Secukinumab provides sustained low rates of radiographic progression in psoriatic arthritis: 52-week results from a phase 3 study, FUTURE 5

Objective

To evaluate the effect of secukinumab on radiographic progression through 52 weeks in patients with PsA from the FUTURE 5 study.

Methods

Patients with active PsA, stratified by prior anti-TNF use (naïve or inadequate response), were randomized to s.c. secukinumab 300 mg load (300 mg), 150 mg load (150 mg), 150 mg no load regimens or placebo at baseline, at weeks 1, 2 and 3 and every 4 weeks starting at week 4. Radiographic progression was assessed by change in van der Heijde-modified total Sharp score (vdH-mTSS; mean of two readers). Statistical analysis used a linear mixed-effects model (random slope) at weeks 24 and 52, and observed data at week 52. Assessments at week 52 included additional efficacy endpoints (non-responders imputation and mixed-effects models for repeated measures) and safety.

Results

The majority (86.6%) of patients completed 52 weeks of treatment. The proportion of patients with no radiographic progression (change from baseline in vdH-mTSS ⩽0.5) was 91.8, 85.2 and 87.2% in 300, 150 and 150 mg no load groups, respectively, at week 52. The change in vdH-mTSS from baseline to week 52 using random slope [mean change (s.e.)] was –0.18 (0.17), 0.11 (0.18) and –0.20 (0.18) in 300, 150 and 150 mg no load groups, respectively; the corresponding observed data [mean change (s.d.)] was –0.09 (1.02), 0.13 (1.39) and 0.21 (1.15). Clinical efficacy endpoints were sustained, and no new or unexpected safety signals were reported through 52 weeks.

Conclusion

Secukinumab 300 and 150 mg with or without s.c. loading regimen provided sustained low rates of radiographic progression through 52 weeks of treatment.

Trial registration

ClinicalTrials.gov, http://clinicaltrials.gov, NCT02404350.

Long-term effectiveness and safety of infliximab, golimumab and ustekinumab in patients with psoriatic arthritis from a Canadian prospective observational registry

OBJECTIVES

The objectives of this study were to describe the demographic profile and baseline disease characteristics of patients with psoriatic arthritis (PsA) treated with either infliximab (IFX), subcutaneous golimumab (GLM) or ustekinumab (UST) treatment in Canadian routine care setting along with assessing long-term effectiveness and safety.

METHODS

Patients with PsA were enrolled into the Biologic Treatment Registry Across Canada registry (ClinicalTrials.gov Identifier: NCT00741793) from 2005 to 2017. The study visits occurred at study enrolment (baseline) and every 6 months thereafter. Effectiveness was assessed by changes in disease parameters (joint counts, Psoriasis Area Severity Index (PASI), Health Assessment Questionnaire, patient/physician global, minimal disease activity, enthesitis, dactylitis, erythrocyte sedimentation rate, C reactive protein). Improvements from baseline were explored with the paired t-test and the McNemar's test. Safety was evaluated by assessing the incidence of adverse events (AEs) and drug survival rates.

RESULTS

A total of 111 IFX-treated, 281 GLM-treated and 70 UST-treated patients were enrolled. Most baseline disease parameters remained similar over time in all three cohorts. UST-treated patients had lower mean baseline Disease Activity Score in 28 joints CRP, swollen joint based on 28 joints and higher PASI compared with patients treated with GLM. Treatment with IFX, GLM and UST was associated with significant improvements in all disease parameters over time (p<0.001) from baseline up to 84, 84 and 40 months, respectively.AEs were reported for 74.8%, 69.8% and 52.9% (138, 114 and 115 events/100 patient-years (PYs)) covering 325, 567 and 87 years of exposure for IFX-treated, GLM-treated and UST-treated patients, respectively. Severe AEs were reported in 19.8%, 8.5% and 5.7% (8.8, 7.2 and 8.0 events/100 PYs) in IFX-treated, GLM-treated and UST-treated patients, respectively. The proportion of patients who discontinued treatment were 63.1%, 50.9% and 50.0%, respectively.

