SAT0174 CHARACTERISTICS AND TREATMENTS OF PATIENTS WITH SJÖGREN’S SYNDROME IN A REAL-WORLD SETTING
Authors: Carlos Gonzalez-Najera, Steven Taylor, Sean Crawford, Premkumar Narasimhan, Xiao Shao, LI Jun
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Sjögren's syndrome (SS) is one of the most common autoimmune diseases. Main symptoms include dry eyes and mouth, followed by difficulty swallowing and serious systemic manifestations including neurological, pulmonary and musculoskeletal effects.<sup>1</sup> However, SS is not homogeneous; it affects patients in different ways, with varying symptoms and severity. Identifying discrete patient types and understanding their commonalities and differences is integral to enhancing disease knowledge, identifying areas of unmet need, defining the size of the affected population and determining appropriate treatment approach. <h3>Objectives</h3> Using data gathered by the SS Foundation through a survey of over 3000 patients with SS, analyses were performed to: 1) describe patient characteristics and treatment in a real-world setting and 2) categorise patients based on baseline characteristics. <h3>Methods</h3> The analytical approach used clustering techniques to synthesise the mixed-data–type survey in two separate analyses. Data were filtered to include patients 40–65 years of age. Analyses were performed firstly to identify relationships between features—related to demographic, disease state, treatments, etc—and secondly to identify clusters of patients. A Bayesian network model was used to evaluate feature correlations and the probability of a specific survey answer given one or many preliminary conditions. With respect to patient clustering, the model used was based on Gower distance and Partitioning Around Medoids, which each can include both numerical and categorical data. <h3>Results</h3> We evaluated comorbidities, symptoms and treatment to identify traits that differed most significantly among patient types. Four discrete patient clusters were identified (disease severity measured by median EULAR SS Patient Reported Index score<sup>2</sup>; Table 1): Recent: Most recently diagnosed, least severe disease manifestation Slower progressing: Longest time since diagnosis, second–lowest disease severity Second–second: Second in time since of diagnosis, second in disease severity Most severe: Most severe disease manifestations and comorbidities The most differentiating comorbidities across all clusters included gastroesophageal reflux disease, fibromyalgia and Raynaud's syndrome (Table 2). The symptoms that impacted patients' lives the most and that were differentiating across clusters were brain fog, fatigue and forgetfulness. The treatments that were most contrasting were oral comfort agents, followed by DMARDS and secretagogues (Figure 1). The patient cluster definitions above suggest some contradictions, because not all significant cluster characteristics progressively worsened with increasing disease severity. <h3>Conclusion</h3> These analyses show differences in disease characteristics and treatment across patient clusters; however, more work is required to validate these clusters. <h3>References</h3> [1] Ienopoli S, et al. Oral and Maxillofac Surg Clin North Am2014;26:91-9. [2] Seror R, et al. Ann Rheum Dis2011;70:968-72. <h3>Acknowledgement</h3> Professional medical writing: Fiona Boswell, PhD, Caudex; funding: Bristol-Myers Squibb <h3>Disclosure of Interests</h3> Carlos Gonzalez-Najera Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Steven Taylor: None declared, Sean Crawford Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Premkumar Narasimhan Employee of: Bristol-Myers Squibb, Xiao Shao Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Jun Li Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb