatively impacted reported greater BASDAI (6.2 vs. 5.0), functional limitation (24.4 vs. 17.4), spinal stiffness (8.4 vs. 7.3), longer diagnostic delay (9.7 vs. 7.4), poorer mental health (6.7 vs. 3.6), anxiety (62.6% vs. 37.1% no anxiety), depression (61.9% vs. 38.5% no depression), or sleep disorders (55.7% vs. 37.5% no sleep disorders), all p<0.001.

The variables associated with negative impact on social life in the multivariable logistic regression were higher disease activity (OR=1.15), poor mental health (OR=1.14), being on a sick leave/unemployed (OR=1.49), divorced/separated (OR=1.46), anxiety (OR= 1.41) and female gender (OR= 1.30; Table 1).

Table 1.

Factors associated with a worsening social life (n= 2,120)

Univariable logistic analysisMultivariable logistic analysisORCI 95%ORCI 95%Age0.990.98, 0.991.000.99, 1.01Gender. Female11.631.39, 1.911.301.06, 1.60Marital status. Divorced/separated21.931.48, 2.501.461.05, 2.04Employment status. Sick Leave/Unemployed32.662.24, 3.171.491.20, 1.85BASDAI (0-10)1.411.35, 1.481.151.08, 1.22Functional Limitation (0-54)1.031.02, 1.031.021.09, 1.02Spinal Stiffness (3-12)1.201.16, 1.241.061.01, 1.11Diagnostic delay1.021.01, 1.031.010.99, 1.02GHQ-12 (0-12)1.221.19, 1.241.141.11, 1.17Anxiety2.842.39, 3.371.411.08, 1.83Depression2.592.17, 3.101.140.87, 1.49Sleep disorders2.101.79, 2.461.020.81, 1.27

1Female vs. male; 2Divorced/separated vs. single/married/widow; 3Sick leave/unemployed vs. other employment status.

Conclusion

Almost half of the axSpA patients reported to have negatively impacted their social life. Being female, divorced/separated, on sick leave/unemployed, with higher disease activity, poor mental health, and anxiety increase the likelihood of worsening social life. As relationships with others and engagement in social or community activities influence quality of life, greater attention to enabling individuals to participate socially through controlling disease activity and addressing mental health comorbidity in the management of axSpA.

Acknowledgements

This study was supported by Novartis Pharma AG. The authors would like to thank all patients who participated in the study.

Disclosure of Interests

Marco Garrido-Cumbrera Grant/research support from: has a research collaboration with and provides services to Novartis Pharma AG, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche and UCB, Christine Bundy Speakers bureau: AbbVie, Celgene, Janssen, Lilly, Novartis and Pfizer, Raj Mahapatra: None declared, Souzi Makri Grant/research support from: Novartis, GSK and Bayer, José Correa-Fernández: None declared, Laura Christen Employee of: Novartis Pharma AG, Carlos Jesús Delgado-Domínguez: None declared, Denis Poddubnyy Speakers bureau: AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche and UCB, Grant/research support from: AbbVie, MSD, Novartis and Pfizer

OP0104 EXPANDED CD8+ T CELL CLONES FROM HLA-B*27-POSITIVE PATIENTS WITH SPONDYLOARTHRITIS SHOW SIGNS OF ANTIGEN-EXPERIENCE

Background

The pathogenesis of Spondyloarthritis (SpA) remains unknown but its strong association with some alleles of HLA-B*27 is peculiar. The arthritogenic antigen hypothesis assumes the existence of specific peptides presented by risk-conferring HLA-B*27 alleles to antigen-specific CD8+ T cells, which then initiate or sustain autoimmune reactions. Several studies analyzing T cell receptor (TCR) repertoire found preferred Variable TCR chains and motifs in the hypervariable complementary determining region (CDR) 3, but analyzed only TCR β-chains in bulk analyses1,2.

Objectives

To analyze full sequence information of TCR including matching α- and β-chains from single CD8+ T cells and characterize the transcriptomes of expanded and non-expanded clonotypes in synovial fluid (SF) of SpA patients.

Methods

We included 17 patients with active gonarthritis: 10 patients with HLA-B27 positive (B27pos) SpA, 4 with HLA-B27 negative (B27neg) SpA and 3 rheumatoid arthritis (RA) patients. Antigen-experienced CD8+ T cells were sorted out of SF by flow cytometry. Single cell sequencing was performed for all patients to analyze matching TCR α- and β-chains. For 7 patients (3 B27pos SpA, 2 B27neg SpA, 2 RA), additionally whole transcriptome analyses were performed.

Results

We found strong biases when analyzing α and β chains of TCR Variable regions and CDR1 and CDR2 sequences (Figure 1 a,b): AV21, AV12-2, and AV17 were highly enriched in B27pos SpA as compared to B27neg subjects. Amongst the highest expressed clones, we could confirm enrichment for previously described TRBV genes as BV19, BV5-1 and BV6-2. We examined TCR α/β combinations and focused on those detected in at least three different B27pos SpA but not in any of the B27neg patients (Figure 1 c-f). The combinations TRBV19/TRAV21 and TRBV6-2/TRAV21 were most likely specific for B27pos SpA and might reflect interaction of these TCR chains with HLA-B*27. Sequences of CDR3 loops, which predominantly interact with HLA-bound antigenic peptides, revealed striking common structural motifs in α- and β-chains. Focusing on the most prominent TRAV21 chains pairing with TRBV19, 5-1 and 6-2 chains, revealed identical sequences in different patients and striking common structural motifs in α- and β-CDR3 sequences in other patients. Such marked similarities in the antigen-recognition loops of the β-chains associated with TRAV21 suggest common or highly similar antigens. Gene expression levels provided evidence that expanded cell populations had tissue resident memory (TRM) phenotypes (elevated expression of activation, migration and tissue retention markers, downregulated genes characteristic for T cell egress), while this phenotype was not very pronounced in non-expanded cells. Furthermore, markers for T cell exhaustion and apoptosis were elevated in expanded cells of B27pos SpA patients.

Figure 1.

Distinct TCRαβ V chain usage in expanded clones from HLA-B27 positive SpA patients. A,B Mean number of all productive TRAV (A) and TRBV (B) genes used in expanded, antigen-experienced CD8 T cell clones (>1% of all cells) from SF of 10 B27pos SpA, 4 B27neg SpA and 3 B27neg RA patients. C-F TRAV chains paired with TRBV19 (C), TRBV5-1 (D), TRBV6-2 (E), or TRBV chains paired with TRAV21 (F) with corresponding TRAJ spanning partners in expanded cells (frequency ≥2) from all 10 B27pos SpA. Number of chains are 1250 (C), 886 (D), 1220 (E), and 4006 (F).

Conclusion

Analysis of single antigen experienced CD8+ T cells from SF of B27pos SpA patients revealed significant clonal expansions and common motifs in the CDR loops. Two of the four CDR1 and CDR2 loops were highly homologous suggesting that these loops interact with α-helices of HLA-B*27. Common motifs in CDR3 loops of expanded clonotypes suggest recognition of a limited set of antigenic peptides presented by HLA-B*27. Many of the expanded clonotypes showed a TRM phenotype, were exhausted and on the way to become apoptotic, which suggests that these clones had sustained contact to specific antigens.

References

[1]Komech, et al. Rheumatology 2018

[2]Hanson, et al. A&R 2020

Acknowledgements

We thank all patients included in this study for their participation. This work was funded by the German Research Foundation (DFG) through grants DO 420/4 to KDo, PO 2124/2-1 to DP, and SyNergy (EXC 2145 SyNergy – ID 390857198) to KDo. Judith Rademacher and Katharina Deschler contributed equally. JR is participant in the BIH-Charité Clinician Scientist Program funded by the Charité –Universitätsmedizin Berlin and the Berlin Institute of Health. The authors would like to thank Martina Seipel for excellent technical assistance, Sabrina Sron for patient recruitment and study coordination, and Hildrun Haibel, Mikhail Protopopov, Fabian Proft, Valeria Rios Rodriguez and Laura Spiller for recruiting patients for this study.

Disclosure of Interests

None declared

OP0026 CLINICAL AND IMAGING-BASED CHARACTERIZATION OF A PROSPECTIVE COHORT OF PATIENTS WITH AXIAL PSORIATIC ARTHRITIS (AXIAL PsA). GESPIC-AXIAL PsA: RESULTS OF AN INTERIM ANALYSIS

Background

Psoriatic arthritis (PsA) is a chronic inflammatory disease, which is subsumed together with axial spondyloarthritis (axial SpA) under the umbrella term spondyloarthritis, whose clinical presentations are very heterogeneous. Axial involvement (axial PsA) has been described to be present in 34% of PsA patients [1] and has been systematically investigated only retrospectively or in cross-sectional studies [2]. Although axial PsA seems to have similar characteristics to axial SpA, it is not clear whether axial PsA and axial SpA, are a spectrum of the same disease with different expression patterns or different diseases with great similarities.

Objectives

To prospectively investigate the clinical and imaging morphology patterns in a well-defined cohort of patients with axial PsA from the German SPondyloarthritis Inception Cohort (GESPIC).

Methods

Prospective, longitudinal, observational study of patients with an imaging confirmed diagnosis of axial PsA. In addition to clinical and laboratory characterization, conventional radiographs and magnetic resonance imaging (MRI) - scans of the entire spine and sacroiliac joints (SIJs) are performed at the baseline visit and patients are followed up every 6 months according to a predefined protocol. After 2 years, additional imaging (X-ray and MRI) is performed for follow-up. In this interim analysis baseline data are presented.

Results

Between August 2019 and December 2021, 85 axial PsA patients were included. The mean age was 45.2 ± 12.9 years with a proportion of 55.3% female patients. Peripheral involvement was present in 43 (50.6%) patients, HLA-B27 was positive in 39 (45.9%), and C-reactive protein was elevated (>5mg/l) in 27 (31.8%) patients. Inflammatory back pain (IBP) in the discretion of the treating rheumatologist was present in 64 (75.3%) patients (Table 1). The modified New York criteria were fulfilled in 44.9% (n=35). MRI of the SIJ showed active inflammatory changes in 44 (55%) and structural changes in 59 (73.8%) patients. MRI of the spine showed active inflammation in 60% (n=48). Exclusively active and/or structural changes of the spine without changes in the SIJ were seen in 18.8% (n=15) (Figure 1).

Table 1.

Characteristics of patients with axial PsA

ParametersAxial PsA (n=85)Age in years (mean ± SD)45.2 ± 12.9Female sex, n (%)47 (55.3%)Inflammatory back pain (IBP) present, n (%)64 (75.3%)Peripheral Involvement, n (%)43 (50.6%)Nail Involvement, n (%)39 (45.9%)PASI-Score (mean ± SD)3.3 ± 5.1BASDAI (mean ± SD), 0-104.9 ± 2.0BASFI (mean ± SD), 0-103.8 ± 2.5ASDAS-CRP (mean ± SD)2.8 ± 1.0DAPSA (mean ± SD)14.5 ± 9.2HLA-B 27 positive, n (%)39 (45.9%)CRP >5mg/l, n (%)27 (31.8%)

ASDAS-CRP =Ankylosing Spondylitis Disease Activity Score - CRP, BASDAI = Bath Ankylosing Spondylitis Disease Activity Index, BASFI =Bath Ankylosing Spondylitis Functional Index, CRP = C-reactive protein, DAPSA = Disease Activity in PSoriatic Arthritis-Score, PASI = Psoriasis Area Severity Index, PsA = Psoriatic arthritis, SD = standard deviation.

Figure 1.

MRI-imaging patterns of axial PsA patients (n=80*). MRI= magnetic resonance imaging, SIJs= sacroiliac joints. *Full imaging data available for 80 patients only due to variable reasons.

Conclusion

In the here presented interims analysis of the baseline data of our prospective cohort study of patients with an imaging-based diagnosis of axial PsA, it is shown that these patients are less frequently HLA-B27 positive and more frequently female when compared to previously described cohorts of “classical” axial SpA patients. Noteworthy, nearly 20% of the patients showed an isolated spinal involvement without active or structural changes in the SIJs.

References

[1]Gladman, D.D., et al., Psoriatic arthritis (PSA)--an analysis of 220 patients. Q J Med, 1987. 62(238): p. 127-41.

[2]Feld, J., et al., Axial disease in psoriatic arthritis and ankylosing spondylitis: a critical comparison. Nat Rev Rheumatol, 2018. 14(6): p. 363-371.

Acknowledgements

The GESPIC-axial PsA cohort is partially supported by an independent research grant from Novartis.

We would especially like to thank C. Höppner, C. Lorenz, and all referring rheumatologists for their tireless support.

Disclosure of Interests

Henriette Käding: None declared, Susanne Lüders: None declared, Mikhail Protopopov: None declared, Judith Rademacher: None declared, Valeria Rios Rodriguez: None declared, Laura Spiller: None declared, Murat Torgutalp: None declared, Denis Poddubnyy: None declared, Fabian Proft Speakers bureau: AMGEN, AbbVie, BMS, Celgene, Janssen, MSD, Novartis, Pfizer, Roche, UCB.

Consultant of: AbbVie, Celgene, Janssen, Novartis, UCB.

Grant/research support from: Novartis, Lilly, UCB.

POS1078 COMPARISON OF PATIENTS WITH AXIAL PsA AND PATIENTS WITH axSpA AND CONCOMITANT PSORIASIS

Background

Psoriatic arthritis (PsA) is a chronic inflammatory disease affecting the peripheral and axial musculoskeletal system as well as skin and nails. Diagnostic criteria of axial PsA (axPsA) are not well defined. Treatment strategy is mostly based on evidence generated for axial spondyloarthritis (axSpA), as only rare clinical trial data for axPsA exist. However, it is still unclear whether axSpA with concomitant psoriasis (axSpA/pso) is the same as axPsA.

Objectives

To compare PsA patients with axial manifestations with axSpA patients with concomitant psoriasis.

Methods

RABBIT-SpA is a prospective longitudinal cohort study including PsA and axSpA patients enrolled at start of a new conventional treatment or b/tsDMARD treatment. Two definitions of axPsA were used:

Clinical definition: documentation of axial manifestation as diagnosed by a rheumatologist

Radiographic definition: presence of sacroiliitis according to modified NY criteria (mNYc).

axSpA patients were stratified into axPsA/pso (with psoriasis either in patient history or present) and axSpA.

Results

Psoriasis was documented in 182/1407 axSpA patients (13%). Of 1355 PsA patients, 295 (22%) fulfilled the clinical definition of axPsA. Using the radiographic definition, 127 (9%) PsA patients fulfilled mNYc, 230 (17%) did not fulfil mNYc and 998 (74%) did not undergo radiographic evaluation.

AxSpA/pso patients differed from axPsA regardless of the definition (Table 1). axPsA patients were older, less often HLA-B27 positive, and peripheral manifestations were much more often present in axPsA than in axSpA/pso. Uveitis and inflammatory bowel disease were more common in axSpA/pso.

Table 1.

Baseline characteristics of axSpA/pso patients and clinical resp. radiographic defined axPsA.

axSpA/psoaxPsA/clinaxPsA/radN182295127female gender, n (%)80 (44)178 (60.3)80 (63)age, mean (SD)47 (12.8)51.1 (11.3)51.6 (11.4)HLA-B27 positive, n (%)106 (67.1)44 (22.7)28 (32.9)CRP mg/l, mean (SD)8.7 (14.6)7.1 (11.8)6.9 (11.5)CRP ≥5 mg/l, n (%)70 (42.4)106 (40)50 (45.9)uveitis ever, n (%)26 (14.3)10 (3.4)7 (5.5)IBD ever, n (%)13 (7.1)14 (4.7)7 (5.5)≥3 comorbidities, n (%)48 (26.4)117 (39.7)48 (37.8)peripheral manifestations, n (%)65 (36.3)251 (85.1)109 (85.8)enthesitis, n (%)29 (16.2)77 (26.4)32 (25.4)number of sites with enthesitis, mean (SD)0.5 (1.6)0.9 (2.2)0.9 (1.9)affected joints, n (%)53 (29.6)234 (80.1)102 (80.3)number of affected joints, mean (SD)1.4 (3.7)6.8 (8.4)5 (5.9)physician global disease activity, mean (SD)5.6 (2.1)5.6 (1.9)5.6 (2)patient global disease activity, mean (SD)5.4 (2.6)5.9 (2.3)5.8 (2.2)patient pain, mean (SD)5.5 (2.6)5.7 (2.3)5.7 (2.2)sakroiliitis, n (%)124 (84.4)97 (56.1)127 (100)clinical axial definition, n (%)n.d.295 (100)97 (76.4)

In contrast, disease activity measured by physician global as well as patient global, and patient pain were similar in axSpA/pso and axPsA.

Conclusion

Regardless whether clinical or radiographic definitions of axPsA were used, differences to axSpA/pso patients were identified. These data indicate a need for a specific diagnostic, and a potentially more targeted treatment approach for axPsA.

Disclosure of Interests

Anne Regierer Grant/research support from: RABBIT-SpA is supported by a joint, unconditional grant from AbbVie, Amgen, Biogen, Hexal, Janssen-Cilag, Lilly, MSD, Novartis, Pfizer, UCB and Viatris., Anja Weiß Grant/research support from: RABBIT-SpA is supported by a joint, unconditional grant from AbbVie, Amgen, Biogen, Hexal, Janssen-Cilag, Lilly, MSD, Novartis, Pfizer, UCB and Viatris., Xenofon Baraliakos: None declared, Frank Behrens: None declared, Denis Poddubnyy: None declared, Georg Schett: None declared, Hanns-Martin Lorenz: None declared, Matthias Worsch: None declared, Anja Strangfeld Grant/research support from: RABBIT-SpA is supported by a joint, unconditional grant from AbbVie, Amgen, Biogen, Hexal, Janssen-Cilag, Lilly, MSD, Novartis, Pfizer, UCB and Viatris.

POS0299 EFFECT OF SECUKINUMAB ON RADIOGRAPHIC PROGRESSION AND INFLAMMATION IN SACROILIAC JOINTS AND SPINE IN PATIENTS WITH NON-RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS: 2-YEAR IMAGING OUTCOMES FROM A PHASE III RANDOMISED TRIAL

Background

Axial spondyloarthritis (axSpA) is characterised by inflammation of the sacroiliac joints (SIJ) and the spine. Secukinumab (SEC) treatment was clinically efficacious and reduced SIJ bone marrow oedema as detected by magnetic resonance imaging (MRI) in patients (pts) with non-radiographic (nr)-axSpA through 52 weeks in the PREVENT (NCT02696031) study.1

Objectives

To report radiographic progression and the course of inflammation as assessed by X-ray and MRI of SIJ and spine over 2 years in the PREVENT study.

Methods

Study design and key endpoints have been reported earlier.1 In total, 555 pts were randomised (1:1:1) to receive SEC 150 mg, with (LD) or without loading (NL) doses, or placebo (PBO). Switch to open-label (OL) SEC or standard of care (SoC) was permitted after Week (Wk) 20. All pts (except those who switched to SoC) received OL SEC from Wk 52. Radiographs of the spine and SIJ were collected at baseline (BL) and Wk 104; MR images of the spine and SIJ were collected at BL, Wk 16, 52, and 104. Spinal radiographs were scored using the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) and SIJ radiographs according to modified New York criteria (mNYC). Pts whose screening SI joint radiographs fulfilled mNY criteria during the eligibility reading session were excluded from the study. Spinal MR images were assessed for signs of inflammation with the Berlin score. SIJ bone marrow oedema was assessed according to the Berlin Active Inflammatory Lesions Scoring. All images were evaluated in blinded fashion independently by 2 central readers. All data are reported from the Wk 104 reading session and are presented as observed.

Results

The vast majority (98%) of pts treated with SEC 150 mg (pooled LD and NL) showed no structural progression, defined as change in total mSASSS score ≤ smallest detectable change (SDC) of 0.76 (80% agreement level) over 2 years. At BL, 62 pts (43 in SEC, 19 in PBO) presented with ≥1 syndesmophyte (≥1 vertebral unit scored by ≥1 reader). Among these pts, 9 in SEC (20.9%) and 7 in PBO (36.8%) groups had developed ≥1 new syndesmophyte by Wk 104. Among 237 SEC and 117 PBO pts without syndesmophytes at BL, only 4 pts on SEC (1.7%) and 4 pts on PBO (3.4%) developed ≥1 new syndesmophyte by Wk 104. SIJ radiographs showed that 88% of pts on SEC and 86% on PBO had no progression in SIJ (defined as change ≤ SDC (0.46) in total mNYC score) by Wk 104. No patient had an increase in total mNYC score of 2 or more. When screening radiographs of eligible pts were scored alongside post-BL images in the final reading campaign, approximately 25% of pts (68/277 and 34/139 pts in the SEC and PBO groups, respectively) were evaluated as mNY-positive at screening (pts were considered mNY-positive if ≥1 reader evaluated them as mNY-positive). Of these, 11/68 pts in the SEC (16.2%) and 5/34 in the PBO (14.7%) groups were evaluated as mNY-negative at Wk 104. In the SEC and PBO groups, 202 (96.7%) and 102 (97.1%) pts who were mNY-negative at screening stayed negative through Wk 104, respectively. Only 7 pts in the SEC (3.3%) and 3 in the PBO (2.9%) groups who were mNY-negative at BL were scored as mNY-positive at Wk 104. In both groups, fewer pts progressed from mNY-negative to mNY-positive than had a change in the opposite direction (from positive to negative), resulting in an overall negative net progression. Spinal inflammation on MRI (Berlin score) was low at BL with a mean of 0.82 in SEC and 1.07 in PBO groups with no meaningful change up to Wk 104 (mean of 0.56, SEC). SEC reduced SIJ bone marrow oedema score versus PBO at Wk 16 and Wk 52 with sustained reduction through Wk 104 in the overall patient population, with greater reduction in pts with BL score >2 (Figure 1).

Conclusion

Most pts initially randomised to SEC or PBO showed no radiographic progression through 2 years. There was some discrepancy between SIJ eligibility and efficacy reads. SEC reduced SIJ inflammation (bone marrow oedema) on MRI in pts with active nr-axSpA.

References

[1]Deodhar A, et al. Arthritis Rheumatol. 2021;73:110–20.

Disclosure of Interests

Juergen Braun Speakers bureau: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, Medac, MSD (Schering-Plough), Novartis, Pfizer (Wyeth), Roche, Sanofi-Aventis, UCB pharma, Eli Lilly, Consultant of: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, Medac, MSD (Schering-Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi-Aventis, UCB, Eli Lilly, Grant/research support from: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, Medac, MSD (Schering-Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi-Aventis, UCB, Eli Lilly, Ricardo Blanco Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, UCB pharma, MSD, Eli Lilly, Consultant of: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, UCB pharma, MSD, Grant/research support from: AbbVie, MSD, Roche, Helena Marzo-Ortega Speakers bureau: AbbVie, Celgene, Janssen, Eli Lilly and Company, Novartis, Pfizer, Takeda, UCB, Consultant of: AbbVie, Celgene, Janssen, Eli Lilly and Company, Novartis, Pfizer, Takeda, UCB, Grant/research support from: Janssen, Novartis, UCB, Lianne S. Gensler Consultant of: Gilead, Eli Lilly, Janssen, Novartis, Pfizer, UCB, Grant/research support from: UCB, Pfizer, Filip van den Bosch Speakers bureau: AbbVie, BMS, Celgene, Galapagos, Janssen, Eli Lilly, Merck, Novartis, Pfizer, UCB, Consultant of: AbbVie, BMS, Celgene, Galapagos, Janssen, Eli Lilly, Merck, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, BMS, Celgene, Galapagos, Janssen, Eli Lilly, Merck, Novartis, Pfizer, UCB, Stephen Hall Speakers bureau: Novartis, Merck, Janssen, Pfizer, Eli Lilly, UCB, Consultant of: Novartis, Merck, Janssen, Pfizer, Eli Lilly, UCB, Grant/research support from: AbbVie, UCB, Janssen, Merck, Hideto Kameda Speakers bureau: Abbvie, Asahi-Kasei, Astellas, BMS, Chugai, Eisai, Eli Lilly, Gilead Sciences, Janssen, Mitsubishi-Tanabe, Novartis, Pfizer, Consultant of: Abbvie, Astellas, Boehringer, Eli Lilly, Gilead Sciences, Janssen, Novartis, Sanofi, UCB, Grant/research support from: Abbvie, Asahi-Kasei, Boehringer, Chugai, Eisai, Mitsubishi-Tanabe, Denis Poddubnyy Speakers bureau: AbbVie, BMS, Lilly, MSD, Novartis, Pfizer, UCB, Consultant of: AbbVie, Biocad, BMS, Eli Lilly, Gilead, MSD, Novartis, Pfizer, Samsung Bioepis, UCB, Grant/research support from: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, Marleen G.H. van de Sande Speakers bureau: Novartis, MSD, Consultant of: Abbvie, Novartis, Eli Lily, Grant/research support from: Novartis, Eli Lilly, Janssen, UCB, Désirée van der Heijde Paid instructor for: Novartis, AbbVie, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Lilly, Pfizer, UCB Pharma, and Director of Imaging Rheumatology BV, Tingting Zhuang Shareholder of: Novartis, Employee of: Novartis, Anna Stefanska Shareholder of: Novartis, Employee of: Novartis, Aimee Readie Shareholder of: Novartis, Employee of: Novartis, Hanno Richards Shareholder of: Novartis, Employee of: Novartis, Atul Deodhar Speakers bureau: AbbVie, Boehringer Ingelheim, Eli Lilly, Janssen, Novartis, Pfizer, UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Eli Lilly, GSK, Novartis, Pfizer, UCB

AB0826 Keep an Eye on the Back: Spondyloarthritis in Patients with Acute Anterior Uveitis

Background

Patients with acute anterior uveitis (AAU) have an increased risk for concomitant spondyloarthritis (SpA). Different referral strategies have been proposed to identify AAU patients with high probability of SpA, among them an Assessment of SpondyloArthritis international Society(ASAS)-based referral strategy focusing on patients with chronic back pain starting before the age of 45 years and the Dublin Uveitis Evaluation Tool (DUET) also including psoriasis, HLA-B27 and arthralgia (Poddubnyy et al., Haroon et al., both ARD 2015).

Objectives

To analyse the prevalence of SpA in patients with AAU, to identify parameters associated with SpA presence, and to evaluate referral algorithms.

Methods

Patients with non-infectious AAU underwent structured rheumatologic assessment including magnetic resonance imaging of sacroiliac joints allowing a definitive diagnosis/exclusion of concomitant SpA. Fisher’s exact test and Mann–Whitney U test were used to compare AAU patients with and without SpA. Furthermore, logistic regression analyses were performed. Sensitivity, specificity, positive predictive value, positive and negative likelihood ratios were analysed for referral strategies.

Results

The 189 AAU patients with complete rheumatologic assessment and SIJ imaging were 40.8 years old, and 55% were males. SpA was diagnosed in 106 AAU patients (56%). The majority (93%) had predominantly axial SpA, 7 patients peripheral SpA. In 74 patients (70%), the SpA diagnosis was established for the first time. Pelvic X-rays were available for 88 (89%) of the axSpA patients, 66% of whom were classified as having radiographic axSpA.

SpA was equally frequent in patients experiencing the first episode of AAU and in patients with recurrent disease. In our cohort, AAU patients with and without underlying SpA showed no differences in their ophthalmologic examination. In multivariable logistic regression analysis, psoriasis (OR 12.5 [95%CI 1.3-120.2]), HLA-B27 positivity (OR 6.3 [95%CI 2.4-16.4]), elevated CRP (OR 4.8 [95%CI 1.9-12.4]) and male sex (OR 2.1 [95%CI 1.1-4.2]) were associated with SpA presence.

