SAT0326 Duration of remission and minimal disease activityafter starting and discontinuation of biologic (B) dmards in early psoriatic arthritis patients treated according to treat-to-target strategy (results of an open-label remarca study)
Authors: E. Loginova, T. Korotaeva, E. Gubar, S. Glukhova, E. Nasonov
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> The main goal of treat-to-target (T2T) strategy in psoriatic arthritis (PsA) is achievement of remission (REM) or minimal disease activity (MDA). There is limited data concerning the duration of REM/MDA after starting and discontinuation of bDMARDs in early (E) PsA patients (pts). <h3>Objectives</h3> to investigate the timing and duration of REM/MDA after starting and discontinuation of bDMARDs therapy in EPsA pts treated according to T2T strategy. <h3>Methods</h3> 34 (M-18/F-16) pts with active EPsA according to the CASPAR criteria non-responder to methotrexate (MTX) subcutaneous treatment, bDMARD-na&amp;x0457;ve were included; mean age 38±11 years, PsA duration 12±10 months (mon.), psoriasis duration 89.8±91.1 mon., median Disease Activity index for Psoriatic Arthritis (DAPSA) 33.55 [28.34–41.77]. All pts started bDMARDs: Adalimumab (21 pts), Certolisumab pegol (3 pts), Etanercept (2 pts), Ustekinumab (8 pts)±MTX. The median duration of bDMARDs treatment was 9 [6.5–15], Min 3 mon. – Max 24 mon. The bDMARDs treatment was stopped due to an individual inefficiency, loss of efficacy or non-medical reasons. At baseline and every 3 mon. all pts underwent assessment of PsA activity by DAPSA and MDA criteria (tender joint count ≤1, swollen joint count ≤1, PASI≤1 or BSA ≤3, patient pain global assessment VAS≤15, patient's global disease activity VAS≤20, HAQ≤0,5, enthesitis count ≤1). The proportion of pts who achieved REM by DAPSA≤4 and MDA (5 of 7 cutpoints) at least once, as well as timing and duration of REM/MDA after starting and cessation of bDMARDs were performed. Pts reports about a flare coming, close to the scheduled time of assessment, was taken into account. M±SD, Me [Q75; Q50], (%) were calculated. All p&lt;0.05 were considered to indicate statistical significance. <h3>Results</h3> By the 24 mon. of the study REM by DAPSA and MDA was reached at least once by 27 (79%) and 28 (82%) out of 34 pts, accordingly. Mean timing of REM by DAPSA and MDA after starting of bDMARDs was 5.8±3.2 and 4.0±1.9 mon., accordingly. During the observation 19 out of 27 pts (70.4%) had stopped bDMARDs due to different reasons. 8 out of 27 pts (29.6%) continued the treatment and had REM according to DAPSA by the end of the study. After cessation of bDMARDs flares by DAPSA were seen in 12 out of 19 pts (63.2%) with the mean duration of REM 5.8±2.3 mon. (Fig 1.). The loss of MDA was seen in 12 out of 20 pts (60%) with the mean duration of MDA 6.2±3.0 mon. Pts reports about the time of PsA symptoms flares was 3.5±3.4 mon. 5 out of 34 pts (15%) loss the efficacy after 12.0±4.7 mon. of bDMARDs treatment. <h3>Conclusions</h3> Most EPsA pts treated with bDMARDs according to T2T strategy achieved REM and MDA within 5 mon. Flares after bDMARDs discontinuation within 6 mon were found in more than a half of pts. according to PsA activity indices and within 3 mon. by pts reports. REM and flare timing after bDMARDs therapy discontinuation indicate that further studies concerning optimal management PsA pts by bDMARDs are needed. <h3>Disclosure of Interest</h3> None declared