Incidence and prevalence of alopecia areata in the Australian primary care setting: A retrospective analysis of electronic health record data

BACKGROUND

Alopecia areata (AA) is a common immune-mediated non-scarring hair loss, with a worldwide incidence between 0.57% and 3.8%. The incidence and prevalence of AA in the Australian general population have not been previously reported.

OBJECTIVE

To describe the incidence and prevalence of AA in Australia using primary care data. A secondary objective was to identify common demographic characteristics, comorbidities and treatment patterns among Australians living with AA.

METHODS

We analysed electronic health record data captured from a national clinical practice management software over a 10-year index period between 2011 and 2020 calendar years, inclusive. The incidence of new-onset AA and the prevalence of active records with AA were estimated. Differences in incidence by sociodemographic groups, and patterns of treatment were also evaluated.

RESULTS

There were 976 incident AA records. The incidence of new-onset AA in the total study cohort was 0.278 per 1000 person-years (95% CI 0.26-0.295). By age, the incidence was highest in the 19- to 34-year-old age bracket (0.503 per 1000 person-years: 95% CI 0.453-0.554). AA incidence was lower among females than males (IRR 0.763, p < 0.001, 95% CI 0.673-0.865). Among active records, 520 were prevalent AA records. AA point prevalence at 31/12/2020 was 0.13% (1.26 per 1000 persons; 95% CI 1.15-1.37).

CONCLUSION

This is the first study to describe the epidemiology (incidence and point prevalence) and management of AA in the Australian primary health-care population through large-scale database analysis. Incidence and prevalence findings were consistent with earlier estimates from other regions.

POS1019 REAL-WORLD EVALUATION OF TREATMENT PATTERNS AND PERSISTENCE OF TOFACITINIB IN TREATMENT OF PSORIATIC ARTHRITIS IN AUSTRALIA: AN ANALYSIS OF THE OPAL DATASET

Background

Tofacitinib (TOF), a potent selective inhibitor of Janus kinase (JAK), is an approved treatment of psoriatic arthritis (PsA). In Australia, patients with active PsA despite six months of therapy with a pre-specified combination of csDMARDs are eligible to receive subsidised b/tsDMARDs. The clinician can prescribe the b/tsDMARD they deem to be the most clinically appropriate for the patient. Limited data exist to describe the real-world treatment patterns, characteristics and clinical outcomes of patients with PsA who receive TOF in the real-world setting.

Objectives

To describe real-world treatment patterns and treatment persistence among patients with PsA treated with TOF in the Australian post-approval setting using the OPAL dataset.

Methods

The OPAL dataset is a collection of deidentified clinical data derived from the electronic medical records of 112 rheumatologists at 43 sites around Australia. Adult patients with a diagnosis of PsA who received at least one prescription of TOF, a tumour necrosis factor inhibitor (TNFi) or an interleukin 17 inhibitor (IL-17Ai) between May 2019 and Sept 2020 were eligible, with data up to Sept 2021 included in the analysis. Results were summarised descriptively. Treatment persistence was summarised using Kaplan-Meier methods.

Results

Of 16,692 patients with PsA identified in the OPAL dataset, 1,486 (TOF n=406, IL-17Ai n=416, and TNFi n=664) were eligible for inclusion in this study. At the time of treatment initiation, the mean (SD) age of TOF, IL-17Ai and TNFi treated patients was 55.56 (12.68), 52.65 (12.72) and 50.32 (14.57) years, respectively. 19.2% of patients receiving TOF were first line compared with 41.8% of IL-17Ai and 62.8% of TNFi treated patients. The mean (SD) time from symptom onset to treatment initiation was longest for patients receiving TOF in first line (153.29 (127.50) months) compared to first line IL-17Ai (116.83 (113.97) months) and TNFi treated patients (92.37 (89.01) months). Overall, 34.2% of TOF, 32.9% of IL-17Ai and 26.4% of TNFi treated patients initiated therapy without concomitant cDMARDs being recorded.

Overall median persistence was 16.54 months (95% CI 13.84, 19.53) for TOF treated patients, 17.65 months (95% CI, 15.75, 19.56) for IL-17Ai treated patients and 17.16 months (95% CI 14.86, 20.48) for TNFi treated patients. As expected, persistence was generally longer in patients treated as first line (Figure 1) with patients receiving TOF observed to have slightly higher persistence in the first 15 months of treatment.

Figure 1.

Treatment persistence of patients receiving TOF, IL-17Ai and TNFi as first line therapy. Plot curtailed at 15 months as relatively few patients have information past this point. Where no stop date was recorded, censoring occurs at last recorded visit

Conclusion

In this analysis of a large Australian real-world dataset, TOF was more commonly utilised as a later line therapy for patients with PsA. Patients receiving TOF were observed to have slightly higher persistence within the first 15 months of starting first line therapy in this preliminary analysis.

Acknowledgements

The authors acknowledge the members of OPAL Rheumatology Ltd and their patients for providing clinical data for this study, and Software4Specialists Pty Ltd for providing the Audit4 platform. Financial support was provided by Pfizer Australia

Disclosure of Interests

Geoff Littlejohn Consultant of: Abbvie, Janssen, Bristol Myers Squibb, Gilead, Eli Lilly, and MSD, Jo Leadbetter: None declared, Belinda Butcher: None declared, Marie Feletar: None declared, Catherine OSullivan: None declared, Tegan Smith: None declared, David Witcombe Employee of: Pfizer Australia, Ho Yin Employee of: Pfizer Australia, Peter Youssef Speakers bureau: AbbVie, Novartis, Janssen and Eli Lilly

A systematic review of conversion from calcineurin inhibitor to mammalian target of rapamycin inhibitors for maintenance immunosuppression in kidney transplant recipients

This was a systematic review of randomized controlled trials comparing delayed conversion of mammalian target of rapamycin inhibitors (mTORi) for calcineurin inhibitors (CNIs) versus CNI continuation in kidney transplantation. Databases (2000-2012) and conference abstracts (2009-2012) were searched giving a total of 29 trials. Outcomes analyzed included GFR, graft loss, rejection and adverse events and were expressed as weighted mean differences (WMDs) or as risk ratios (RRs). Patients converted to mTORi up to 1 year posttransplant in intention-to-treat analysis had higher GFR compared with those remaining on CNI (WMD 0.28 mL/min/1.73 m(2) , 95% confidence interval [CI] 0.21-0.36; I(2)  = 68%, p < 0.001). Stratifying trials by time posttransplant or type of mTORi did not change the overall heterogeneity. For on-treatment population, mTORi was associated with higher GFR (14.21 mL/min/1.73 m(2) , 10.34-18.08; I(2)  = 0%, p = 0.970) 2-5 years posttransplant. The risk of rejection at 1 year was higher in mTORi trials (RR 1.72, 1.34-2.22; I(2)  = 12%, p = 0.330). Discontinuation secondary to adverse events was more common in patients on mTORi, whereas the incidence of skin cancers and cytomegalovirus infection was lower in patients on mTORi. Conversion from CNI to mTORi is associated with short-term improvements in GFR in a number of studies but longer-term follow-up data of graft and patient survival are required.