POS1060 A PROSPECTIVE, LONGITUDINAL STUDY TO EVALUATE REAL-WORLD PATIENT EXPERIENCES AND TREATMENT SATISFACTION WITH SECUKINUMAB FOR PSORIATIC ARTHRITIS

Background:

Psoriatic arthritis (PsA) is an inflammatory disease that impairs quality of life. Despite therapeutic advances, up to a third of patients do not respond or are unable to sustain a treatment response. Thus, data on patient treatment experience in PsA is critical.

Objectives:

To assess real-world experiences of patients with PsA treated with secukinumab.

Methods:

This is an ongoing 12-month, prospective, longitudinal, web-based survey study of patients with PsA initiating secukinumab. Patient demographics and medical history are collected at baseline using a rheumatologist case report form. Patient experience data are collected at baseline, 3, 6, 9, and 12 months by patient surveys. The primary endpoint is change in the Psoriatic Arthritis Impact of Disease 12-item questionnaire (PsAID12) from baseline to 3 months. In addition, this study will explore other changes at 3 months, including PsA symptoms, treatment satisfaction with secukinumab, and other patient-reported outcome measures. Baseline and available month 3 data from patients enrolled to date were analyzed descriptively.

Results:

Baseline demographic and medical history data were available for 72 patients; 32 (44.4%) were male, 59 (81.9%) were White, and 15 (20.8%) reported modifying their diet because of PsA. The mean (SD) time since symptom onset (n = 29) and since PsA diagnosis (n = 53) was 56.3 (45.6) and 34.4 (44.7) months, respectively. More than half of the patients who started treatment with secukinumab were biologic experienced (38/62; 61.3%). Primary and secondary loss of effectiveness were the main reasons for previous biologic discontinuation (Table 1). At 3 months (n = 49), the mean (SD) PsAID12 change from baseline was –1.8 (1.8) points. Additionally, 24.5% of patients reported their PsA symptoms to be “much better,” 40.8% reported “moderately better,” and 32.7% “a little better” compared with baseline; none reported “no change” or worsened symptoms. On a scale of 1-10, patients rated their overall satisfaction with secukinumab treatment at month 3 with a mean (SD) score of 6.8 (2.1). Patients were also highly satisfied with their symptom improvement, speed to symptom improvement, and the mode and frequency of secukinumab administration (Table 1).

Table 1.

Summary of Prior PsA Treatment and Treatment Satisfaction with Secukinumab at Month 3

Physician-reported treatment characteristicsBaseline measure(N = 62)Most recent PsA biologic prior to secukinumab, n (%)n = 31Adalimumab12 (38.7)Certolizumab pegol8 (25.8)Etanercept6 (19.4)Infliximab, including -dyyb3 (9.7)Golimumab1 (3.2)Unknown/not sure1 (3.2)Primary reasons for discontinuing previous PsA biologic treatment, n (%)an = 30Primary and secondary loss of effectiveness25 (83.3)Disease progression6 (20.0)Worsening of or new comorbidities1 (3.3)How the medication was taken2 (6.7)Adverse effects/intolerance4 (13.3)Otherb1 (3.3)Patient-reported treatment satisfaction with secukinumab, mean (SD)cMonth 3 (N = 49)Symptom improvement6.7 (2.3)Speed of symptom improvement6.9 (2.0)Dose frequency7.4 (1.9)cMethod of administration7.2 (1.5)Ease of use8.2 (1.5)Side effects, if any7.9 (1.9)Patient support services by manufacturer8.3 (1.7)

PsA, psoriatic arthritis.

a Rheumatologists may list > 1 reason. Data tabulated based on the number of case report forms received from rheumatologists at analysis cutoff (n = 30).

b Other reasons included availability of new treatment, patient request, or family history of disease.

c n = 48.

Conclusion:

Most patients were biologic experienced and reported primary or secondary loss of effectiveness as the main reason for discontinuation of their previous biologic. Patients reported overall symptom improvement and satisfaction with secukinumab treatment at 3 months after initiation.

Disclosure of Interests:

M Elaine Husni Consultant of: AbbVie, Amgen, Janssen, Novartis, Eli Lilly, UCB, and Regeneron, Michael Bozyczko Employee of: National Psoriasis Foundation, Daniel Wolin Employee of: RTI Health Solutions, Carolyn Sweeney Employee of: RTI Health Solutions, Eric Davenport Employee of: RTI Health Solutions, Steven Hass Employee of: Novartis, Esther Yi Employee of: Novartis, Peter Hur Employee of: Novartis, Linda Grinnell-Merrick Consultant of: AbbVie, Amgen (previously Celgene), Novartis, Pfizer, and Regeneron.