Table 1.

Parameters associated with the presence of spondyloarthritis in patients with acute anterior uveitis.

univariablemultivariableOR95%CIOR95%CIPsoriasis (ever)14.6(1.9; 112.4)12.5(1.3; 120.2)HLA-B27 positivity6.2(2.7; 14.6)6.3(2.4; 16.4)Elevated CRP (≥ 5 mg/l)4.1(1.8; 9.0)4.8(1.9; 12.4)Male sex2.2(1.2; 4.0)2.1(1.1; 4.2)Inflammatory back pain (ASAS definition)2.1(1.2; 3.9)1.9(0.9; 4.0)Any peripheral manifestation (ever)1.9(1.1; 3.5)1.9(0.9; 3.8)Age in years1.0(1.0; 1.0)1.0(1.0; 1.0)

Univariable and multivariable logistic regression analyses. ASAS Assessment of SpondyloArthritis international Society; CRP C-reactive protein; OR odds ratio; CI confidence interval.

The Dublin Uveitis Evaluation Tool showed higher specificity for SpA recognition than the ASAS referral tool (42% vs. 28%), which had slightly higher sensitivity (78% vs. 80%). However, both referral strategies would have missed more than 20% of SpA patients.

Conclusion

We revealed a high prevalence of overall and previously undiagnosed SpA in AAU patients. Therefore, we propose rheumatologic evaluation for all AAU patients with musculoskeletal symptoms. Rheumatologists should consider that SpA in AAU patients might present “atypically” with back pain starting after 45 years and lasting shorter than 3 months.

Figure 1.

Performance of Referral Strategies in Patients with Acute Anterior Uveitis. Dublin Uveitis Evaluation Tool (DUET) and an ASAS-based referral tool (ASAS). + respective tool fulfilled, - not fulfilled. ASAS Assessment of SpondyloArthritis international Society; AxSpA axial spondyloarthritis, pSpA peripheral spondyloarthritis.

Acknowledgements

The authors would like to thank the rheumatologists S. Lüders, B. Muche and A.-K. Weber for participating in the clinical data acquisition; and A. Langdon and L. Meinke for their support monitoring and coordinating this study. Furthermore, we are grateful to all participating ophthalmologists who included their patients in this study and to all patients. The study was supported by an unrestricted research grant from AbbVie. AbbVie had no role in the study design or in the collection, analysis, or interpretation of the data, the writing of the manuscript, or the decision to submit the manuscript for publication. Dr. Judith Rademacher and Dr. Dominika Pohlmann are participants in the BIH-Charité Clinician Scientist Program funded by the Charité –Universitätsmedizin Berlin and the Berlin Institute of Health.

Disclosure of Interests

Judith Rademacher: None declared, Hanna Müllner: None declared, Torsten Diekhoff Speakers bureau: AbbVie, MSD, Novartis, Canon MS, Consultant of: Lilly, Hildrun Haibel Speakers bureau: AbbVie, MSD, Janssen, Roche, Pfizer, Sobi, Consultant of: Janssen, Sobi, Novartis, Sabrina Igel: None declared, Dominika Pohlmann Speakers bureau: Bayer, Consultant of: AbbVie, Celgene, Janssen, Novartis, UCB, Grant/research support from: Bayer, Allergan, Fabian Proft Speakers bureau: AMGEN, AbbVie, BMS, Celgene, Janssen, MSD, Novartis, Pfizer, Roche, UCB, Consultant of: AbbVie, Celgene, Janssen, Novartis, UCB, Grant/research support from: UCB, Novartis, Lilly, Mikhail Protopopov Consultant of: Novartis, Valeria Rios Rodriguez Consultant of: AbbVie, Falk e.V., Murat Torgutalp: None declared, Uwe Pleyer Shareholder of: stock or stock options from Novartis, BionTec, Speakers bureau: AbbVie, Alimera, Novartis, Grant/research support from: AbbVie, Denis Poddubnyy Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer and UCB, Consultant of: AbbVie, Biorad, Eli Lilly, Gilead, GlaxoSmithKline, Janssen, MSD, Novartis, Pfizer, Samsung Bioepis and UCB, Grant/research support from: AbbVie, Eli Lilly, MSD, Novartis, Pfizer

POS0302 TREATING SPONDYLOARTHRITIS EARLY: DOES IT MATTER? RESULTS FROM A SYSTEMATIC LITERATURE REVIEW

Background

So far, no consensus has been reached on a definition of early SpA. The ASAS-SPEAR (SPondyloarthritis EARly definition) project aims to develop a consensual definition. Therefore, it is important to know whether treatment earlier in the disease course compared to treatment of established disease leads to better outcomes in axSpA.

Objectives

To summarize the evidence on the relationship between symptom duration or the presence of radiographic damage and clinical response in patients with axSpA treated with NSAIDs, bDMARDs or tsDMARDs.

Methods

A SLR was conducted using Medline, EMBASE and the Cochrane Library (April 28, 2021), supplemented by hand-searches in the FDA website. Randomized controlled trials (RCTs) and cohort studies in patients with axSpA addressing the impact of symptom duration or disease duration and presence of radiographic damage on treatment response (to NSAIDs, b/tsDMARDs) were included. Based on a cut-off of symptom/disease duration or the absence/presence of radiographic damage, groups of ‘early’ and ‘established’ disease were compared. Treatment outcomes were measures of disease activity, function or quality of life.

Two reviewers independently identified eligible studies and extracted the data, including the risk of bias (RoB) assessment. For categorical outcomes we calculated relative risk (RR), relative risk ratio (RRR) and number needed to treat (NNT), and differences in differences (DID) for continuous outcomes.

Results

From the 8769 articles retrieved, 23 were included and 3 added by hand-search, most of them with low RoB. Nineteen studies (9 RCTs) compared groups based on symptom (n=6)/disease duration (n=13) and 7 studies (4 RCTs) based comparisons on absence/presence of radiographic damage in posthoc analyses.

When early axSpA was defined by symptom duration in RCTs (n=4), in patients with nr-axSpA, early treatment was associated with higher RR and RRR and lower NNT for ASAS40 in two studies (Table 1); a third study showed that patients achieving ASDAS-ID and ASAS-PR had shorter symptom duration than those not achieving this. Lastly, in one study including patients with axSpA patients, no difference in treatment response was observed based on symptom duration. In most of the cohort studies using a definition based on symptom/disease duration (n=10), no association was found between symptom/disease duration and treatment response (n=8). Only in one cohort study, disease duration was a significant predictor of quality of life, and in another cohort study, it was a predictor of functional improvement.

Table 1.

Assessment of treatment response in RCTs based on symptom duration

StudyPopulationEarly vs established (years)RR (early vs established)RRR (95%IC)NNTs (early vs established)ASAS20Landewé 2014axSpA<5 vs ≥51.5 vs 1.50.96 (0.53-1.73)5.5 vs 4.8ASAS40Sieper 2012nr-axSpA<5 vs ≥58.2 vs 1.65.24 (1.12-24.41)2.4 vs 9.1Kay 2019nr-axSpA<5 vs ≥55.0 vs 3.31.52 (0.60-3.87)2.1 vs 3.93.6 vs 3.51.01 (0.46-2.20)2.1 vs 2.9ASDAS-MIKay 2019nr-axSpA<5 vs ≥55.1 vs 6.50.78 (0.19-3.16)2.7 vs 4.97.1 vs 6.41.11 (0.34-3.66)2.1 vs 3.0StudyPopulationSymptom durationp valueRespondersNon respondersASDAS-IDSieper 2019nr-axSpA6.1±6.28.3±8.1<0.001ASAS-PRSieper 2019nr-axSpA5.3±5.78.0±7.8<0.001Cell coloursIn favor of early diseaseIn favor of establish diseaseNon significant

When early axSpA was defined based on disease duration or the presence of radiographic damage, there was no significant difference in response to treatment between early and established axSpA.

Conclusion

Studies addressing treatment response based on symptom duration or radiographic damage in axSpA are scarce.

When defining early axSpA based on symptom duration, in nr-axSpA, treatment with bDMARDs may lead to better outcomes compared to established axSpA whereas in axSpA there is no difference in response to treatment between early and established disease.

When early axSpA is defined based on disease duration or radiographic damage, no differences in response to treatment are found between early and established disease.

Acknowledgements

The Assessment of Spondyloarthritis international Society (ASAS) supported Diego Benavent financially for this work.

Disclosure of Interests

Dafne Capelusnik Speakers bureau: Bristol Myers Squibb, Pfizer, Grant/research support from: Pfizer, Diego Benavent Speakers bureau: Janssen, Roche, Grant/research support from: Novartis, Désirée van der Heijde Consultant of: AbbVie, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Lilly, Novartis, Pfizer, UCB Pharma

Director of Imaging Rheumatology bv., Robert Landewé Consultant of: AbbVie, BMS, Galapagos, Gilead, GSK, Janssen, Lilly, Novartis, Pfizer, UCB, Denis Poddubnyy Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Biocad, Eli Lilly, Gilead, GlaxoSmithKline, Janssen, MSD, Novartis, Pfizer, Samsung Bioepis, and UCB, Grant/research support from: AbbVie, Eli Lilly, MSD, Novartis, and Pfizer, Astrid van Tubergen Consultant of: Novartis, Galapagos, Grant/research support from: Pfizer, UCB, Novartis, Louise Falzon: None declared, Victoria Navarro-Compán Speakers bureau: AbbVie, Eli Lilly, Janssen, MSD, Novartis, Pfizer, UCB Pharma, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB Pharma, Grant/research support from: AbbVie, Novartis, Sofia Ramiro Speakers bureau: Eli Lilly, MSD, Novartis, UCB, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB, Sanofi, Grant/research support from: AbbVie, Galapagos, Novartis, Pfizer, UCB

POS0149 WHAT IS BACKFILL? - DETAILED CT / MRI ANALYSIS OF NEW BONE FORMATION IN AXIAL SPONDYLOARTHRITIS

Background

Several magnetic resonance imaging (MRI) findings of the sacroiliac joint space in axial spondyloarthritis (axSpA) were previously described such as inflammation or fatty metaplasia inside an erosion, i.e. “backfill”. However, it is incompletely understood if one or all of these changes represent calcified bone matrix.

Objectives

This study aims to one-by-one link the aforementioned changes to computed tomography (CT) measurements and to understand, which of those findings represents new bone formation.

Methods

Out of 178 patients from two prospective studies that included CT and MRI of the sacroiliac joints all patients with the final diagnosis of axSpA were selected. MRI was screened by two senior musculoskeletal radiologists in consensus for joint-space related MRI findings and grouped into three categories, Type A: hyperintense in STIR and hypointense in T1 (inflammation inside erosion), Type B: hyperintense in both sequences and Type C: hypointense in STIR and hyperintense in T1 (backfill). By using image fusion techniques and one-by-one comparison, the Hounsfiled Units (HU) of those lesions as well as normal cartilage and spongeous and cortical bone were measured in CT.

Results

Ninety-nine patients with axSpA were identified and 48 Type A, 88 Type B and 84 Type C lesions were assessed. Please see Figure 1 for CT measurements. The HU values of cartilage were 73.6±15.0, spongious bone 188.0±69.9, cortical bone 1086.0±100.3, Type A 341.2±96.7, Type B 359.3±153.5 and Type C 446.8±123.0, respectively. The lesion values were significantly higher than cartilage and spongious bone but lower than cortical bone (p<0.001). Type A and B showed similar HU (p=0.93), whereas Type C lesions where denser (p<0.001).

Figure 1.

CT-Measurements of cartilage, bone and lesions.

Conclusion

All joint space lesions (Type A to C) show calcified matrix and, thus, resemble new bone formation with gradually more calcified matrix in Type C lesions, i.e. typical backfill. Therefore, the nomenclature of those lesions should be critically re-assessed.

Disclosure of Interests

None declared

AB0759 Efficacy of secukinumab in patients with non-radiographic axial spondyloarthritis: analysis by symptom duration and age

Background

Patients (pts) with axial spondyloarthritis (axSpA) often experience delayed diagnosis, which can lead to treatment delay1. However, earlier diagnosis and treatment of axSpA pts can lead to a greater clinical response2. Secukinumab (SEC) 150 mg has demonstrated sustained improvement in signs and symptoms over 2 years in non-radiographic (nr)-axSpA pts3.

Objectives

To assess the efficacy of SEC in pts with nr-axSpA [tumour necrosis factor (TNF) naïve] by subgroups of younger versus (vs) older pts and early vs late symptom duration of back pain.

Methods

PREVENT (NCT02696031) is a phase 3, randomised study in pts with nr-axSpA and detailed study design is reported previously4. In this post hoc analysis, efficacy outcomes including Assessment of SpondyloArthritis international Society 40 (ASAS40), ASAS partial remission (ASAS PR), Ankylosing Spondylitis Disease Activity Score-C-reactive protein (ASDAS-CRP) inactive disease (ID) and low disease activity (LDA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and the proportion of pts meeting the minimal clinically important difference criteria for total back pain (improvement of ≥50%) were assessed in the TNF naïve population. Age categories included 4 approximately equally distributed age groups (18 to 33, 34 to 42, 43 to 51 and ≥52 years). The categories for time since onset of back pain as a surrogate of disease symptoms and sign, was based on patients’ distribution and the hypothesis that patients with shorter disease duration will present better results (≤2, >2 to 5, >5 to 10 and >10 years). Missing responses were imputed as non-response up to Week (Wk) 16 and reported as observed at Wks 52 and 104. Data is presented here for categories 18-33 vs ≥52 years and patients with symptom duration ≤2 vs >10 years.

Results

At Wk 104, greater improvements in ASAS40 scores were reported in younger (18-33 years) vs older age categories (>52 years) treated with SEC and also in patients with shorter disease duration (≤2 years) when compared to long term disease (Figure 1 and Table 1).

Table 1.