CONCLUSIONS

IFX, GLM and UST treatment significantly reduced disease activity and improved functionality in patients with PsA followed by routine clinical practice and had a safety profile similar to that previously reported in the literature.

TRIAL REGISTRATION NUMBER

NCT00741793.

Is it safe to lift COVID-19 travel bans? The Newfoundland story

A key strategy to prevent a local outbreak during the COVID-19 pandemic is to restrict incoming travel. Once a region has successfully contained the disease, it becomes critical to decide when and how to reopen the borders. Here we explore the impact of border reopening for the example of Newfoundland and Labrador, a Canadian province that has enjoyed no new cases since late April, 2020. We combine a network epidemiology model with machine learning to infer parameters and predict the COVID-19 dynamics upon partial and total airport reopening, with perfect and imperfect quarantine conditions. Our study suggests that upon full reopening, every other day, a new COVID-19 case would enter the province. Under the current conditions, banning air travel from outside Canada is more efficient in managing the pandemic than fully reopening and quarantining 95% of the incoming population. Our study provides quantitative insights of the efficacy of travel restrictions and can inform political decision making in the controversy of reopening.

Genetic variability of human angiotensin-converting enzyme 2 (hACE2) among various ethnic populations

BACKGROUND

There appears to be large regional variation for susceptibility, severity, and mortality for COVID-19 infections. Numerous potential factors could explain the wide variability in the number of infections and death among the countries. We examined genetic differences in the human angiotensin-converting enzyme 2 (hACE2) gene, as its receptor serves as a cellular entry for SARS-CoV-2. At present, there is a paucity of data regarding the differences for ACE2 polymorphisms and expression levels between ethnicities.

METHODS

We compared the allele frequency of mutations between European and East Asians. Molecular dynamic simulation were performed to investigate the influences of significant mutant on protein structure. The binding free energies were calculated between S protein and hACE2. We also examined hACE2 gene expression in eight global populations from HapMap3.

RESULTS

Four missense mutations showed significant minor allele frequency difference between Asians and Caucasians. Molecular dynamic demonstrated that two of these variants (K26R and I468V) may affect binding characteristics between S protein of the virus and hACE2 receptor. We also noted marginal differences in gene expression for some populations in HapMap3 as compared to the Chinese population.

CONCLUSION

Our studies reveal subtle changes in the genetics of hACE2 between human populations, but the magnitude of the difference was small and the significance is not clear in the absence of further in vitro and functional studies.

Public interest in whole genome sequencing and information needs: an online survey study

Aim: To survey the general public about whole genome sequencing interest, including pharmacogenomic testing, and to identify information important for sequencing decisions. Patients & methods: An online survey of 901 members of the general public in an eastern Canadian province. Results: Interest in whole genome sequencing, including pharmacogenomic testing, was high with few differences among demographic variables. Issues identified as very important to sequencing decisions included familial implications of testing, whether treatment was available for conditions tested and knowing who could access genomic information. Most respondents would value support when interpreting sequencing results. Conclusion: Findings reveal the kind of information and support users of sequencing services would value and could inform the implementation of sequencing into care in ways that accord with public preferences and needs.

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Table.

W52 clinical efficacy

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

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

Missing data not imputed.

SD, standard deviation.

Conclusion:

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

References:

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

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

Disclosure of Interests:

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

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Conclusion:

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

Table 1.

Baseline Demographics

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

Disclosure of Interests:

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

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Conclusion:

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

References:

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

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

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

Disclosure of Interests:

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

Figure.

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

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

Background:

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

Objectives:

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

Methods:

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

Table 1.

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

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

* p≤.05

Results:

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

Conclusion:

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

Disclosure of Interests:

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

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Table 1.