OP0052 COMPARISON OF PATIENTS WITH PSORIATIC ARTHRITIS (PSA) AND INVESTIGATOR-DEFINED AXIAL PSA TO PATIENTS WITH PSA AND ELEVATED PATIENT-REPORTED SPINE PAIN: FINDINGS FROM THE CORRONA PSORIATIC ARTHRITIS/SPONDYLOARTHRITIS (PSA/SPA) REGISTRY

Background:

Efforts are underway by GRAPPA and ASAS to define axial disease in psoriatic arthritis (axPsA).1AxPsA is typically diagnosed based on clinical evaluation and judgement, imaging, and patient-defined axial symptoms. In the MAXIMISE trial, part of the inclusion criteria for axPsA required patients to have a BASDAI ≥ 4 and patient-reported spine pain ≥ 40 in addition to clinician judgement.2

Objectives:

To compare characteristics of patients with PsA and investigator-identified axPsA to patients with PsA with BASDAI ≥ 4 and patient-reported spine pain ≥ 40.

Methods:

Adult patients with PsA enrolled in the registry from March 2013–December 2019 were included. Investigators identified the subset of patients with axPsA based on clinical assessments, imaging, and laboratory workup. All patients completed a BASDAI questionnaire and spine pain VAS. Patients with investigator-identified axPsA were compared with those who had BASDAI ≥ 4 and spine pain VAS ≥ 40 (elevated spine symptoms; non-mutually exclusive groups). Presence of other manifestations at enrollment was also evaluated: enthesitis (SPARCC enthesitis count > 0), dactylitis (dactylitis count > 0), peripheral arthritis (PA; tender and/or swollen joint count > 0), nail psoriasis (VAS > 0), skin psoriasis (affected body surface area > 0%). The prevalence of investigator-defined axPsA and elevated spine symptoms, alone and with other manifestations, was summarized for all patients and those who initiated biologics at enrollment using frequency counts and percentages.

Results:

Of 3393 patients with PsA, 391 (11.5%) had investigator-defined axPsA and 863 (25.4%) had elevated spine symptoms (Figure 1A); 127 (3.7%) patients met both criteria. In the total population with PsA, 2982 patients had ≥ 1 PsA manifestation when axPsA was investigator defined, of whom 2235 (74.9%) had multiple manifestations. Among those with ≥ 1 manifestation, the most common presentations were PA + skin (14.6%), skin (13.1%), and PA + nail + skin (11.3%). When using the criteria for elevated spine symptoms, 2996 patients had ≥ 1 PsA manifestation, of whom 2299 (76.7%) had multiple manifestations. Among those with ≥ 1 manifestation, the most common presentations were skin (12.3%), PA + skin (11.2%), and PA + nail + skin (8.8%). Of 769 patients who initiated a biologic at enrollment, 109 (14.2%) had investigator-defined axPsA and 270 (35.1%) had elevated spine symptoms (Figure 2A). Among all biologic initiators with PsA, 733 had ≥ 1 PsA manifestation when axPsA was investigator defined, of whom 630 (85.9%) had multiple manifestations; the most common presentations were PA + skin (16.2%), PA + skin + nail (12.8%), and enthesitis + PA + nail + skin (7.8%). When using the criteria for elevated spine symptoms, 732 biologic initiators had ≥ 1 disease manifestation, of whom 650 (88.8%) had multiple manifestations; the most common presentations were PA + skin (11.7%), PA + skin + nail (8.5%), and PA + axPsA + skin (6.3%). The prevalence of skin, PA, and dactylitis was higher in those with elevated spine symptoms vs investigator-defined axPsA, whereas the prevalence of enthesitis was higher in those with investigator-defined axPsA (Figure 1B and 2B).

Conclusion:

In the Corrona PsA/SpA Registry, there was a higher number of patients with elevated spine symptoms than with investigator-defined axPsA; these patients also had more coexisting manifestations. Although they may have had other reasons for back pain (ie, degenerative spine disease or central sensitization), it is possible that axPsA could be present in some and this warrants further evaluation.

References:

[1]Goel N, et al.J Rheumatol. 2019;95(Suppl):54-7.