Efficacy responses with SEC up to Week 104 based on age and symptom duration

Age 18-33 yearsAge >52 years≤2 years of back pain>10 years of back painSEC 150 mg LD (N=61)SEC 150 mg NL (N=59)PBO (N=61)SEC 150 mg LD (N=25)SEC 150 mg NL (N=33)PBO (N=28)SEC 150mg LD (N=51)SEC 150 mg NL (N=33)PBO (N=47)SEC 150 mg LD (N=50)SEC 150 mg NL (N=46)PBO (N=49)ASDAS-CRP ID and LDA50.8*55.9*34.4*36.0*39.4*21.4*51.0*48.5*40.4*44.0*30.4*26.5*77.4#81.1#72.2#45.8#46.7#33.3#77.3#60.0#77.3#53.3#48.7#37.2#71.7†70.2†77.6†50.0†57.1†60.9†74.4†69.2†82.1†55.3†53.3†53.8†BASDAI 5045.9*47.5*27.9*28.0*36.4*17.9*45.1*51.5*29.8*34.0*23.9*20.4*77.8#71.7#72.2#37.5#53.3#37.0#75.6#60.0#75.0#46.7#46.2#43.2#73.5†72.3†77.6†47.6†60.9†52.2†78.0†65.4†76.9†53.8†53.1†51.3†ASAS PR29.5*32.2*8.2*12.0*12.1*7.1*27.5*24.2*8.5*18.0*10.9*12.2*41.5#50.9#38.9#12.5#20.0#22.2#45.5#40.0#38.6#22.2#23.1#20.5#46.9†44.7†59.2†23.8†31.8†21.7†56.1†34.6†46.2†25.6†25.8†23.1†Total back pain50.8*50.8*27.9*24.0*30.3*32.1*51.0*48.5*36.2*32.0*23.9*32.7*74.1#75.5#72.2#58.3#46.7#44.4#73.3#63.3#72.7#53.3#48.7#47.7#71.4†68.1†79.6†61.9†52.2†52.2†75.6†69.2†74.4†61.5†50.0†59.0†

Data is presented as % of responders. Symbols are used to denote the Weeks. *Week 16; #Week 52; †Week 104

. All patients received open-label SEC 150 mg treatment after Week 52 up to Week 104

. ASDAS-CRP ID and LDA (ASDAS-CRP <2.1); Total back pain improvement ≥50%

. LD, loading dose; NL, without loading; PBO, placebo

Conclusion

Efficacy responses were numerically higher with SEC in patients with nr-axSpA with shorter symptom duration and in younger age. These data suggest that earlier treatment improves patient outcomes in nr-axSpA.

References

[1]Lapane KL, et al. BMC Fam Pract. 2021;22(1):251

[2]Poddubnyy D, Sieper J. Curr Rheumatol Rep. 2020;22(9):47

[3]Poddubnyy D, et al. Ann Rheum Dis. 2021;80 (suppl1):707

[4]Deodhar A et al. Arthritis Rheumatol. 2021;73(1):110-120

Disclosure of Interests

Atul Deodhar Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Celgene, Eli Lilly, Galapagos, Glaxo Smith & Kline, Janssen, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Eli Lilly, Glaxo Smith & Kline, Novartis, Pfizer, UCB, Denis Poddubnyy Speakers bureau: AbbVie, BMS, Lilly, MSD, Novartis, Pfizer, UCB, Roche, Consultant of: AbbVie, BMS, Eli Lilly, MSD, Novartis, Pfizer, UCB, Roche, Grant/research support from: AbbVie, MSD, Novartis, Pfizer, Ricardo Blanco Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, UCB pharma, MSD and Lilly, Consultant of: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, UCB pharma and MSD, Grant/research support from: AbbVie, MSD, and Roche, Stephen Hall Speakers bureau: Novartis, Merck, Janssen, Pfizer, Eli Lilly, and UCB, Consultant of: Novartis, Merck, Janssen, Pfizer, Eli Lilly, and UCB, Grant/research support from: AbbVie, UCB, Janssen, and Merck, Marina Magrey Consultant of: Eli Lily, Novartis, Grant/research support from: AbbVie, UCB and Amgen, Erhard Quebe-Fehling Shareholder of: Shareholder of Novartis, Employee of: Novartis, Renato Calheiros Shareholder of: Shareholder of Novartis, Employee of: Novartis, Patricia Pertel Shareholder of: Shareholder of Novartis, Employee of: Novartis, Helena Marzo-Ortega Speakers bureau: AbbVie, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Takeda and UCB, Consultant of: AbbVie, Celgene, Janssen, Moonlake, Lilly, Novartis, Pfizer and UCB, Grant/research support from: Janssen, Novartis and UCB

POS0963 HOW IS EARLY SPONDYLOARTHRITIS DEFINED IN THE LITERATURE? RESULTS FROM A SYSTEMATIC REVIEW

Background

The term “early spondyloarthritis (SpA)” has been frequently used to refer to the first phase of the disease, however, no standardized definition on “early” has been established. The ASAS-SPEAR (SPondyloarthritis EARly definition) project aims at developing a consensual definition on what is meant by “early SpA”. In order to inform the ASAS-SPEAR working group, it is highly relevant to assess the current meaning of “early SpA” in the literature.

Objectives

To identify all possible definitions of “early SpA” employed in the literature, including “early axial SpA (axSpA)” and “early peripheral SpA (pSpA)”.

Methods

A systematic literature review was conducted in Medline, EMBASE and the Cochrane Library (through April 28th, 2021). The eligibility criteria were studies with any design, in adults that included any mention of “early SpA” or its subtypes in the title or abstract. Two reviewers independently identified eligible studies and extracted data, including the literal definition of early SpA used in each of them. The proportion of studies reporting a definition was calculated, and the different definitions were assessed, including the core of the definition: whether they were based on symptom duration, disease duration, radiographic damage, a combination of them or any other aspects, and their boundaries.

Results

Out of 9,651 titles identified, 355 publications reporting data from 186 studies were included (291 full papers, 64 conference abstracts). Among them, 217 (61%) were cohort studies, 72 (20%) were reviews and 46 (13%) were clinical trials. Over time, an increasing number of publications on early SpA were identified: <2005 (n=34), 2005-2010 (n=48), 2011-2015 (n=109) and 2016-2020 (n=164). Overall, 63 studies (34%) included the term “early axSpA”, 60 (32%) “early ankylosing spondylitis (AS)”, 58 (31%) “early SpA”, 4 (2%) “early non-radiographic axSpA (nr-axSpA)” and 1 (1%) “early pSpA”. In total, 116 (62%) studies reported a specific definition: 40 (34%) based it on symptom duration, 35 (30%) on radiographic damage, 32 (28%) on disease duration, 6 (5%) on both symptom/disease duration and radiographic damage, and 3 (3%) on other aspects. Symptom duration was defined as the time since the onset of low back pain in 21/40 (53%) studies, whereas in 14/40 (35%) the symptom of onset was not specified. Thirty-five of 116 studies (30%) included a definition referred to “early SpA”, 38 (33%) to “early axSpA”, 38 (33%) to “early AS”, 4 (3%) to “early nr-axSpA”, and 1 (1%) to “early pSpA”. Figure 1 shows the 18 distinct definitions that were identified (after combining some similar categories). The three most used definitions per subtype of disease are shown in Table 1. Regarding the studies that referred to “early axSpA”, the most used definition was symptom/disease duration <5 years, whereas for “early AS” was symptom/disease duration <10 years. After 2010, the definition of “early axSpA” based on the absence of radiographic sacroiliitis was less used compared to before 2010 (5/30, 17% vs 3/8, 38%).

Table 1.

Top 3 candidate definitions for “early SpA” and subtypes

Core of the definitionNumber of studies, n (%)SpA (n= 35)nr-axSpA10 (29%)< 2 years duration10 (29%)< 1 year duration6 (17%)AxSpA (n=38)< 5 years duration12 (34%)< 3 years duration9 (24%)nr-axSpA duration8 (21%)AS/r-axSpA (n=38)<10 years duration9 (24%)nr-axSpA7 (18%)< 2 years duration6 (16%)nr-axSpA (n=4)nr-axSpA2 (50%)< 1 year & nr-axSpA1 (25%)< 5 years & nr-axSpA1 (25%)pSpA (n=1)< 12 weeks duration1 (100%)

“Duration” refers to symptom duration or disease duration.

Figure 1.

Number of studies stratified by the core of the definition.

Conclusion

Over time, the term “early SpA” and its subtypes are increasingly used. Despite addressing early SpA, more than one third of the studies did not include a clear definition of the term. The studies reporting a definition of early SpA showed a large heterogeneity, with two out of three of them based on the duration of symptoms or disease. These results emphasize the need for a standardised definition of early SpA.

Acknowledgements

The Assessment of Spondyloarthritis international Society (ASAS) supported Diego Benavent financially for this work.

Disclosure of Interests

Diego Benavent Speakers bureau: Jannsen, Roche, Grant/research support from: Novartis., Dafne Capelusnik Speakers bureau: Bristol Myers Squibb, Pfizer, Grant/research support from: Pfizer, Désirée van der Heijde Consultant of: AbbVie, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Lilly, Novartis, Pfizer, UCB Pharma., Employee of: Director of Imaging Rheumatology bv., Robert B.M. Landewé Consultant of: AbbVie, BMS, Galapagos, Gilead, GSK, Janssen, Lilly, Novartis, Pfizer, UCB, Denis Poddubnyy Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Biocad, Eli Lilly, Gilead, GlaxoSmithKline, Janssen, MSD, Novartis, Pfizer, Samsung Bioepis, and UCB, Grant/research support from: AbbVie, Eli Lilly, MSD, Novartis, and Pfizer, Astrid van Tubergen Consultant of: Novartis, Galapagos, Grant/research support from: Pfizer, UCB, Novartis, Louise Falzon: None declared, Sofia Ramiro Speakers bureau: Eli Lilly, MSD, Novartis, UCB, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB, Sanofi, Grant/research support from: AbbVie, Galapagos, Novartis, Pfizer, UCB, Victoria Navarro-Compán Speakers bureau: AbbVie, Eli Lilly, Janssen, MSD, Novartis, Pfizer, UCB Pharma, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB Pharma, Grant/research support from: Abbvie and Novartis

POS1445 EARLY DETECTION OF AXIAL PSORIATIC ARTHRITIS IN PATIENTS WITH PSORIASIS: A PROSPECTIVE, MULTICENTER STUDY

Background

In the absence of reliable serological and/or imaging biomarkers that can support an early diagnosis of psoriatic arthritis (PsA) in patients with psoriasis (PsO), and considering the known diagnostic delay there is a need for screening tools for detection of early PsA. While different validated screening/referral tools focusing on peripheral manifestations of PsA exist, validated referral algorithms for PsA with axial involvement (also referred to as axial PsA - axPsA) are still missing.

Objectives

In this prospective, multicenter study we applied a dermatologist-centered screening tool and a structured rheumatologic examination including magnetic resonance imaging (MRI) of sacroiliac joints (SIJs) and spine to detect axPsA in patients with psoriasis (PsO).

Methods

Patients with PsO were systematically screened by their dermatologist for eligibility for referral to a rheumatology clinic. Eligible patients were ≥ 18 years with a confirmed diagnosis of PsO who reported having chronic back pain (≥ 3 months) with onset prior to 45 years of age and who had not been treated with any biologic or targeted synthetic DMARD 12 weeks prior to screening. For those patients who qualified for referral a rheumatologic investigation including clinical, laboratory and genetic assessments as well as imaging with conventional radiography and MRI of sacroiliac joints and spine was performed. The primary outcome of the study was the proportion of patients diagnosed with axPsA among all referred PsO patients.

Results

In total 355 patients were screened at 14 dermatology sites, of whom 151 (42.5%) qualified for referral to rheumatology clinic and 100 (28.2%) were seen by a rheumatologist. The diagnosis of axPsA was confirmed in 14 patients (3/14 with both, axial and peripheral involvement) and the diagnosis of peripheral PsA (pPsA) without axial involvement was made in five patients. The ASAS classification criteria for axSpA were fulfilled in nine (64.3%) of the patients diagnosed with axPsA. All but one patient diagnosed with PsA (13/14 with axPsA and 5/5 with pPsA) fulfilled the CASPAR criteria for PsA.

Patient characteristics are presented in Table 1. All patients diagnosed with axPsA had active inflammatory and/or structural (post)inflammatory changes in the sacroiliac joints and/or spine on imaging. In five patients (35.7%), MRI changes indicative of axial involvement were found only in the spine as illustrated in Figure 1.

Table 1.

Clinical characteristics of all referred patients with PsO and suspicion of axSpA.

Patient characteristicpPsA (N=5)axPsA (N=14)No PsA (N=81)p-value1Age (years) – Mean (SD)42.8 (9.0)46.2 (13.6)45.7 (13.3)0.883Female – n (%)2 (40.0)9 (64.3)45 (55.6)0.543PASI – Mean (SD)3.3 (2.1)4.3 (4.9)4.0 (4.5)0.971Inflammatory back pain – n (%)5 (100.0)8 (57.1)36 (44.4)0.379HLA-B27 positive – n (%)04 (28.6)12 (14.8)0.204Elevated CRP (>5 mg/L) – n (%)1 (20.0)5 (35.7)11 (13.6)0.041Peripheral arthritis, current (last 7 days) – n (%)5 (100.0)3 (21.4)3 (3.7)0.012Radiographic sacroiliitis as per mNY criteria – n (%)04 (28.6)1 (1.2)<0.001Active inflammation, sacroiliac joint (MRI) – n (%)08 (57.1)0<0.001Structural (post)inflammatory changes, sacroiliac joint (MRI) – n (%)08 (57.1)0<0.001Active inflammation, spine (MRI) – n (%)013 (92.9)0<0.001Structural (post)inflammatory changes, spine (MRI) – n (%)08 (57.1)0<0.001

1Statistically significant differences between the axPsA and No PsA groups of patients were determined by using Mann–Whitney U test for continuous data and Chi-square test for categorical data

Figure 1.

Imaging features of axial involvement in PsO patients diagnosed with axPsA

Conclusion

Our study revealed that applying a dermatologist-centered screening tool may be useful for the early detection of patients with a high probability of PsA (and specifically axPsA) in PsO patients. Given the high prevalence of isolated spinal involvement (without SIJs), imaging of the entire axial skeleton may be required as a part of diagnostic procedure in patients with suspected axPsA.

Acknowledgements

Caroline Höppner, Rebecca Bolce, David Sandoval, Hagen Russ, Burkhard Muche, Judith Rademacher, Hildrun Haibel, Laura Spiller and all cooperating dermatologists.

Disclosure of Interests

Fabian Proft: None declared, Susanne Lüders: None declared, Theresa Hunter Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Gustavo Luna: None declared, Valeria Rios Rodriguez: None declared, Mikhail Protopopov: None declared, Katharina Meier: None declared, Georgios Kokolakis: None declared, Kamran Ghoreschi: None declared, Denis Poddubnyy: None declared

POS0153 MRI SPINAL LESIONS IN PATIENTS WITHOUT MRI OR RADIOGRAPHIC LESIONS IN THE SACROILIAC JOINTS TYPICAL OF AXIAL SPONDYLOARTHRITIS

Background

There are limited data as to the frequency of spinal lesions on MRI in patients without MRI or radiographic features typical of sacroiliac joint (SIJ) disease and to what degree spine MRI might enhance diagnostic evaluation.

Objectives

To assess the frequency of MRI lesions of the spine in the ASAS-Classification Cohort according to the presence of MRI SIJ lesions typical of axSpA and/or radiographic sacroiliitis (mNY+).

Methods

MRI spine lesions were recorded by 9 central readers in an eCRF that captures global assessment of the spine (“Is the MRI consistent with axSpA: yes/no”) (yes=MRIglobal spine+) and detailed anatomical-based scoring of each discovertebral unit plus lateral and posterior structures. Independently, readers globally assessed SIJ scans for active and/or structural lesions typical of axSpA. We compared the frequency of MRIglobal spine+ and frequencies of different types of spinal lesions according to the presence/absence of axSpA on global evaluation of SIJ scans by ≥5 of 9 readers (MRIglobal SIJ+) and mNY+ sacroiliitis using Fisher’s exact test. Analysis was also stratified by rheumatologist diagnosis.

Results

Among 51 cases with SIJ as well as spine MRI scans and radiographs of the SIJ,19 (37.3%) had MRIglobal SIJ+, and 12 (23.5%) and 7 (13.7%) had MRIglobal spine+ by ≥2 and ≥5 reader agreement, respectively. MRIglobal spine+ occurred significantly more frequently in the presence of mNY+ sacroiliitis and MRIglobal SIJ+ but was also recorded in 4 of 32(12.5%) (≥2 readers) and 1 of 32(3.4%) (≥5 readers) cases that were MRIglobal SIJ- and x-ray negative, all 4 cases being diagnosed with axSpA. Moreover, vertebral corner BME lesions, but not spinal structural lesions, were significantly more frequent in MRIglobal SIJ- cases that had been clinically diagnosed as axSpA versus non-axSpA (Table 1).

Table 1.

Frequency of Spinal MRI lesions According to SIJ Imaging Positive for AxSpA

MRI Spinal Lesions, N (%)MRIglobalSIJ+ (n=19)MRIglobalSIJ- (n=32)P valueMRIglobal SIJ+ and/or mNY+ (n=22)MRIglobal SIJ- and mNY- (n=29)P valueMRIglobal SIJ- and SpA Diagnosis+(n=17)MRIglobal SIJ- and SpA Diagnosis- (n=15)P valueMRIglobal consistent with axSpA (≥2/9 readers agree)8 (42.1%)4 (12.5%)0.048(36.4%)4(13.8%)0.104 (23.5%)0 (0%)0.10MRIglobal consistent with axSpA (≥5/9 readers agree)6 (31.6%)1 (3.1%)0.016 (27.3%)1 (3.4%)0.031 (5.9%)0 (0%)1.0VC BME ≥19 (47.4%)15 (46.9%)46.9% RT 62.5% CT 29.4% GT1.010(45.5%)14(48.3%)1.011 (64.7%)4 (26.7%)0.04VC BME ≥26 (31.6%)10 (31.3%)31.2% RT 55.6% CT 19.6% GT1.06(27.3%)10(34.5%)0.769 (52.9%)1 (6.7%)0.007VC BME ≥36 (31.6%)7 (21.9%)21.9% RT 53.8% CT 13.7% GT0.526(27.3%)7(24.1%)1.07 (41.2%)0 (0%)0.008VC BME ≥45 (26.3%)5 (15.6%)0.475(22.7%)5(17.2%)0.735 (29.4%)0 (0%)0.046Vertebral Endplate BME ≥12 (10.5%)3 (9.4%)1.02(9.1%)3(10.3%)1.02 (11.8%)1 (6.7%)1.0Lateral vertebral BME3 (15.8%)3 (9.4%)0.663(13.6%)3(10.3%)1.03 (17.6%)0 (0%)0.23Facet BME ≥14 (21.1%)1 (3.1%)3.1% RT 20.0% CT 2.0% GT0.064(18.2%)1(3.4%)0.151 (5.9%)0 (0%)1.0Posterior BME ≥15 (26.3%)2 (6.3%)0.095(22.7%)2(6.9%)0.221 (5.9%)1 (6.7%)1.0VC Fat ≥18 (42.1%)42.1% RT 44.4% CT 15.7% GT10 (31.3%)31.2% RT 55.6% CT 19.6% GT0.558(36.4%)10(34.5%)1.05 (29.4%)5 (33.3%)1.0VC Fat ≥27 (36.8%)5 (15.6%)0.107(31.8%)5(17.2%)0.323 (17.6%)2 (13.3%)1.0VC Fat ≥36 (31.6%)31.6% RT 66.7% CT 11.8% GT3 (9.4%)0.066(27.3%)3(10.3%)0.151 (5.9%)2 (13.3%)0.59VC Fat ≥46 (31.6%)1 (3.1%)0.016(27.3%)1(3.4%)0.030 (0%)1 (6.7%)0.47Lateral Fat ≥16 (31.6%)2 (6.3%)0.046(27.3%)2(6.9%)0.060 (0%)2 (13.3%)0.21Erosion ≥13 (15.8%)2 (6.3%)0.353(13.6%)2(6.9%)0.641 (5.9%)1 (6.7%)1.0Bone Spur ≥14 (21.1%)5 (15.6%)0.714(18.2%)5(17.2%)1.04 (23.5%)1 (6.7%)0.34Ankylosis ≥12 (10.5%)0 (0%)0.132(9.1%)0(0%)0.180 (0%)0 (0%)-

Conclusion

Spinal lesions on MRI indicative of axSpA per majority read occurred in about 3% of patients without positive imaging in the SIJ. Frequency of spinal BME lesions was higher in cases with negative SIJ imaging but clinically diagnosed with axSpA.

Disclosure of Interests

None declared

POS1037 EFFECT OF GUSELKUMAB, A SELECTIVE IL-23p19 INHIBITOR, ON AXIAL-RELATED ENDPOINTS IN PATIENTS WITH ACTIVE PsA: RESULTS FROM A PHASE 3, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED STUDY THROUGH 2 YEARS

Background

Guselkumab (GUS), a selective IL-23p19 inhibitor, showed greater mean improvements in Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores vs placebo (PBO) at Week (W) 24 in patients (pts) with active PsA and investigator-confirmed sacroiliitis in pooled post hoc analyses of data from phase 3 DISCOVER (D)-1&2 trials. Improvements in symptoms of axial involvement were maintained through 1 year.1

Objectives

To assess maintenance of GUS effect on symptoms of axial involvement in biologic-naïve PsA pts with investigator-confirmed sacroiliitis through 2 years of D-2.

Methods

In D-2, 739 bio-naïve pts with active PsA (≥5 swollen + ≥5 tender joints, CRP ≥0.6 mg/dL despite standard therapies) were randomized 1:1:1 to GUS 100 mg every 4W (Q4W; n=245), GUS 100 mg at W0, W4, then Q8W (n=248), or PBO (n=246) with PBO→GUS 100 mg Q4W at W24. Pts with investigator-identified axial symptoms and sacroiliitis (prior X-ray or MRI, or pelvic X-ray at screening) were evaluated. Efficacy was assessed by changes in BASDAI, modified BASDAI (mBASDAI, excluding Q3 [peripheral joint pain]), and BASDAI Q2 (Spinal Pain) scores, and proportions of pts achieving BASDAI 50, Spinal Pain score ≤2, and AS Disease Activity Score (ASDAS) responses through W100. Through W24, pts who met treatment failure criteria or had missing data were considered nonresponders. After W24, missing data were imputed as nonresponse for binary endpoints or no change from baseline for continuous endpoints (nonresponder imputation [NRI]). Axial-related outcomes were also summarized by HLA-B27 status (+/-).

Results

246 pts had investigator-confirmed sacroiliitis. Baseline characteristics were similar across treatment groups (62% male; mean age 44.4 years; mean BASDAI scores 6.5-6.6). At W24, LS mean/mean changes in BASDAI (-2.4/-2.6) and ASDAS (-1.3/-1.5) scores were greater in GUS- vs PBO-treated pts. Improvements were maintained through W100 in GUS-treated pts: BASDAI, -3.1; Spinal Pain, -3.1; mBASDAI, -3.1; ASDAS, -1.7. Response patterns were similar for BASDAI 50 response rates in GUS-treated pts (W24 38-40%; W100 49-54%). At W24, GUS-treated pts had higher response rates for achievement of ASDAS inactive disease, major improvement, and clinically important improvement vs PBO; response rates (NRI) were maintained, or in some cases further increased, at 2 years. Results were consistent for achievement of ASDAS LDA and Spinal Pain score ≤2 (data not shown). GUS-related improvements in axial symptoms through W100 were generally consistent in HLA-B27+/- pts (data not shown).

Conclusion

In bio-naïve pts with active PsA and investigator-confirmed sacroiliitis, GUS provided durable improvements in axial symptoms through W100, with substantial proportions of pts achieving and maintaining clinically meaningful improvements.

References

[1]Mease PJ et al. Lancet Rheumatol 2021;3:e715-723

Table 1.

Axial symptom assessments through W100 in PsA pts with investigator-confirmed sacroiliitis in DISCOVER-2 (NRI)

GUS Q4W N=82GUS Q8W N=68PBO→GUS Q4W N=96Change in BASDAI scoreW24, LS mean (95% CI)-2.5 (-2.9, -2.0)-2.4 (-3.0, -1.8)-1.2 (-1.7, -0.7)Mean (SD)-2.5 (2.0)-2.6 (2.4)-1.4 (2.4)W52, mean (SD)-2.9 (2.3)-2.7 (2.5)-2.9 (2.6)W100, mean (SD)-3.0 (2.3)-3.1 (2.6)-3.3 (2.6)Change in mBASDAI (excludes Q3) scoreW24, LS mean (95% CI)-2.4 (-2.9, -1.9)-2.4 (-2.9, -1.8)-1.2 (-1.7, -0.7)Mean (SD)-2.5 (2.1)-2.6 (2.5)-1.3 (2.3)W52, mean (SD)-2.7 (2.6)-2.6 (2.5)-2.9 (2.4)W100, mean (SD)-3.3 (2.6)-3.1 (2.6)-3.0 (2.4)Change in Spinal Pain (BASDAI Q2) scoreW24, LS mean (95% CI)-2.2 (-2.7, -1.7)-2.3 (-2.9, -1.7)-0.9 (-1.5, -0.4)Mean (SD)-2.3 (2.6)-2.5 (2.8)-1.1 (2.5)W52, mean (SD)-2.6 (2.7)-2.5 (2.7)-2.5 (2.7)W100, mean (SD)-2.8 (2.7)-3.1 (2.8)-3.0 (2.8)Change in ASDAS scoreW24, LS mean (95% CI)-1.3 (-1.6, -1.1)-1.3 (-1.6, -1.1)-0.6 (-0.8, -0.4)Mean (SD)-1.4 (1.0)-1.5 (1.2)-0.7 (1.1)W52, mean (SD)-1.5 (1.1)-1.5 (1.3)-1.5 (1.3)W100, mean (SD)-1.6 (1.2)-1.7 (1.2)-1.6 (1.2)

Disclosure of Interests

Philip J Mease Speakers bureau: AbbVie, Aclaris, Amgen, BMS, Celgene, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Inmagene, Janssen, Novartis, Pfizer, SUN Pharma, and UCB, Consultant of: AbbVie, Aclaris, Amgen, BMS, Celgene, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Inmagene, Janssen, Novartis, Pfizer, SUN Pharma, and UCB, Grant/research support from: AbbVie, Aclaris, Amgen, BMS, Celgene, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Inmagene, Janssen, Novartis, Pfizer, SUN Pharma, and UCB, Philip Helliwell Speakers bureau: AbbVie, Janssen, and Novartis, Consultant of: Eli Lilly, Janssen, and Pfizer, Dafna D Gladman Consultant of: AbbVie, Amgen, BMS, Celgene, Eli Lilly, Galapagos, Gilead, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: Abbvie, Amgen, BMS, Celgene, Eli Lilly, Janssen, Novartis, Pfizer and UCB, Denis Poddubnyy Consultant of: AbbVie, Eli Lilly, GlaxoSmithKline, MSD, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Eli Lilly, MDS, Novartis, and Pfizer, Xenofon Baraliakos Speakers bureau: AbbVie, Biocad, Chugai, Eli Lilly, Janssen, MSD, Novartis, Pfizer, Roche, and UCB, Consultant of: AbbVie, Biocad, Chugai, Eli Lilly, Janssen, MSD, Novartis, Pfizer, Roche, and UCB, Grant/research support from: AbbVie, Biocad, Chugai, Eli Lilly, Janssen, MSD, Novartis, Pfizer, Roche, and UCB, Soumya D Chakravarty Shareholder of: Johnson & Johnson, Employee of: Janssen Scientific Affairs, 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, Shihong Sheng Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, Stephen Xu Shareholder of: Johnson & Johnson, Employee of: Janssen Research & Development, LLC, May Shawi Shareholder of: Johnson & Johnson, Employee of: Janssen Global Services, LLC, Désirée van der Heijde Consultant of: AbbVie, Amgen, Astellas, AstraZeneca, Bayer, BMS, Boehringer Ingelheim, Celgene, Cyxone, Daiichi, Eisai, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, and UCB Pharma, Employee of: Imaging Rheumatology BV, Atul Deodhar Speakers bureau: AbbVie, Eli Lilly, Janssen, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly, Galapagos, Glaxo Smith & Kline, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Eli Lilly, Glaxo Smith & Kline, Novartis, Pfizer, and UCB

POS0973 INFLUENCE OF ANATOMICAL VARIATION OF THE SACROILIAC JOINTS ON INFLAMMATORY LESIONS ON MAGNETIC RESONANCE IMAGING

Background

Anatomical variation of the sacroiliac (SI) joints is more common among patients with LBP than healthy controls; increased biomechanical strain to the joint may play a role in axial spondyloarthritis (axSpA).