The association between (selected top markers)

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

Performance of the genetic assay in predicting PsA

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

Conclusion:

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

Disclosure of Interests:

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

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Conclusion:

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

References:

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

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

Table.

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

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

Data are % (95% CI)

*p>0.05, †p<0.05,‡p<0.001

LSmeans, p values based on MMRM

LSmean diffs, p values vs PBO

Acknowledgments:

None

Disclosure of Interests:

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

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Table 1.

Patient Reported AEs, n (%)

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

*Medical Dictionary for Regulatory Activities (MedDRA) preferred term

Table 2.

Lab Results*

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

*NCI toxicity grade

ALT=Alanine aminotransferase

Conclusion:

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

References:

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

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

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

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

Acknowledgments:

None

Disclosure of Interests:

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

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Table 1.

Analysis of sociodemographic and clinical variables in relation to pharmacologic treatment

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

B, B coefficient; NA, [not applicable]

Conclusion:

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

Disclosure of Interests:

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

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Table 1.

Clinical Features by Imaging Clustering

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

Median (IQ range) and frequencies (%)

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

Conclusion:

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

Acknowledgments:

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

Disclosure of Interests:

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

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Conclusion:

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

References:

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

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

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

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

Table.

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

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

*P vs placebo<0.02

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

Mediation analysis4used linear and logistics regression models with Bootstrapping method

Acknowledgments:

None

Disclosure of Interests:

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

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Conclusion:

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

References:

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

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

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

Figure.

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

Disclosure of Interests:

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

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Table 1.

Demographics of psoriatic arthritis (PsA) patients.

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

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

Figure 2.

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

Conclusion:

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

Disclosure of Interests:

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

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Conclusion:

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

References:

[1]Deodhar A (A#807),

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

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

Table.

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

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

* p < 0.001 (Chi-square)

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

bIn pts with D at W0

cIn pts with E at W0

Acknowledgments:

None

Disclosure of Interests:

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

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

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

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

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

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

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

cScored 1–10 on NRS

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

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

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

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

Conclusion:

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

References:

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

Disclosure of Interests:

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

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

Background:

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

Objectives:

Assess GUS efficacy and safety through W52.

Methods:

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

Results:

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

Table 1.

Observed Efficacy1

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

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

Conclusion:

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

References:

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

Acknowledgments:

None

Disclosure of Interests:

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

Differential correlation network analysis identified novel metabolomics signatures for non-responders to total joint replacement in primary osteoarthritis patients

INTRODUCTION

Up to one third of total joint replacement patients (TJR) experience poor surgical outcome.

OBJECTIVES

To identify metabolomic signatures for non-responders to TJR in primary osteoarthritis (OA) patients.

METHODS

A newly developed differential correlation network analysis method was applied to our previously published metabolomic dataset to identify metabolomic network signatures for non-responders to TJR.

RESULTS

Differential correlation networks involving 12 metabolites and 23 metabolites were identified for pain non-responders and function non-responders, respectively.

CONCLUSION

The differential networks suggest that inflammation, muscle breakdown, wound healing, and metabolic syndrome may all play roles in TJR response, warranting further investigation.

Guselkumab in biologic-naive patients with active psoriatic arthritis (DISCOVER-2): a double-blind, randomised, placebo-controlled phase 3 trial

BACKGROUND

The interleukin-23 (IL-23)/T-helper 17 cell pathway is implicated in psoriatic arthritis pathogenesis. Guselkumab, an IL-23 inhibitor that specifically binds the IL-23 p19 subunit, significantly and safely improved psoriatic arthritis in a phase 2 study. DISCOVER-2 was a phase 3 trial to assess guselkumab in biologic-naive patients with psoriatic arthritis.