[2]Baraliakos X, et al.Ann Rheum Dis. 2019;78:195-6.

Disclosure of Interests:

Alexis Ogdie Grant/research support from: Pfizer to Penn, Novartis to Penn, Amgen to Forward/NDB, Consultant of: Abbvie, Amgen, Bristol-Myers Squibb, Celgene, Corrona, Janssen, Eli Lilly, Novartis, Pfizer, Taylor Blachley Employee of: Corrona, LLC, Meghan Glynn Shareholder of: Corrona, LLC – shareholder, Grant/research support from: Pfizer – grant/research support, Employee of: Corrona, LLC – employment, Sabrina Rebello Employee of: Corrona, LLC, Blessing Dube Employee of: Corrona, LLC, Robert McLean Employee of: Corrona, LLC, Peter Hur Employee of: Novartis Pharmaceuticals Corporation, 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

FRI0269 CHARACTERIZATION OF PATIENTS WITH ANKYLOSING SPONDYLITIS WHO INITIATED SECUKINUMAB: ELECTRONIC HEALTH RECORDS DATA FROM THE COLUMBUS REPOSITORY

Background:

Secukinumab was the first anti-interleukin 17A monoclonal antibody treatment approved by the FDA for ankylosing spondylitis (AS). There is scarce information on the characteristics of secukinumab vs other biologic initiators with AS.

Objectives:

To describe real-world physician and patient characteristics, and treatment patterns of secukinumab and tumor necrosis factor inhibitor (TNFi) initiators.

Methods:

Electronic health records (EHR) data from adult patients with AS who initiated a biologic therapy between January 2018 and March 2019 (index date) were included from the Columbus Repository, a network capturing EHR data from 120 US rheumatology providers. Physician and patient characteristics, and treatment patterns were reported for patients who were prescribed secukinumab and TNFis (adalimumab, etanercept, certolizumab pegol, infliximab, infliximab-abda, and golimumab). Categorical variables were summarized using frequency counts and percentages and continuous variables were presented using means and standard deviations. Standardized mean differences andPvalues were used to compare treatment groups.

Results:

As of March 2019, AS treatment data were available for 82 secukinumab initiators and 160 TNFi initiators. Regarding overall practice size, 33% of practices had a single physician, and 65% of physicians were located in the South US region. Secukinumab initiators were younger than TNFi initiators (47.4 vs 49.8 years) and had a similar prevalence of HLA-B27 positivity (≈ 55%; Table 1). Comorbid psoriatic arthritis (PsA) was more commonly reported among secukinumab initiators vs TNFi initiators (17% vs 9%), while hypertension (5% vs 11%), obesity (2% vs 11%), and uveitis (2% vs 9%) were less common (Figure 1). Secukinumab initiators were more likely to have prior opioid use vs TNFi initiators but were less likely to have prior methotrexate use (Figure 2A); 67% of secukinumab initiators and 49% of TNFi initiators were biologic experienced, of whom 73% and 76%, respectively, used 1 prior biologic, 25% and 20% used 2 prior biologics, and 2% and 4% used ≥ 3 prior biologics (Figure 2B). The most common reasons for discontinuation of prior biologics among secukinumab and TNFi initiators were because the biologic was no longer required (47% vs 41%) and lack of efficacy (20% vs 24%) (Figure 2C).

Table 1.

Baseline Demographics and Disease Characteristics Among Patients With AS at the Index Date.

.CharacteristicSecukinumab(N = 82)TNFi(N = 160)SMD*PValueAge, mean (SD), years47.4 (12.8)49.8 (14.6)0.170.21Female, n (%)43 (52)90 (56)0.080.57Race/ethnicity, n (%)N = 65N = 1290.200.66White52 (80)106 (82)Hispanic8 (12)13 (10)Black3 (5)8 (6)Asian1 (2)2 (2)Other1 (2)0Geographic distribution, n (%)0.370.05South49 (60)113 (71)Midwest27 (33)28 (18)West5 (6)16 (10)Northeast1 (1)3 (2)Health insurance, n (%)N = 79N = 1560.410.39Commercial57 (72)94 (60)Medicare8 (10)33 (21)Medicaid2 (3)4 (3)Other12 (15)25 (16)HLA-B27 positivity, n (%) [N]14 (54) [N = 26]31 (56) [N = 55]0.051.00Body mass index, mean (SD), kg/m230.6 (6.1)30.9 (7.7)0.030.82

SMD, standardized mean difference.

* Comparisons with SMD > 0.1 were suggestive of clinically relevant differences.

Conclusion:

Secukinumab initiators with AS were younger and more opioid and biologic experienced, were more likely to have a PsA diagnosis, and were more likely to discontinue their previous biologic because the biologic was no longer required compared to patients who initiated TNFis.

Acknowledgments:

This study was funded by Novartis Pharmaceuticals Corporation, East Hanover, NJ. Support for third-party writing assistance for this abstract, furnished by Kheng Bekdache, PhD, of Health Interactions, Inc, was provided by Novartis Pharmaceuticals Corporation, East Hanover, NJ.

Disclosure of Interests:

Howard Busch Speakers bureau: AbbVie, Amgen, Crescendo, Exagen, Genentech, Mallinckrodt, Novartis, Primus, Sanofi/Regeneron, and UCB, 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, Peter Hur Employee of: Novartis Pharmaceuticals Corporation, Esther Yi Employee of: Novartis Pharmaceuticals Corporation

SAT0385 CAN MISCLASSIFICATION BETWEEN SPONDYLOARTHRITIS (SPA) AND RHEUMATOID ARTHRITIS (RA) OCCUR? SPA-RELATED CLINICAL MANIFESTATIONS AMONG RA AND SPA PATIENTS - A SYSTEMATIC LITERATURE REVIEW

Background:

Delayed diagnosis is associated with worse outcomes and poor treatment responses in patients with SpA, including psoriatic arthritis (PsA) and axial spondyloarthritis.1Misclassification may be associated with this delay, as SpA and RA, especially seronegative RA, may present with similar manifestations such as joint pain, swelling, fatigue, and disability. Key features that typically distinguish SpA from RA include spine pain, dactylitis, enthesitis, psoriasis, and nail psoriasis.2Increased physician awareness of the potential overlap and distinctions between SpA and RA manifestations is needed for the early diagnosis and appropriate treatment for SpA.

Objectives:

To identify and summarise the published literature on the prevalence of SpA-related clinical manifestations among patients with RA and SpA.

Methods:

Publications were retrieved from Embase®, Cochrane, MEDLINE®, and MEDLINE® In-Process databases. Studies were included if they were non-interventional, recruited patients with RA and SpA, or patients with seronegative/seropositive RA, and reported the following manifestations: enthesitis, dactylitis, axial symptoms, psoriasis, or nail psoriasis. Two reviewers assessed each citation against predefined eligibility criteria, with discrepancies reconciled by a third independent reviewer.

Results:

Of the 4479 publications retrieved, 18 studies were included (Figure 1). All studies compared SpA populations to patients with RA. Of the 18 studies, 11 studies reported patients with only PsA, 2 studies reported patients with only ankylosing spondylitis (AS), and 5 studies reported mixed SpA populations. Three studies each reported data pertaining to seropositive/seronegative RA and early RA, defined as symptom onset <1 year. The majority (N=12) of studies used ultrasound imaging to identify manifestations of interest. Enthesitis (N=17) was the most frequently evaluated manifestation while axial symptoms (N=2) was least evaluated. Of the studies reporting enthesitis, the majority (N=14) reported a higher prevalence of enthesitis in the SpA cohort compared to the RA cohort. The remaining studies (N=3) reported no significant difference in enthesitis between the SpA and RA cohorts. Notably, these 3 studies comprised of the 2 studies evaluating only AS patients, and all 3 studies evaluated late RA patients. In contrast, the 3 studies that reported early RA and PsA patients found a significantly higher prevalence of enthesitis in early PsA vs. early RA cohort. Two of the 3 studies reporting RA serostatus found a higher prevalence of enthesitis, psoriasis, and/or nail psoriasis in the SpA population compared to seronegative and seropositive RA cohorts. All studies reporting axial symptoms, dactylitis, psoriasis, and nail psoriasis found a higher prevalence of the corresponding manifestation in the SpA vs. RA cohort.

Conclusion:

While this review found a higher prevalence of key SpA-related clinical manifestations in SpA vs. RA, overlap was present suggesting that misclassification could occur. Differences in the prevalence of manifestations were also seen in the early vs. late RA populations as well as by RA serostatus. This suggests that an earlier and comprehensive evaluation, including advanced imaging of peripheral manifestations such as enthesitis, dactylitis, axial symptoms, and skin signs such as psoriasis and nail disease, among RA and SpA patients may reduce misclassification and inappropriate treatment. Further research is needed to confirm these findings.