Objectives

To assess the association of lesions joint shape variation on inflammatory lesions on SI joint magnetic resonance imaging (MRI) in patients with axSpA.

Methods

In this post-hoc analysis a total of 684 patients from four different prospective cohorts were evaluated (379 axSpA). Two readers independently scored all patients for joint form, erosion, sclerosis, fat metaplasia and bone marrow edema (BME). Logistic regression analyses were used to assess the association of lesions on imaging joint form; this analysis was performed separately for axSpA patients and controls.

Results

Typical joints were observed in 56.5% of axSpA patients (200/354) and 55.7% of control patients (169/303); in axSpA patients exhibited a significantly higher proportion of intra-articular variants (18.4% vs. 11.6%; p<0.001) and crescent joint shapes (11.0% vs. 5.3.%; p<0.001) than controls. AxSpA patients with intraarticular joint form variants had increased odds for erosions (OR 2.09; 95%CI 1.18-3.69) and BME (OR 1.79; 95%CI 1.13-2.82); this association was not seen in controls. Accessory joints increased the odds for sclerosis in axSpA patients (OR 2.54;95%CI 1.10-5.84) and for BME (2.05; 95%CI 1.03-4.07) and sclerosis (OR 17.91; 95%CI 6.92-46.37) in controls.

Conclusion

Joint form variations are associated with inflammatory lesions on SI joint MRI of axSpA patients but not controls; this indicates a role for atypical joint forms in sacroiliitis.

References

[1]Ziegeler, K., Kreutzinger, V., Proft, F., Poddubnyy, D., Hermann, K. G. A., & Diekhoff, T. (2021). Joint anatomy in axial spondyloarthritis: strong associations between sacroiliac joint form variation and symptomatic disease. Rheumatology (Oxford). doi:10.1093/rheumatology/keab318

Disclosure of Interests

Katharina Ziegeler Grant/research support from: Received research grant from the Assessment of Spondyloarthritis international Society (ASAS)., Sevtap Tugce Ulas: None declared, Denis Poddubnyy Speakers bureau: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, Bristol-Myers Squibb, Roche, UCB, Biocad, GlaxoSmithKline and Gilead, Grant/research support from: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, Fabian Proft Speakers bureau: Novartis, Eli Lilly, UCB, AbbVie, AMGEN, BMS, Hexal, Janssen, MSD, Pfizer and Roche, Grant/research support from: Novartis, Eli Lilly and UCB, Valeria Rios Rodriguez Speakers bureau: AbbVie and Falk e.V, Judith Rademacher: None declared, Kay-Geert Hermann Speakers bureau: AbbVie, MSD, and Novartis, Employee of: Co-owner of the BerlinFlame GmbH, Torsten Diekhoff Speakers bureau: MSD, Novartis and Eli Lilly

AB0796 Quantitative bone marrow lesion characterization at the sacroiliac joint with T1-mapping

Background

Conventional magnetic resonance imaging (MRI) uses T1-weighted and short-tau inversion recovery (STIR) sequences to characterize bone marrow lesions in axial spondyloarthritis. However, quantification is restricted to the extent of marrow lesions because signal intensities are highly variable within and across patients and scanners. Furthermore, some marrow lesions are less visible in MRI and need further characterization with computed tomography (CT), e.g. sclerosis. Quantitative MRI in form of mapping sequences might help to better characterize bone marrow lesions.

Objectives

To evaluate the performance of T1-mapping for differentiating different bone marrow lesions at the sacroiliac joints in patients with suspected axial spondyloarthritis.

Methods

Sixty-two patients (mean age 41±12.5; thirty-two were finally diagnosed with axial spondyloarthritis and 30 with another condition) underwent CT and MRI of the sacroiliac joints. Besides standard oblique coronal T1 and STIR sequences a T1-mapping sequence (Modified Look-Locker Inversion Recovery) was added to the protocol. Bone marrow lesions (maximum 4 lesions per patient, 1 lesion of the same type per joint) were characterized by an expert radiologist into four groups, namely sclerosis (lesion type (LT) 1), osteitis (LT2), fat lesion (LT3) and mixed marrow lesions (LTm). Relaxation times on T1-maps were compared using Kruskal-Wallis test correcting for multiple comparisons and correlated to quantitative measures from conventional MRI sequences and CT.

Results

119 lesions were selected (LT1: 38, LT2: 27, LT3: 40; LTm: 14). T1-map showed highly significant differences between LT1-3 with the lowest values for sclerosis (1522±227 ms), followed by osteitis (1906±82 ms) and fat lesions (2391±200 ms); p<0.0005. However, mixed lesions showed a broad distribution of values (1869±670), irrespective of their characteristics. T1-map correlated to a high degree with conventional T1-values (r = 0.74) and Hounsfield units in CT (r = -0.69) with p < 0.0001, respectively, but not with STIR (p = 0.8).

Conclusion

T1-Mapping allows for accurately characterizing lesions at the sacroiliac joint in patients with suspected axial spondyloarthritis and, thus, may combine information from two conventional sequences and CT into one in the future while providing superior capacity for quantification. However, in our study mixed lesions and inhomogeneous bone marrow remained problematic. Thus, further sequence development is needed before its implementation in clinical routine.

Figure 1.

T1-mapping values of the different lesions, LT1: Sclerosis, LT2: Osteitis, LT3: Fat lesion, LTm: Mixed lesion. Differences are highly significant, which allows T1-mapping to characterize those different lesions in one sequence.

Disclosure of Interests

Torsten Diekhoff Speakers bureau: Novartis, Eli Lilly, MSD, Canon MS, Consultant of: Novartis, Dominik Deppe: None declared, Denis Poddubnyy: None declared, Katharina Ziegeler: None declared, Fabian Proft: None declared, Kay-Geert Hermann: None declared, Mikhail Protopopov: None declared, Felix Radny: None declared, Marcus Makowski: None declared

OP0150 ASAS RECOMMENDATIONS FOR REQUESTING AND REPORTING IMAGING EXAMINATIONS IN PATIENTS WITH SUSPECTED AXIAL SPONDYLOARTHRITIS

Background

Clinicians face uncertainties in their daily practice when requesting imaging examinations for patients with suspected axial spondyloarthritis (axSpA) or when producing an imaging report because the requirements and desired information of radiologists and rheumatologists / orthopedics alike are sometimes not completely known or understood.

Objectives

This project aimed to develop practical consensus recommendations for the standardized communication around imaging of sacroiliac joints and spine for diagnostic purposes in patients with suspected axSpA or their management in clinical practice.

Methods

An international task force was established combining radiologists (n=7) and rheumatologists (n=13) from the Assessment of SpondyloArthritis international Society (ASAS), two members of Young ASAS and a patient representative. The task force defined the project’s aims and developed a project statement. Then, considering published literature and the work of other groups, two survey rounds were designed, and all ASAS members invited to respond: first, to identify items for further consideration, second, to consider the detail of information to be communicated. Finally, ASAS members discussed the recommendations proposed by the task force during the ASAS annual workshop in January 2022 and voted regarding endorsement of the recommendations.

Results

The final set of recommendations is presented in Figure 1. Six recommendations deal with imaging requests in patients with axSpA. The first three recommendations entail clinical features, patients’ symptoms and risk factors. Recommendation 4 concerns previous imaging and reports and recommendation 5 refers to contraindications to imaging or contrast media. Recommendation 6 is about the suspected diagnosis and possible clinical differential diagnoses and the reason for the examination. Eleven additional recommendations refer to the radiology report. The first point addresses clinical information included in the report. Recommendations 2 to 4 advise on information about the technical conduct of the exam, the use of contrast media and image quality. Imaging findings that should be mentioned in the report if present are listed in recommendations 5 to 7. Finally, recommendations 8 to 11 combine advice for the conclusion, and for suggesting additional imaging or referral to a rheumatology expert if a different physician requested the imaging. The recommendations were endorsed by ASAS with approval from 73% of voting members (43 agreed, 10 rejected, 6 abstained).

Figure 1.

ASAS recommendations for requesting and reporting imaging in patients with suspected axial Spondyloarthritis.

Conclusion

These ASAS recommendations provide guidance for requesting and reporting imaging examinations in the context of axSpA and for standardizing and enhancing communication between rheumatologists and radiologists to improve diagnosis and patient care.

Disclosure of Interests

Torsten Diekhoff Paid instructor for: Novarits, Eli Lilly, MSD, Canon MS, Consultant of: Eli Lilly, Iris Eshed: None declared, Chiara Giraudo: None declared, Kay-Geert Hermann: None declared, Manouk de Hooge: None declared, Lennart Jans: None declared, Anne Grethe Jurik: None declared, Robert G Lambert: None declared, Pedro M Machado: None declared, Walter P Maksymowych: None declared, Michael Mallinson: None declared, Helena Marzo-Ortega: None declared, Victoria Navarro-Compán: None declared, Susanne Juhl Pedersen: None declared, Mikkel Østergaard: None declared, Monique Reijnierse: None declared, Martin Rudwaleit: None declared, Fernando Sommerfleck: None declared, Ulrich Weber: None declared, Xenofon Baraliakos: None declared, Denis Poddubnyy: None declared

POS0970 SAME OR DIFFERENT? ANALYSIS OF SIMILARITIES AND DIFFERENCES OF CROHN’S DISEASE AND ULCERATIVE COLITIS IN SPONDYLOARTHRITIS: AN ANCILLARY ANALYSIS FROM THE WORLDWIDE ASAS-perSpA STUDY

Background

Crohn’s disease (CD) and ulcerative colitis (UC) are grouped as inflammatory bowel disease (IBD), and both are frequently found as extra-musculoskeletal manifestations in spondyloarthritis (SpA). Several studies have described the connection between SpA and IBD in both directions. Still until today, no studies have investigated possible differences in the musculoskeletal manifestations between the two main entities of inflammatory bowel disease: CD and UC.

Objectives

To evaluate the clinical characteristics associated with the presence of CD or UC in patients with spondyloarthritis from the international cross-sectional ASAS-perSpA study.

Methods

We analyzed 3152 patients from the ASAS per-SpA cohort who had a diagnosis of axial SpA or peripheral SpA according to the treating rheumatologist. Patients with IBD - confirmed by endoscopy - were identified and stratified by CD or UC. Patients in which their IBD disease was not specified, were excluded. Demographics, clinical characteristics, treatments and patient-reported outcomes were compared between both subgroups.

Results

Among the 146 patients diagnosed with IBD from the 3152 patients included in the analysis, 87 (59.6%) presented with CD (75 patients with axial SpA and 12 with peripheral SpA) and 39 (26.7%) with UC (34 patients with axial SpA and 5 with peripheral SpA) - Figure 1. A total of 20 (13.7%) patients with IBD were excluded, due to an inconclusive diagnosis of IBD. Patients with CD and UC had similar age (44.9 vs 44.0 years old) and sex distribution, although a slightly higher frequency of males was observed in CD than UC (63.2% vs 51.3%). The diagnostic delay for SpA was 7.0 years for CD and 8.1 years for UC. We did not find differences between both groups related to any musculoskeletal manifestations such as chronic back pain, uveitis, arthritis, enthesitis or dactylitis (Table 1). The only parameter showing a significant difference between CD and UC was the Bath Ankylosing Spondylitis Functional Index (BASFI) with a mean score of 3.3 vs 2.2 respectively (p=0.02) (Table 1). CD patients showed a higher tendency to be HLA-B27 positive (51.9% in CD vs. 39.4% in UC), but this did not reach statistical significance. No differences were observed regarding treatment patterns between both groups.

Table 1.

Demographics and clinical characteristics related to spondyloarthritis of patients with concomitant Crohn’s disease or ulcerative colitis (n=146).

Crohn’s Disease N=87Ulcerative Colitis N=39PAge, mean (SD)44.9 (13.5)44.0 (13.0)0.68Sex, n/N (%) male55/87 (63.2)20/39 (51.3)0.21Smoker ever, n/N (%)36/87 (41.4)19/39 (48.7)0.44Diagnostic delay of SpA (years), mean (SD)7.0 (6.9)8.8 (8.1)0.38Psoriasis ever, n/N (%)9/87 (10.3)6/39 (15.4)0.47Uveitis ever, n/N (%)17/87 (19.5)11/39 (28.2)0.28Synovitis ever, n/N (%)42/87 (48.3)18/39 (46.2)0.83Enthesitis ever, n/N (%)26/87 (29.9)14/39 (35.9)0.50Dactylitis ever, n/N (%)3/87 (3.4)1/39 (2.6)0.79Axial involvement ever (according to the rheumatologist), n/N (%)79/87 (90.8)37/39 (94.9)0.44Sacroiliitis on X-ray, n/N (%)64/87 (73.6)26/39 (66.7)0.19HLA-B27 positive, n/N (%)28/54 (51.9)13/33 (39.4)0.26CRP mg/L, mean (SD)11.1 (33.8)15.3 (30.1)0.13ASDAS-CRP, mean (SD)2.4 (1.0)2.4 (1.1)0.84BASFI, mean (SD) 0-103.3 (2.6)2.2 (2.1)0.02csDMARDs ever, n/N (%)71/87 (81.6)35/39 (89.7)0.25bDMARDs ever, n/N (%)72/87 (82.8)33/39 (84.6)0.80

ASDAS, Ankylosing Spondylitis Disease Activity Score; BASFI, Bath Ankylosing Spondylitis Functional Index; bDMARD, biological disease-modifying antirheumatic drugs; CRP, c-reactive protein; csDMARD, conventional synthetic disease-modifying antirheumatic drugs; SD, standard deviation; SpA, spondyloarthritis.

Conclusion

In our ancillary analysis of the ASAS-perSpA study in patients with SpA and concomitant CD or UC, no differences in the clinical presentation or demographic characteristics between the two subgroups were observed, except for the BASFI.

Disclosure of Interests

None declared

POS0930 SAFETY AND EFFICACY OF IXEKIZUMAB TREATMENT IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS: 3-YEAR CLINICAL TRIAL RESULTS FROM THE COAST PROGRAMME

Background

Ixekizumab (IXE) has demonstrated efficacy at week (wk) 16 which was maintained through 2 years (yrs) and was associated with a consistent safety profile in patients (pts) with r- and nr-axSpA, who are bDMARD-naïve and TNFi-experienced.1-3

Objectives

To report safety and efficacy from the COAST programme at 3 yrs: 1 yr of the originating studies (COAST-V/W/X) and 2 yrs of COAST-Y.

Methods

COAST-Y (NCT03129100) is the phase 3, long-term extension study of the 3 originating studies COAST-V/W/X. Pts continued with the dose received at the end of the originating trial at week (wk) 52: either with 80 mg IXE every 4 wks (Q4W) or every 2 wks (Q2W). Pts assigned to adalimumab (ADA) or placebo (PBO) were re-randomised to IXE Q4W or Q2W at wk 16 in COAST-V and -W. Pts who received PBO for 52 wks in COAST-X were switched to IXE Q4W to continue in COAST-Y. Starting at wk 116 (wk 64 of COAST-Y), pts receiving IXE Q4W could have their dose escalated to Q2W. This analysis focused on pts receiving ≥1 dose of IXE Q4W, observed data while on IXE Q2W dose escalation are excluded. Continuous data are summarised as observed. Safety data while on IXE were analysed for pts who received ≥1 dose of IXE; observed data while on PBO or ADA are excluded.

Results

A total of 932 pts received ≥1 dose of IXE, 414 received ≥1 dose of IXE Q4W, and 562/932 (60%) pts completed 3 yrs of follow-up (PBO→IXE Q4W, 63/119 (53%); ADA→IXE Q4W, 29/44 (66%); and IXE Q4W→IXE Q4W, 114/251(45%)). Through 3 yrs, the most frequently reported treatment-emergent adverse events were infections [incidence rate (IR) 25.7/100 patient years (PY)] and injection site reactions [IR 7.4/100 PY]; the majority of which were mild/moderate in severity. Serious adverse events were reported at an IR of 4.8/100 PY, of which osteoarthritis was the most frequent at 0.4/100 PY. A total of 3 deaths were reported among all pts who received ≥1 dose of IXE [IR 0.1/100 PY]. For all pts, baseline disease activity (Ankylosing Spondylitis Disease Activity Score; ASDAS) was high (see Table 1). The 3 yr mean (SD) change from baseline (observed) in ASDAS among bDMARD-naïve pts with r-axSpA, TNFi-experienced pts with r-axSpA, and bDMARD-naïve pts with nr-axSpA is presented in the Table 1. A consistent disease control through 3 yrs was confirmed across additional efficacy endpoints (Table 1).

Table 1.

Baseline demographics and disease activity characteristics through 3 yrs. Data presented as mean (SD) unless otherwise specified.

COAST-VCOAST-WCOAST-XPBO (N=87)ADA (N=90)IXE Q4W (N=81)PBO (N=104)IXE Q4W (N=114)PBO (N=105)IXE Q4W (N=96)Age43 (12)42 (11)41 (12)47 (13)47 (13)40 (12)41 (15)Male, n (%)71 (83)73 (81)68 (84)87 (84)91 (80)44 (42)50 (52)Symptom duration (years)16.6 (10.1)15.6 (9.3)15.8 (11.2)19.9 (11.6)18.8 (11.6)10.1 (8.3)11.3 (10.7)HLA-B27, n (%)76 (89)82 (91)75 (93)86 (83)91 (80)77 (74)71 (75)ASDAS3.9 (0.7)3.7 (0.8)3.7 (0.7)4.1 (0.8)4.2 (0.9)3.8 (0.9)3.8 (0.8)BASDAI6.8 (1.2)6.7 (1.5)6.8 (1.3)7.3 (1.3)7.5 (1.3)7.2 (1.5)7.0 (1.5)3 years (observed)PBO→ADA→IXEPBO→IXEIXEIXE Q4WIXE Q4WQ4W→IXE Q4WQ4W→PBO→Q4W→N=42N=44IXE Q4WN=46IXE Q4WIXE Q4WIXE Q4WN=81N=114N=31N=56ASDAS CFB-1.9 (0.9)-1.5 (0.9)-1.9 (0.9)-1.6 (1.0)-1.7 (1.0)1.8 (1.0)-1.7 (1.4)ASDAS LDA, n (%)13/24 (54)21/29 (72)33/44 (75)7/20 (35)16/41 (39)13/19 (68)19/29 (66)BASDAI CFB-3.9 (1.9)-3.5 (2.3)-4.0 (2.2)-3.7 (1.7)-3.4 (2.2)-4.4 (2.1)-3.4 (2.7)BASDAI50, n (%)15/24 (63)18/29 (62)31/44 (71)9/20 (45)20/41 (49)12/19 (63)16/29 (55)ASAS40, n (%)13/24 (54)18/29 (62)30/44 (68)10/20 (50)23/41 (56)15/19 (79)17/29 (59)

Conclusion

This analysis of a subset of pts in COAST-Y demonstrated that the safety profile is consistent with the established safety profile, with no new safety signals observed. IXE Q4W was efficacious (observed data) in all patients studied who remained on the treatment through 3 yrs.

References

[1]Dougados et al. Ann Rheum Dis 2020;79.

[2]Deodhar et al. Lancet 2020; 395.

[3]Braun et al. Ann Rheum Dis, 2021; 80: supp 1

Figure 1.

Observed mean CFB in ASDAS for pts treated with IXE Q4W in COAST-V. At wk 16, PBO pts received IXE Q4W.

Acknowledgements

The authors thank So Young Park, PhD, of Eli Lilly and Company for statistical review, and Edel Hughes, PhD, of Eli Lilly and Company for writing and process support.

Disclosure of Interests

Atul Deodhar Speakers bureau: AbbVie, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly and Company, Janssen, Novartis, Pfizer, UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly and Company, Galapagos, Glaxo Smith & Kline, Janssen, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Eli Lilly and Company, Glaxo Smith & Kline, Novartis, Pfizer, UCB, Denis Poddubnyy Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly and Company, MSD, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Biocad, Eli Lilly and Company, Gilead, GlaxoSmithKline, Janssen, MSD, Novartis, Pfizer, Samsung Bioepis, and UCB, Grant/research support from: AbbVie, Eli Lilly and Company, MSD, Novartis, and Pfizer, Proton Rahman Speakers bureau: Abbott, AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Janssen, Novartis, and Pfizer., Grant/research support from: Janssen, Novartis, Rebecca Bolce Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Soyi Liu Leage 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, Caroline Johnson Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Ann Leung Employee of: Employee of Syneos Health, and a contractor for Eli Lilly and Company, Désirée van der Heijde Consultant of: AbbVie, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Eli Lilly and Company, Novartis, Pfizer, UCB Pharma, and Director of Imaging Rheumatology BV.

AB0114 IMPROVEMENT OF GUT MICROBIOTA DYSBIOSIS IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS AFTER ONE YEAR OF BIOLOGICAL TREATMENT

Background

Emerging evidence suggests that dysbiosis of the gut microbiota is involved in the initiation and perpetuation of spondyloarthritis (SpA). Biological disease-modifying antirheumatic drugs (bDMARDs) are a successful treatment to improve symptoms and reduce structural damage occurring in SpA; however, non-responders are frequent and few predictive factors for clinical response have been identified. Whether or not a patient responds to treatment could be related to gut microbiota composition.

Objectives

To investigate the gut microbiota changes in patients with radiographic axial SpA (r-axSpA) after receiving one year of treatment with bDMARDs and identify potential microbial biomarkers predictive of treatment response.

Methods

Patients with r-axSpA were recruited between 2015 and 2019 in an extension of the prospective GErman SPondyloarthritis Inception Cohort (GESPIC) before beginning bDMARD therapy. All patients had high disease activity (BASDAI >=4 and/or ASDAS >=2.1) despite previous treatment with nonsteroidal anti-inflammatory drugs, and had not received treatment with bDMARDs for at least three months before enrollment in the study. The choice of bDMARD was left to the discretion of the clinical rheumatologists in accordance with standard practice. Disease activity measures (BASDAI, CRP and ASDAS) and fecal samples were assessed at baseline prior to treatment and after one year of treatment. Patients with back pain negative for inflammatory disease served as a control group. Microbiota composition was determined by 16S rRNA gene sequencing, followed by taxonomic profiling with the SILVA138 database. Response to bDMARD therapy was defined as a clinically important improvement of ASDAS (>=1.1).

Results

A total of 99 patients with r-axSpA and 63 control individuals were included based on the availability of clinical and microbiome samples. Average age (mean±SD) was 36.4±10.4 years and 64 patients were males. The prevalence of HLA-B27 was 89.9% among r-axSpA patients compared to 7.9% among control individuals. Simpson indices showed an increase in alpha diversity between baseline and year 1 in r-axSpA patients which was statistically insignificant (paired Wilcoxon p=0.154) but brought the r-axSpA cohort nearer to controls. Likewise, Bray-Curtis dissimilarities to measure beta diversity showed a qualitative normalization to healthy individuals after treatment when visualized in principal coordinate space.

At the genus level, patients were mainly depleted in Lachnospiraceae taxa such as Blautia, Roseburia, and Fusicatenibacter, and enriched in Collinsella compared to the control group at baseline. After one year of treatment, most SpA patients exhibited increased abundances of these taxa, most notably Blautia. Patients also exhibited depletions in Bacteroides and Faecalibacterium, which was strongly enriched in HLA-B27+ individuals at baseline (adjusted Wilcoxon p<0.001). Collinsella showed a very slight median increase after one year of treatment, with no significant difference between responders and non-responders (adjusted Wilcoxon p=0.33). Shifts in highly abundant Prevotella and Bacteroides were strongly correlated with the change in ASDAS after one year when controlling for intra-individual variance and overall changes in alpha diversity.

Conclusion

The gut microbiota composition of r-axSpA patients who underwent treatment with bDMARDs for one year more closely resembled the controls. The unique enrichment of Collinsella in r-axSpA patients remained stable across time and treatment, suggesting it may be a disease biomarker.

Figure 1.

a) Flowchart of axSpA patients summarizing the main clinical and disease activity parameters of the cohort. b) Taxa with the most pronounced shifts in median relative abundance in patients with axSpA after receiving biological treatment for one year. c-d) Alpha and beta diversity analyses, respectively, of axSpA patients before and after treatment compared to control individuals. Labeled points in d represent group means.

Disclosure of Interests

None declared

AB0878 Higher vitamin D serum level is associated with a better clinical response to bDMARDs in patients with axial spondyloarthritis

Background

Vitamin D deficiency has been shown to be associated with higher disease activity and severity of several inflammatory diseases such as rheumatoid arthritis, inflammatory bowel disease and spondyloarthritis (SpA). It is, however, unknown if vitamin D level might affect the response to treatment with biologic disease-modifying anti-rheumatic drugs (bDMARDs) in patients with SpA.

Objectives

To investigate the association between vitamin D serum levels and the response to a bDMARD therapy in patients with axial SpA.

Methods

Patients with a radiographic axial SpA (r-axSpA), fulfilling the modified New York criteria and starting a bDMARD therapy were recruited between 2015 and 2019 in an extension of the prospective German Spondyloarthritis Inception Cohort (GESPIC-AS). All patients were required to have at inclusion high disease activity (BASDAI >=4 and/or ASDAS >=2.1) despite previous treatment with nonsteroidal anti-inflammatory drugs. Demographics, patient clinical characteristics and vitamin D serum levels were collected at baseline. Disease activity measures (BASDAI, CRP, ASDAS) were assessed at baseline and after 6 months of bDMARD treatment. Vitamin D deficiency was defined as serum level of 25-hydroxyvitamin D < 20 ng/mL. A multivariable regression analysis was performed to determine the association between vitamin D serum level at baseline and the treatment response as defined by BASDAI and ASDAS change scores at month 6 as compared to baseline.

Results

A total of 129 patients with r-axSpA were included in the study. No patient took supplements of vitamin D at baseline. Patients had an average age (mean±SD) of 36.5±10.5 years, 64.3% were males and 86.6% were HLA-B27 positive. The prevalence of vitamin D deficiency in our cohort was 54.3%. Patient characteristics and disease activity were comparable with regard to the presence of vitamin D at baseline (Table 1); with the exception of body mass index (BMI), which was higher in patients with vitamin D deficiency. In the multivariable linear regression analysis, baseline serum level of vitamin D was independently and significantly associated with higher change in BASDAI and ASDAS (Figure 1).

Table 1.

Baseline characteristics of patients with radiographic axial SpA (n=129) according to vitamin D levels at baseline.