METHODS

This phase 3, double-blind, placebo-controlled study was done at 118 sites in 13 countries across Asia, Europe, and North America. We enrolled biologic-naive patients with active psoriatic arthritis (at least five swollen joints, at least five tender joints, and C-reactive protein ≥0·6 mg/dL) despite standard therapies. Patients were randomly assigned (1:1:1, computer-generated permuted blocks; stratified by baseline disease-modifying antirheumatic drug use and C-reactive protein concentration) to subcutaneous injections of guselkumab 100 mg every 4 weeks; guselkumab 100 mg at weeks 0, 4, then every 8 weeks; or placebo. The primary endpoint was American College of Rheumatology 20% improvement (ACR20) response at week 24 in all patients per assigned treatment group. Safety was assessed in all patients per treatment received. This trial is registered at ClinicalTrials.gov, NCT03158285 (active, not recruiting).

FINDINGS

From July 13, 2017, to Aug 3, 2018, 1153 patients were screened, of whom 741 were randomly assigned to receive guselkumab every 4 weeks (n=246), every 8 weeks (n=248), or placebo (n=247). One patient in the every 4 weeks group and one in the placebo group did not start treatment, and the remaining 739 patients started treatment; 716 patients continued treatment up to week 24. Significantly greater proportions of patients in the guselkumab every 4 weeks group (156 [64%] of 245 [95% CI 57-70]) and every 8 weeks group (159 [64%] of 248 [58-70]) than in the placebo group (81 [33%] of 246 [27-39]) achieved an ACR20 response at week 24 (percentage differences vs placebo 31% [95% CI 22-39] for the every 4 weeks group and 31% [23-40] for the every 8 weeks group; both p<0·0001). Up to week 24, serious adverse events occurred in eight (3%) of 245 patients receiving guselkumab every 4 weeks (three serious infections), three (1%) of 248 receiving guselkumab every 8 weeks (one serious infection), and seven (3%) of 246 receiving placebo (one serious infection). No deaths occurred.

INTERPRETATION

Guselkumab, a human monoclonal antibody that specifically inhibits IL-23 by binding the cytokine's p19 subunit, was efficacious and demonstrated an acceptable benefit-risk profile in patients with active psoriatic arthritis who were naive to treatment with biologics. These data support the use of selective inhibition of IL-23 to treat psoriatic arthritis.

FUNDING

Janssen Research and Development.

Metabolomics Signature for Non-Responders to Total Joint Replacement Surgery in Primary Osteoarthritis Patients: The Newfoundland Osteoarthritis Study

Although total joint replacement (TJR) surgery is considered as the most effective treatment for advanced osteoarthritis (OA) patients, up to one-third of patients reported unfavorable long-term post-operative pain outcomes. We aimed to identify metabolic biomarkers to predict non-responders to TJR using a metabolomics approach. TJR patients were recruited and followed-up at least 1-year post-surgery; TJR outcomes were assessed by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function subscales. Targeted metabolomic profiling was performed on plasma samples collected pre-surgery and pairwise metabolite ratios, as proxies for enzymatic reactions, were calculated. Association tests were performed between each metabolite ratio and non-responders. The metabolome-wide significance was defined as p < 2 × 10^-5 . A total of 461 TJR patients due to primary OA were included in the analysis. Fifteen percent of patients were classified as pain non-responders; 16% were classified as function non-responders. Lower baseline WOMAC pain and function scores were significantly associated with pain and function non-responders, respectively (both p < 0.03). Two metabolite ratios were significantly associated with pain non-responders; acetylcarnitine (C2) to phosphatidylcholine acyl-alkyl C40:1 (PC ae C40:1) was five times higher in pain non-responders whereas phosphatidylcholine diacyl C36:4 (PC aa C36:4) to isoleucine was twenty one times lower in pain non-responders than responders (all p ≤ 1.93 × 10^-5 ). One metabolite ratio, glutamine to isoleucine, was significantly lower in function non-responders than responders (eight times lower; p = 1.08 × 10^-5 ). Three metabolite ratios (C2 to PC ae C40:1, PC aa C36:4, and glutamine to isoleucine) related to inflammation and muscle breakdown could be considered as novel plasma markers for predicting non-responders to TJR and warrant further investigation. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:793-802, 2020.