References:

[1]Seo et al. Clin Rheumatol. 2015;34:1397-1405.

[2]Merola et al. RMD. 2018;4:e000656.

Acknowledgments:

This study was sponsored by Novartis Pharmaceuticals Corporation, East Hanover, NJ.

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, Mohit Kumar Bhutani Employee of: Novartis Healthcare Pvt Ltd, Peter Hur Employee of: Novartis Pharmaceuticals Corporation, Esther Yi Employee of: Novartis Pharmaceuticals Corporation, Nina Kim Employee of: Postdoctoral fellow at the University of Texas at Austin and Baylor Scott and White Health, providing services to Novartis Pharmaceuticals Corporation

SAT0429 SECUKINUMAB IMPROVES CLINICAL AND PATIENT-REPORTED OUTCOMES AT 6 MONTHS AMONG PATIENTS WITH PSORIATIC ARTHRITIS IN THE US-BASED CORRONA PSORIATIC ARTHRITIS/SPONDYLOARTHRITIS (PsA/SpA) REGISTRY

Background:

Secukinumab, an interleukin-17 antagonist approved for the treatment of PsA, improves all PsA manifestations in the GRAPPA-OMERACT core domain set.1Few US-based studies have evaluated the real-world effectiveness of secukinumab in patients with PsA.

Objectives:

To examine clinical and patient-reported outcomes (PROs) in patients with PsA enrolled in the Corrona PsA/SpA registry initiating secukinumab with ≥ 1 follow-up visit.

Methods:

Included were adult patients with PsA in the Corrona registry who initiated secukinumab after April 1, 2017 and remained on secukinumab at their 6-month (window, 5-8 months) follow-up visit. The primary outcome was achievement of minimal disease activity (MDA) at 6 months among patients not in MDA at secukinumab initiation. MDA was defined as meeting 5 of the 7 following criteria: tender joint count (TJC) ≤ 1, swollen joint count (SJC) ≤ 1, psoriasis affected body surface area (BSA) < 3%, patient assessment of pain on visual analog scale (VAS) ≤ 15, patient global assessment VAS ≤ 20, HAQ-DI ≤ 0.5, and tender entheseal points ≤ 1 using the Leeds Enthesitis Index (LEI). Secondary outcomes included the proportion of patients who achieved resolution (0 sites) of TJC, SJC, enthesitis (using the LEI), and dactylitis among those with ≥ 1 site at initiation and improvement from baseline in clinical outcomes (BSA, nail psoriasis, physician global assessment, TJC, SJC, and DAPSA) and PROs (patient-reported pain, patient global assessment, HAQ-DI, and Work Productivity and Activity Impairment questionnaire) at 6 months. Outcomes were evaluated in the overall population and in potentially recalcitrant patients with failure of or intolerance to ≥ 3 previous biologics to examine if the later line biologic could be adequately effective.

Results:

A total of 100 patients with PsA who initiated and maintained secukinumab after 6 months were included. The mean (SD) age was 51.6 (11.6) years, 54.3% were male, and 96.8% were white. The mean (SD) symptom and disease duration were 10.8 (9.7) and 7.0 (7.0) years, respectively. Thirty patients (30.0%) initiated secukinumab 150 mg and 70 (70.0%) initiated secukinumab 300 mg. Most (83.0%) were biologic experienced; 17 patients initiated secukinumab as a 1st biologic, 34 as 2nd, 26 as 3rd, and 23 as ≥ 4th. At initiation, 75/90 patients (83.3%) were not in MDA; 26/71 (36.6%) of those with follow-up data available achieved MDA at 6 months (Figure 1). In the overall population, 28 patients (41.2%) with TJC ≥ 1, 24 (44.4%) with SJC ≥ 1, 17 (60.7%) with enthesitis, and 9 (75.0%) with dactylitis at initiation achieved resolution at 6 months (Table 1). Improvement was observed at 6 months in clinical outcomes and PROs in the overall population (Figures 1 and 2) and in patients who initiated secukinumab as a ≥ 4th-line biologic.

Table 1.