Patients with vitamin D deficiency (<20 ng/mL)n=70Patients with normal levels of vitamin Dn=59Age, years36.6±11.036.3±10.0Male sex46 (65.7)37 (62.7)BMI, kg/m226.0±4.5*24.0±3.8Smoking, ever41 (58.6)29 (49.2)Winter and Spring, n (%)33 (47.1)23 (39.0)Symptom duration, years11.5±11.310.3±7.1HLA-B27 positive62 (88.6)50 (84.7)Uveitis ever17 (24.3)12 (20.3)Psoriasis ever11 (15.7)7 (11.9)IBD ever, n (%)2 (2.9)7 (11.9)CRP, mg/L12.9±19.313.9±15.3BASDAI5.7±1.45.4±1.4ASDAS3.4±0.83.5±0.8BASFI4.6±2.24.4±1.9BASMI3.1±1.52.7±1.3NSAID intake, current50 (71.4)45 (76.3)DMARDs intake, ever9 (12.9)6 (10.2)TNFi naive55 (78.6)47 (79.7)Corticoids intake, current5 (7.1)2 (3.4)

*p value <0.05.

All numerical variables were presented as mean±SD, all categorical variables were presented as n (%).

BMI, body mass index; CRP, C-reactive protein; DMARD, disease-modifying antirheumatic drug; IBD, inflammatory bowel disease; NSAID, nonsteroidal anti-inflammatory drug; TNFi, tumor necrosis factor inhibitor.

Figure 1.

Association between the response to bDMARDs (change in BASDAI and ASDAS after 6 months) and level of vitamin D at baseline in patients with radiographic axial SpA in the multivariable regression analysis.

Conclusion

Higher vitamin D levels at baseline may predict a better treatment response to bDMARDs in patients with r-axSpA. It has to be shown, however, if vitamin D supplementation might result in a better treatment response in axial SpA.

Disclosure of Interests

None declared

POS1460 CONTRIBUTING TO THE TRAINING OF IMAGING IN RHEUMATOLOGY BY EXPERTS WORLDWIDE VIA INTERACTIVE MOBILE E-TEACHING: BERLINCASEVIEWER

Background

Rheumatology education today can be very diverse, and you can find everything from structured textbooks to YouTube channels to social media accounts. Peer-reviewed content is still recognized as a very high-quality source of information. App-based content has the advantage of bundling information in one place, always available on the go. However, the majority of offerings are only available in English.

Objectives

An app was to be created to learn about imaging in rheumatology in a very easy to understand way in different languages, with experts being able to create translated content very easily.

Methods

Using mySQL, Java, Objective C and JavaScript, a case database with specific structure and numerous interactive elements was created for academic teaching. Special functions for the annotation of images were provided. The development was initially for devices with the iOS operating system, and later for Android. Rheumatologists and radiologists worldwide were invited to participate via the social media channels LinkedIn, Instagram, Facebook, Twitter, and TikTok.

Results

The app, called BerlinCaseViewer, was developed for smartphones, tablets and Mac computers. All information is entered and processed in a web-based database. Using XML files and ZIP archives, the relevant data is then transferred to the mobile apps. Case of the month and learning modules on rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis are available, many in English, Spanish, French, Italian, Portuguese, German, and other languages (Figure 1). In addition to the medical image data, the patient’s medical history is also presented in an exciting way with the help of multiple-choice questions. Only when all questions are answered, the diagnosis becomes visible. Timeline functions can be used to visualize medical courses as well. Colored overlays are used to annotate images and can be placed with pixel precision. The user can decide whether these should be displayed as aids. Content is peer-reviewed before publication.

Figure 1.

Multi-lingual presentation of medical training cases.

Conclusion

BerlinCaseViewer is a new approach not only to train medical professionals, but also to connect colleagues and overcome language barriers. As a platform, BerlinCaseViewer is open to all medical professionals to collaborate, whether to contribute their own cases or translate existing cases for use in the local language.

References

[1]BerlinCaseViewer home page: https://www.berlincaseviewer.de/

Disclosure of Interests:

Kay-Geert Hermann Shareholder of: Co-founder of BerlinFlame GmbH, Mikhail Protopopov: None declared, Aline Serfaty: None declared, Ihsane Hmamouchi: None declared, Fernando Sommerfleck: None declared, Fabio Macori: None declared, Katharina Ziegeler: None declared, Torsten Diekhoff: None declared, Denis Poddubnyy Shareholder of: Co-founder of BerlinFlame GmbH, Joachim Sieper Shareholder of: Co-founder of BerlinFlame GmbH

OP0019 BIMEKIZUMAB IN PATIENTS WITH ACTIVE ANKYLOSING SPONDYLITIS: 24-WEEK EFFICACY & SAFETY FROM BE MOBILE 2, A PHASE 3, MULTICENTRE, RANDOMISED, PLACEBO-CONTROLLED STUDY

Background

Bimekizumab (BKZ) is a monoclonal IgG1 antibody that selectively inhibits IL-17F in addition to IL-17A. In a phase 2b study, BKZ showed rapid and sustained efficacy and was well tolerated up to 156 weeks (wks) in patients (pts) with active ankylosing spondylitis (AS).1,2

Objectives

To assess efficacy and safety of BKZ vs placebo (PBO) in pts with active AS up to Wk 24 in the ongoing pivotal phase 3 study, BE MOBILE 2.

Methods

BE MOBILE 2 (NCT03928743) comprises a 16-wk double-blind, PBO-controlled period and 36-wk maintenance period. Pts were aged ≥18 yrs, met modified New York criteria and had active AS (BASDAI ≥4, spinal pain ≥4) at BL. Pts were randomised 2:1, BKZ 160 mg Q4W:PBO. From Wk 16, all pts received BKZ 160 mg Q4W. Primary and secondary efficacy endpoints were assessed at Wk 16.

Results

Of 332 randomised pts (BKZ: 221; PBO: 111), 322 (97.0%) completed Wk 16 and 313 (94.3%) Wk 24. BL characteristics were comparable between groups: mean age 40.4 yrs, symptom duration 13.5 yrs; 72.3% pts male, 85.5% HLA-B27+, 16.3% TNFi-experienced. At Wk 16, the primary (ASAS40: 44.8% BKZ vs 22.5% PBO; p<0.001) and all ranked secondary endpoints were met (Table 1). Responses with BKZ were rapid, including in PBO pts who switched to BKZ at Wk 16, and increased to Wk 24 (Figure 1; Table 1). Substantial reductions of hs-CRP by Wk 2 and MRI SIJ and spine inflammation by Wk 16 were achieved with BKZ vs PBO (Table 1). At Wk 24, ≥50% pts had achieved ASDAS <2.1 (Figure 1).

Table 1.

Efficacy at Wks 16 and 24

BLWk 16Wk 24PBO N=111BKZ 160 mg Q4W N=221PBO N=111BKZ 160 mg Q4W N=221p valuePBO→BKZ 160 mg Q4W N=111BKZ 160 mg Q4W N=221Ranked endpoints in hierarchical orderASAS40* [NRI] n (%)--25 (22.5)99 (44.8)<0.00163 (56.8)119 (53.8)ASAS40 in TNFi-naïve† [NRI] n (%)--22 (23.4)a84 (45.7)b<0.00156 (59.6)a100 (54.3)bASAS20† [NRI]n (%)--48 (43.2)146 (66.1)<0.00185 (76.6)159 (71.9)BASDAI CfB† [MI] mean (SE)6.5 (0.1)6.5 (0.1)–1.9 (0.2)–2.9 (0.1)<0.001–3.3 (0.2)–3.3 (0.1)ASAS PR† [NRI]n (%)--8 (7.2)53 (24.0)<0.00128 (25.2)56 (25.3)ASDAS-MI† [NRI] n (%)--6 (5.4)57 (25.8)<0.00143 (38.7)67 (30.3)ASAS 5/6† [NRI]n (%)--16 (14.4)94 (42.5)<0.00157 (51.4)107 (48.4)BASFI CfB† [MI] mean (SE)5.2 (0.2)5.3 (0.2)–1.1 (0.2)–2.2 (0.1)<0.001–2.2 (0.2)–2.4 (0.2)Nocturnal spinal pain CfB† [MI]mean (SE)6.8 (0.2)6.6 (0.1)–1.9 (0.2)–3.3 (0.2)<0.001–3.7 (0.3)–3.8 (0.2)ASQoL CfB† [MI] mean (SE)8.5 (0.4)9.0 (0.3)–3.2 (0.3)–4.9 (0.3)<0.001–4.9 (0.4)–5.4 (0.3)SF-36 PCS CfB† [MI] mean (SE)34.6 (0.8)34.4 (0.6)5.9 (0.8)9.3 (0.6)<0.00110.6 (0.8)10.8 (0.6)BASMI CfB† [MI] mean (SE)3.8 (0.2)3.9 (0.1)–0.2 (0.1)–0.5 (0.1)0.005–0.5 (0.1)–0.6 (0.1)Other endpointsnEnthesitis-free state†c [NRI]n (%)--22 (32.8)d68 (51.5)e-33 (49.3)d70 (53.0)eASAS40 in TNFi-experienced [NRI]n (%)--3 (17.6)f15 (40.5)g---ASDAS-CRP CfB [MI]mean (SE)3.7 (0.1)3.7 (0.1)–0.7 (0.1)–1.4 (0.1)-–1.7 (0.1)–1.6 (0.1)hs-CRP (mg/L) [MI] geometric mean (median)6.7 (6.3)6.5 (8.2)6.0 (6.3)2.4 (2.4)-1.9 (2.2)2.1 (2.3)MRI spine Berlin CfBh [OC] mean (SD)3.3 (4.9)i3.8 (5.3)j0.0 (1.4)k–2.3 (3.9)l---SPARCC MRI SIJ score CfBh [OC] mean (SD)5.8 (7.7)i7.4 (10.7)m1.1 (6.9)k–5.6 (9.9)l---

Randomised set. *Primary endpoint; †Secondary endpoint; an=94; bn=184; cMASES=0 in pts with BL MASES >0; dn=67; en=132; fn=17; gn=37; hIn pts in MRI sub-study; in=45; jn=82; kn=43; ln=79; mn=83; nNominal p values not shown.

Over 16 wks, 120/221 (54.3%) BKZ pts had ≥1 TEAE vs 48/111 (43.2%) PBO; three most frequent on BKZ were nasopharyngitis (BKZ: 7.7%; PBO: 3.6%), headache (4.1%; 4.5%) and oral candidiasis (4.1%; 0%). No systemic candidiasis was observed. Up to 16 wks, incidence of SAEs was low (1.8%; 0.9%); no MACE or deaths were reported; 2 (0.9%) IBD cases occurred in pts on BKZ.

Conclusion

Dual inhibition of IL-17A and IL-17F with BKZ in pts with active AS resulted in rapid, clinically relevant improvements in efficacy outcomes vs PBO. No new safety signals were observed.1,2

References

[1]van der Heijde D. Ann Rheum Dis 2020;79:595–604; 2. Gensler L. Arthritis Rheumatol 2021;73(suppl 10):0491.

Acknowledgements

This study was funded by UCB Pharma. Editorial services were provided by Costello Medical.

Disclosure of Interests

Désirée van der Heijde Consultant of: AbbVie, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Lilly, Novartis, Pfizer, UCB Pharma, Employee of: Imaging Rheumatology BV (Director), Xenofon Baraliakos Speakers bureau: AbbVie, BMS, Chugai, Eli Lilly, Galapagos, Gilead, MSD, Novartis, Pfizer, and UCB Pharma, Paid instructor for: AbbVie, BMS, Chugai, Eli Lilly, Galapagos, Gilead, MSD, Novartis, Pfizer, and UCB Pharma, Consultant of: AbbVie, BMS, Chugai, Eli Lilly, Galapagos, Gilead, MSD, Novartis, Pfizer, and UCB Pharma, Maxime Dougados Consultant of: AbbVie, Eli Lilly, Novartis, Merck, Pfizer, and UCB Pharma, Grant/research support from: AbbVie, Eli Lilly, Novartis, Pfizer, and UCB Pharma, Matt Brown Speakers bureau: Novartis, Consultant of: Pfizer, Clementia, Ipsen, Regeneron, Grey Wolf Therapeutics, Grant/research support from: UCB Pharma, Denis Poddubnyy Speakers bureau: AbbVie, BMS, Eli Lilly, MSD, Novartis, Pfizer, and UCB Pharma, Consultant of: AbbVie, Biocad, Eli Lilly, Gilead, GSK, MSD, Novartis, Pfizer, Samsung Bioepis, and UCB Pharma, Grant/research support from: AbbVie, MSD, Novartis, and Pfizer, Filip van den Bosch Speakers bureau: AbbVie, Bristol Myers-Squibb, Celgene, Janssen, Merck, Novartis, Pfizer and UCB Pharma, Consultant of: AbbVie, Amgen, Eli Lilly, Galapagos, Janssen, Merck, Novartis, Pfizer and UCB Pharma, Nigil Haroon Consultant of: AbbVie, Amgen, Janssen, Merck, Novartis and UCB Pharma, Huji Xu: None declared, Tetsuya Tomita Speakers bureau: AbbVie, Astellas, Bristol-Myers Squibb, Eisai, Eli Lilly, Janssen, Kyowa Kirin, Mitsubishi-Tanabe, Novartis, and Pfizer, Consultant of: AbbVie, Eli Lilly, Gilead, Novartis, and Pfizer, Lianne S. Gensler Consultant of: AbbVie, Eli Lilly, Gilead, GSK, Novartis, Pfizer, and UCB Pharma, Grant/research support from: Novartis, Pfizer, and UCB Pharma; paid to institution, Marga Oortgiesen Employee of: UCB Pharma, Carmen Fleurinck Employee of: UCB Pharma, Thomas Vaux Employee of: UCB Pharma, Alexander Marten Employee of: UCB Pharma, Atul Deodhar Speakers bureau: Janssen, Novartis, and Pfizer; consultant of AbbVie, Amgen, Aurinia, BMS, Celgene, Eli Lilly, GSK, Janssen, MoonLake, Novartis, Pfizer, and UCB Pharma, Grant/research support from: AbbVie, Eli Lilly, GSK, Novartis, Pfizer, and UCB Pharma.