AB0819 FLARES AMONG PATIENTS WITH PSORIATIC ARTHRITIS (PsA) - FREQUENCY AND IMPACT ON PATIENT OUTCOMES: REAL-WORLD SURVEY IN THE US AND EUROPE
Authors: A. M. Orbai, W. Tillett, S. Grieb, S. Peterson, E. Holdsworth, S. Meakin, S. Bruce Wirta, S. D. Chakravarty, L. Gossec
Journal: Annals of the Rheumatic Diseases (2020)

Background: Flares in PsA, presenting as periods of acute disease activity, are thought to negatively impact patients’ lives. This has not been extensively studied in a real-world setting. Objectives: Describe flares, assess impact on quality of life and work productivity, and explore predictors. Methods: A cross-sectional survey among patients with PsA recruited by rheumatologists and dermatologists was conducted in France, Germany, Italy, Spain, UK and US. Data were collected Jun-Aug 2018 via patient record forms and patient self-complete forms. Physicians recorded flare status (in flare currently/flared in last 12 mo/longer than 12 mo or never), demographics, physician perceived severity and clinical outcomes. Patients reported quality of life [QoL] (EQ5D-5L), work productivity (WPAI), disability (HAQ-DI), pain (PsAID12 pain scale). Patients were compared by flare status using parametric or non-parametric tests. Logistic regression explored predictors of flare. Multivariate regression explored the impact of flare status on patient reported outcomes (PRO). The model was adjusted for gender, age, BMI, physician speciality. Results: Data were collected for 2,238 patients (586 US, 1,652 EU). Mean age was 48.7 years (13.2 SD), 53.8% were male. Physicians reported 7.5% were currently in flare and 22.0% had flared in the last 12 mo. Patients had experienced 2.2 mean flares in the last 12 mo (4.9 SD), lasting a mean 16.4 days (16.2 SD). Patients in flare were comparable demographically with those not; however, those in flare were less likely to work full time (43.6 vs. 59.3%, p&lt;0.01). Patients not in flare had clinically active disease (Table 1). Table 1. Clinical characteristics of patients by flare status Currently in flare (n=168) Flared in last 12 mo (n=492) Not flared in last 12 mo/never flared (n=1578) p-value In remission, n (%) 4 (2.4) 157 (33.2) 799 (53.5) &lt;0.01 *Current BSA affected, mean (SD) 10.3 (12.0) 6.5 (7.6) 5.0 (7.7) &lt;0.01 *66 SJC, mean (SD) 5.4 (4.6) 4.5 (7.3) 2.4 (6.9) &lt;0.01 *68 TJC, mean (SD) 7.8 (5.8) 5.5 (8.3) 3.1 (5.6) &lt;0.01 Physician-perceived severity, n (%) Mild 35 (20.8) 346 (70.3) 1297 (82.2) &lt;0.01 Moderate 101 (60.1) 139 (28.3) 261 (16.5) Severe 32 (19.0) 7 (1.4) 20 (1.3) *Calculated on available data: Total base sizes: BSA=1665; SJC=514; TJC=493; Satisfaction=931 Results showed that flare status significantly impacted QoL, work productivity, disability, and pain (Table 2). Exploring predictors of flare in the last 12 mo in un-adjusted analyses showed that demographic characteristics were not predictive of flare status, however patients presenting as moderate or severe at diagnosis were at greater risk of flare. Patients who were prescribed a bDMARD at diagnosis were at lower risk (Figure 1). Table 2. Impact of flare status on PROs Current flare status Change in predicted PRO values P value EQ5D utility (n=933) Not in flare (ref) In flare 0.83 -0.23 &lt;0.01 EQ5D VAS (n=946) Not in flare In flare 76.1 -21.3 &lt;0.01 WPAI % overall work impairment (n=496) Not in flare In flare 20.1 +28.5 &lt;0.01 HAQ-DI (n=901) Not in flare In flare 0.4 +0.6 &lt;0.01 PsAID12 pain score (n=922) Not in flare In flare 2.5 +3.0 &lt;0.01 PRO key for worse outcome (range): EQ5D utility (0-1.0) = lower; EQ5D VAS (1-100) = lower; WPAI (0-100) = higher; HAQ-DI (0-3) = higher; PsAID12 pain (0-10) = higher Figure 1. Predictors of flaring in last 12 months Conclusion: One third of patients surveyed were either currently in flare or had flared in the last 12 mo. Being in flare adversely impacted QoL, disability and work productivity. Flare may be predicted by overall physician-reported PsA disease severity at diagnosis. Disclosure of Interests: 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., 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, Suzanne Grieb Grant/research support from: Janssen, Steve Peterson Employee of: Janssen Research &amp; Development, LLC, Elizabeth Holdsworth Employee of: Adelphi Real World, Sophie Meakin Employee of: Adelphi Real World, Sara Bruce Wirta Employee of: Janssen-Cilag Sweden AB, Soumya D Chakravarty Shareholder of: Johnson &amp; Johnson, Employee of: Janssen Scientific Affairs, LLC, Laure Gossec Grant/research support from: Lilly, Mylan, Pfizer, Sandoz, Consultant of: AbbVie, Amgen, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Sandoz, Sanofi-Aventis, UCB