Long-term efficacy and safety of secukinumab in patients with psoriatic arthritis: 5-year (end-of-study) results from the phase 3 FUTURE 2 study

BACKGROUND

Secukinumab is an interleukin-17A inhibitor used in the treatment of patients with active psoriatic arthritis. In the phase 3 FUTURE 2 trial, secukinumab showed sustained improvement in clinical outcomes over 2 years. Because scarce data exists on the long-term treatment with biological therapies in patients with psoriatic arthritis, we aimed to assess and describe the 5-year (end-of-study) results on the efficacy and safety of secukinumab 300 mg and 150 mg doses, as well as dose escalation, from the FUTURE 2 study.

METHODS

FUTURE 2 is a phase 3, double-blind, placebo-controlled study done at 76 centres in Asia, Australia, Canada, Europe, and the USA. Patients with active psoriatic arthritis aged 18 years or older were randomly assigned to either secukinumab (300 mg, 150 mg, or 75 mg) or placebo weekly from baseline and then every 4 weeks from week 4. Secukinumab dose was escalated from 150 mg to 300 mg and from 75 mg to 150 mg or 300 mg starting at week 128, if active signs of disease were observed in patients, on the basis of the physician's assessment, with the escalated dose maintained thereafter. We assessed key efficacy endpoints at week 260 (5 years) for secukinumab 300 mg and 150 mg, including American College of Rheumatology (ACR) and Psoriasis Area and Severity Index (PASI) responses. The safety analysis included all patients who received one or more doses of secukinumab. We report data as observed. This study is registered with ClinicalTrials.gov, NCT01752634.

FINDINGS

At randomisation, 65% of patients were naive to tumour necrosis factor inhibitors and 47% were receiving concomitant methotrexate. Of 397 patients randomly assigned in FUTURE 2, 248 (62%) completed 5 years of treatment, including 64 (64%) of 100 patients in the original secukinumab 300 mg group, 65 (65%) of 100 in the 150 mg group, 59 (60%) of 99 in the 75 mg group, and 60 (61%) of 98 in the placebo group. Overall, 127 (52%) of 242 patients required dose escalation during the study. ACR responses at 5 years were 71 (74%; ACR20), 50 (52%; ACR50), and 31 (32%; ACR70) of 96 evaluable patients in the secukinumab 300 mg group, and 67 (70%; ACR20), 41 (43%; ACR50), and 28 (29%; ACR70) of 96 evaluable patients in the secukinumab 150 mg group. From 24 to 32 weeks and from 48 to 84 weeks after dose escalation from secukinumab 150 mg to 300 mg, the proportions of ACR and PASI non-responders decreased, whereas the proportions of ACR and PASI responders increased. During the entire treatment period, the most frequent treatment-emergent serious adverse event was serious infection (exposure-adjusted incidence 1·7, 95% CI 1·1-2·5; n=25) in the any secukinumab group. No new or unexpected safety signals were reported.

INTERPRETATION

Secukinumab 300 mg and 150 mg provided sustained improvement in the signs and symptoms of psoriatic arthritis, with consistent safety over 5 years. This study supports the clinical benefit and safety of long-term treatment with secukinumab in patients with psoriatic arthritis.

FUNDING

Novartis.

P250 Effect of secukinumab on radiographic progression through 2 years in patients with active PsA: end-of-study results from a Phase 3 study

Background

Secukinumab demonstrated sustained efficacy, inhibition of radiographic progression and a stable safety profile over 52 weeks in patients with psoriatic arthritis (PsA) in FUTURE 5. We report the end-of-study (2-year) results on the effect of secukinumab on radiographic progression in PsA patients in FUTURE 5.

Methods

Adults (N = 996) with active PsA were randomised to subcutaneous secukinumab 300 mg load, 150 mg load, 150 mg no load or placebo at baseline, Weeks 1, 2, 3 and 4, and every 4 weeks thereafter. The secukinumab dose could be escalated from 150 to 300 mg from Week 52 onwards, based on physician judgement. Radiographic progression (mean change in vdH-mTSS) was based on hand/wrist/foot radiographs obtained at baseline, and Weeks 16 (nonresponders), 24, 52 and 104, assessed by two blinded readers (plus an adjudicator if required). Radiographic data were analysed using a linear mixed-effects model (random intercept, random slopes) at Weeks 24 and 52, and as observed at Week 104. Data are presented for patients originally randomised to secukinumab (300 and 150 mg); the 150 mg groups also included patients who had dose escalation to 300 mg. Analyses by prior TNF inhibitor (TNFi) status (naive vs inadequate response) were also performed.

Results

Overall, 85% (300 mg), 82% (150 mg) and 75% (150 mg no load) of patients completed 2 years of treatment. A total of 86 (39%) and 92 (41%) patients had their dose escalated to 300 mg in the 150 mg and 150 mg no load groups, respectively. In the overall population, the proportions of patients with no radiographic progression (change from baseline in vdH-mTSS≤0.5) with secukinumab were 89.5% (300 mg), 82.3% (150 mg) and 81.1% (150 mg no load) at 2 years; the corresponding proportions of patients with changes from baseline in vdH-mTSS≤0.0 were: 81.2%, 69.1% and 73.4%, respectively. Radiographic progression was low in secukinumab-treated patients in the overall population and by prior TNFi use over 2 years (Table 1). Clinical responses were sustained through 2 years of secukinumab treatment.

Conclusion

Low radiographic progression was observed over 2 years of treatment with secukinumab 300 and 150 mg in PsA patients.

Disclosures

H. Tahir: Member of speakers’ bureau; AbbVie, Janssen, Eli Lilly, Novartis. Grants/research support; Novartis, Eli Lilly. P. Mease: Consultancies; AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Galapagos, Gilead, GlaxoSmithKline, Janssen, Leo, Eli Lilly, Merck, Novartis, Pfizer, Sun Pharmaceutical Industries, INC pharma, UCB, Crescendo Bioscience. Member of speakers’ bureau; AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Genentech, Janssen, Leo, Merck, Novartis, Pfizer, UCB, Crescendo Bioscience. Grants/research support; AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Janssen, Leo, Eli Lilly, Merck, Novartis, Pfizer, Sun Pharmaceutical Industries, INC pharma, UCB, Crescendo Bioscience. R. Landewé: None. P. Rahman: Consultancies; AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Janssen, Eli Lilly, Novartis, UCB. Member of speakers’ bureau; AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Janssen, Eli Lilly, Novartis. Grants/research support; Janssen, Novartis. A. Singhal: Grants/research support; AbbVie, Gilead, Sanofi, Regeneron, Amgen, Roche, Bristol-Myers Squibb, Janssen, Lilly, Novartis, Pfizer, UCB, Astra Zeneca, MedImmune, FujiFilm, Nichi-Iko, Mallinckrodt. E. Böttcher: Consultancies; Amgen, Roche, Eli Lilly, Pfizer, MSD, Novartis. Member of speakers’ bureau; Amgen, Roche, Eli Lilly, Pfizer, MSD, Novartis. S. Navarra: Member of speakers’ bureau; Astellas, Johnson & Johnson, Novartis, Pfizer. A. Readie: Shareholder/stock ownership; Novartis. Other; Employee of: Novartis. S. Mpofu: Shareholder/stock ownership; Novartis. Other; Employee of: Novartis. E. Delicha: Consultancies; Novartis. L. Pricop: Shareholder/stock ownership; Novartis. Other; Employee of: Novartis. D. van der Heijde: Corporate appointments; Imaging Rheumatology BV. Consultancies; AbbVie, Amgen, Astellas, AstraZeneca, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Daiichi, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, UCB Pharma.