Resolution of Peripheral Arthritis, Enthesitis, and Dactylitis at 6 Months Among Patients With ≥ 1 Site at Initiation

Secondary OutcomesInitiation,Mean (SD) [n]6-Month Follow-Up,Resolution (Count = 0), n (%)TJC (1-68)9.0 (9.7) [68]28 (41.2)SJC (1-66)4.7 (4.2) [54]24 (44.4)Enthesitis (1-6)1.9 (1.1) [28]17 (60.7)Dactylitis (1-20)2.1 (1.3) [12]9 (75.0)

Conclusion:

In the Corrona registry, most secukinumab initiators with PsA were biologic experienced and were not in MDA at time of initiation. Consistent with clinical trials, real-world patients treated with secukinumab achieved MDA as well as improvement in clinical manifestations, PROs, and work productivity.

References:

[1]Orbai AM, et al.J Rheumatol.2019 Oct 15. [Epub ahead of print].

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, Taylor Blachley Employee of: Corrona, LLC, Meghan Glynn Shareholder of: Corrona, LLC – shareholder, Grant/research support from: Pfizer – grant/research support, Employee of: Corrona, LLC – employment, Blessing Dube Employee of: Corrona, LLC, Robert McLean Employee of: Corrona, LLC, Nina Kim Employee of: Postdoctoral fellow at the University of Texas at Austin and Baylor Scott and White Health, providing services to Novartis Pharmaceuticals Corporation, Peter Hur Employee of: Novartis Pharmaceuticals Corporation, Alexis Ogdie Grant/research support from: Pfizer to Penn, Novartis to Penn, Amgen to Forward/NDB, Consultant of: Abbvie, Amgen, Bristol-Myers Squibb, Celgene, Corrona, Janssen, Eli Lilly, Novartis, Pfizer

AB0750 CLINICAL CHARACTERISTICS AND TREATMENT PATTERNS OF PATIENTS WITH PSORIATIC ARTHRITIS WHO WERE PRESCRIBED BIOLOGICS: DATA FROM THE COLUMBUS REPOSITORY

Background:

Real-world data from electronic health records (EHR) allow examination of treatment patterns and clinical practice behaviors for psoriatic arthritis (PsA).

Objectives:

To describe physician and patient characteristics, and treatment patterns of patients with PsA who initiated secukinumab and other biologics using data from the Columbus Repository.

Methods:

EHR data from adult patients with PsA who were prescribed a new biologic therapy between January 2018 and March 2019 (index date) were included from the Columbus Repository, which collects clinical records from a network of US rheumatology providers. Demographics, disease characteristics, and treatment patterns, as well as physicians’ characteristics, were reported for patients who were prescribed secukinumab vs other biologics (abatacept, adalimumab, etanercept, certolizumab pegol, golimumab, infliximab, infliximab-dyyb, infliximab-abda, ustekinumab, and ixekizumab). Treatment groups were mutually exclusive and only the most recently prescribed biologic was represented. Categorical variables were summarized using frequency counts and percentages and continuous variables were presented using means and standard deviations.

Results:

As of March 2019, 234 patients initiated secukinumab and 806 initiated other biologics for PsA treatment; 62 physicians prescribed biologics for PsA. Overall, 73% of physicians’ offices had a single provider contributing patients to the analysis, and 76% of physicians were located in the South US region. Secukinumab initiators were younger (55.2 vs 57.3 years), more likely to be male (44% vs 31%), and had higher BMI (34.0 vs 31.9 kg/m2) vs other biologic initiators. Almost all disease activity measures evaluated had a large proportion (> 80%) of missing data; among those with nonmissing data, secukinumab initiators had numerically higher mean (SD) RAPID3 score vs other biologic initiators (12.6 [6.5] vs 11.6 [7.1]). Overall, 70% of secukinumab initiators and 48% of other biologic initiators were biologic experienced (Figure 1). Comorbidities were similar between groups (Figure 2). The most common reasons for discontinuation of prior biologic were the biologic was no longer required and lack of efficacy (Table 1).

Table 1.

Treatment Patterns Among Patients With PsA at the Index Date

Secukinumab(N = 234)Other Biologic(N = 806)SMD*PValueReason for discontinuing prior biologic treatment, n (%)N = 164N = 3850.200.67No longer required64 (39)136 (35)Lack of efficacy28 (17)75 (19)Cost or administrative5 (3)10 (3)Side effects5 (3)9 (2)Lack of tolerability03 (1)Patient fear of side effects1 (1)0Other25 (15)63 (16)Missing36 (22)89 (23)Prior medication use, n (%)NSAIDs109 (47)365 (45)0.030.78Opioids89 (38)252 (31)0.140.06Steroids68 (29)265 (33)0.080.31DMARDsMethotrexate83 (35)340 (42)0.140.08Sulfasalazine25 (11)93 (12)0.030.81Apremilast53 (23)104 (13)0.26< 0.01Tofacitinib10 (4)36 (4)0.011.00No. of prior biologics, mean (SD)0.95 (0.82)0.62 (0.77)0.41< 0.01

SMD, standardized mean difference.

* Comparisons with SMD > 0.1 were suggestive of clinically relevant differences.

Conclusion:

Secukinumab initiators with PsA were more likely to be male and biologic experienced, have a higher BMI and higher RAPID3 scores indicative of more active disease vs those initiating other biologics. Additional structured and unstructured elements may need to be captured on EHR platforms to gain clarity on disease activity and treatment decisions.

Acknowledgments:

This study was funded by Novartis Pharmaceuticals Corporation, East Hanover, NJ. Support for third-party writing assistance for this abstract, furnished by Kheng Bekdache, PhD, of Health Interactions, Inc, was provided by Novartis Pharmaceuticals Corporation, East Hanover, NJ.

Disclosure of Interests:

Howard Busch Speakers bureau: AbbVie, Amgen, Crescendo, Exagen, Genentech, Mallinckrodt, Novartis, Primus, Sanofi/Regeneron, and UCB, 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, Peter Hur Employee of: Novartis Pharmaceuticals Corporation

Utilization of the validated Psoriasis Epidemiology Screening Tool to identify signs and symptoms of psoriatic arthritis among those with psoriasis: a cross-sectional analysis from the US-based Corrona Psoriasis Registry

Background

Despite increasing awareness of the disease, rates of undiagnosed psoriatic arthritis (PsA) are high in patients with psoriasis (PsO). The validated Psoriasis Epidemiology Screening Tool (PEST) is a five‐item questionnaire developed to help identify PsA at an early stage.

Objectives

To assess the risk of possible undiagnosed PsA among patients with PsO and characterize patients based on PEST scores.

Methods

This study included all patients enrolled in the Corrona PsO Registry with data on all five PEST questions. Demographics, clinical characteristics and patient‐reported outcomes were compared in Corrona PsO Registry patients with PEST scores ≥3 and <3 using t‐tests for continuous variables and chi‐squared tests for categorical variables; scores ≥3 may indicate PsA.

Results

Of 1516 patients with PsO, 904 did not have dermatologist‐reported PsA; 112 of these 904 patients (12.4%) scored ≥3 and were significantly older, female, less likely to be working, and had higher BMI than patients with scores <3. They also had significantly longer PsO duration, were more likely to have nail PsO and had worse health status, pain, fatigue, Dermatology Life Quality Index and activity impairment.

Conclusions

Improved PsA screening is needed in patients with PsO because the validated PEST identified over one‐tenth of registry patients who were not noted to have PsA as having scores ≥3, who could have had undiagnosed PsA. Appropriate, earlier care is important because these patients were more likely to have nail PsO, worse health‐related quality of life and worse activity impairment.

A Portable Sensory Augmentation Device for Balance Rehabilitation Using Fingertip Skin Stretch Feedback

Neurological disorders are the leading causes of poor balance. Previous studies have shown that biofeedback can compensate for weak or missing sensory information in people with sensory deficits. These biofeedback inputs can be easily recognized and converted into proper information by the central nervous system (CNS), which integrates the appropriate sensorimotor information and stabilizes the human posture. In this study, we proposed a form of cutaneous feedback which stretches the fingertip pad with a rotational contactor, so-called skin stretch. Skin stretch at a fingertip pad can be simply perceived and its small contact area makes it favored for small wearable devices. Taking advantage of skin stretch feedback, we developed a portable sensory augmentation device (SAD) for rehabilitation of balance. SAD was designed to provide postural sway information through additional skin stretch feedback. To demonstrate the feasibility of the SAD, quiet standing on a force plate was evaluated while sensory deficits were simulated. Fifteen healthy young adults were asked to stand quietly under six sensory conditions: three levels of sensory deficits (normal, visual deficit, and visual + vestibular deficits) combined with and without augmented sensation provided by SAD. The results showed that augmented sensation via skin stretch feedback helped subjects correct their posture and balance, especially as the deficit level of sensory feedback increased. These findings demonstrate the potential use of skin stretch feedback in balance rehabilitation.