SAT0635 PATIENT-PERCEIVED RESIDUAL BURDEN OF PSORIATIC ARTHRITIS IN PATIENTS IN REMISSION/LOW DISEASE: AN ANALYSIS OF 444 PATIENTS
Authors: Laure Gossec, Maarten de Wit, Clemence Gorlier, Rossana Scrivo, Juan D. Cañete, Penelope Palominos, Ying Ying Leung, Ennio Lubrano, Sandra Tälli, Andra Balanescu, Uta Kiltz, Sibel Aydin, Inna Gaydukova, Lihi Eder, Ana-Maria Orbai, Josef S. Smolen, Laura C. Coates
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> The objective of treatment in psoriatic arthritis (PsA) is remission or low disease (ref1). However, there may remain residual patient burden in patients where inflammation is controlled. <h3>Objectives</h3> To explore patient-perceived burden of disease in PsA patients in remission or low disease, when using different definitions of remission. <h3>Methods</h3> ReFlap (NCT03119805, ref2) was an observational study in 14 countries of consecutive adult patients with definite PsA and &gt;2 years of disease duration. Remission/low disease status was defined at the baseline visit using composite scores: Minimal Disease Activity (MDA), and Disease Activity in PSoriatic Arthritis (DAPSA)&lt;=14 (both corresponding to a status of remission or low disease). Patient-perceived burden of disease was assessed through the PsA Impact of Disease (PsAID12) composite score and its individual components assessing physical and psychological impact (0-10 where 0 is the optimal status). Mean and median levels of patient-reported symptoms were assessed in remission/low disease status. P-values by Wilcoxon test were computed to compare patients in good status according to both MDA and DAPSA (n=161), versus in good status according to DAPSA only (n=90). There was no imputation of missing data. <h3>Results</h3> Of 466 patients, 444 had disease status and impact available: 220 (50.5%) were male, mean age was 52.2±12.6 years, mean disease duration was 10.1±8.1 years; 261 (62.9%) were taking a conventional DMARD and 255 (61.3%) a biologic. Disease activity was moderate: 154 (36.2%) had no current psoriasis skin lesions, mean tender joint count was 4.7±9.5, mean swollen joint count (SJC) was 2.2±7.0, and mean DAPSA was 16.6±17.2. Remission/low disease was more frequent when defined by DAPSA: 251 (56.5%) patients, than by MDA: 171 (38.5%) patients. As expected, objective measures of disease activity were minimal in the good status categories (e.g., SJC was 0.3±0.8 in MDA and 0.4±0.9 in DAPSA-remission/low disease). In remission/low disease, residual disease impact (assessed with PsAID12) was low: most median levels of symptoms were below 1 on a 0-10 scale; 5 aspects of impact had a median level &gt;=1 (figure); only one had a median level of 2, and this was fatigue. Levels of impact were slightly though significantly higher in patients in DAPSA-defined good status than in patients in both MDA and DAPSA-remission/low disease (all p&lt;0.001). <h3>Conclusion</h3> In this unselected population, residual symptoms were of low magnitude using both definitions of good status: DAPSA-based definitions (present in 56%) and MDA (38%), confirming the patient relevance of remission/low disease as a treatment objective. The predominant aspect of impact was fatigue, which is one of the most important domains of impact recognized by patients. Residual burden of disease was lower in the MDA group than in the DAPSA-remission/low disease group, which could indicate that MDA corresponds to a 'deeper' form of disease control, though the clinical relevance of the differences observed should be further explored. A holistic approach should be implemented when evaluating people with PsA including when disease control has been obtained. <h3>References</h3> [1] Gossec L, Smolen JS, et al. European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update. Ann Rheum Dis. 2016;75(3):499-510. [2] Gorlier C, et al. Comparing patient-perceived and physician-perceived remission and low disease activity in psoriatic arthritis: an analysis of 410 patients from 14 countries. Ann Rheum Dis. 2019;78(2):201-208. <h3>Acknowledgement</h3> this study was funded by Pfizer through an investigator-initiated grant. <h3>Disclosure of Interests</h3> Laure Gossec Grant/research support from: AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis-Sandoz, Pfizer, Sanofi, and UCB, Consultant for: AbbVie, Biogen, BMS, Celgene, Janssen, Lilly, MSD, Nordic Pharma, Novartis-Sandoz, Pfizer, Roche, Sanofi, and UCB, Consultant for: L Gossec has received honoraria from Celgene as investigator for this study, Maarten de Wit: None declared, Clemence Gorlier: None declared, Rossana Scrivo: None declared, Juan D. Cañete: None declared, Penelope Palominos: None declared, Ying Ying Leung Grant/research support from: Abbvie, Novartis, Speakers bureau: Abbvie and Novartis, Speakers bureau: Novartis, Ennio Lubrano Consultant for: Consultancy fees as speaker from Abbvie, Celgene, Novartis and Pfizer, Sandra Tälli: None declared, Andra Balanescu Speakers bureau: multiple, Uta Kiltz Grant/research support from: AbbVie, Chugai, Eli Lilly, Grünenthal, Janssen, MSD, Novartis, Pfizer, Roche, and UCB., Consultant for: AbbVie, Chugai, Eli Lilly, Grünenthal, Janssen, MSD, Novartis, Pfizer, Roche, and UCB., Sibel Aydin Consultant for: Abbvie, Celgene, UCB, Novartis, Jannsen, Sanofi, Inna Gaydukova Grant/research support from: JSC BIOCAD, Speakers bureau: paiment from Pfizer, Novartis, Abbvie, Biocad, Selgene, MSD, Sanofy does not exceed 10 000 euros, Lihi Eder Grant/research support from: AbbVie, Eli Lilly and Company, Amgen, Celgene, UCB, Janssen, Novartis, and Pfizer, Consultant for: AbbVie, Eli Lilly and Company, Amgen, Celgene, UCB, Janssen, Novartis, and Pfizer, Ana-Maria Orbai Grant/research support from: AbbVie, Celgene, Horizon Pharma, Janssen, Lilly, and Novartis, Consultant for: Lilly, Janssen, Novartis, Pfizer, and UCB, Josef S. Smolen Grant/research support from: AbbVie, Eli Lilly, Janssen, MSD, Pfizer Inc, Roche, Consultant for: AbbVie, Amgen, AstraZeneca, Astro, Celgene, Celtrion, Eli Lilly, GlaxoSmithKline, ILTOO, Janssen, Medimmune, MSD, Novartis-Sandoz, Pfizer Inc, Roche, Samsung, Sanofi, UCB, Speakers bureau: AbbVie, Amgen, AstraZeneca, Astro, Celgene, Celtrion, Eli Lilly, GlaxoSmithKline, ILTOO, Janssen, Medimmune, MSD, Novartis-Sandoz, Pfizer Inc, Roche, Samsung, Sanofi, UCB, Laura C Coates Grant/research support from: AbbVie, Celgene, Lilly, Novartis and Pfizer, Consultant for: AbbVie, Amgen, BMS, Celgene, Galapagos, Gilead Sciences Inc., Janssen, Lilly, Novartis, Pfizer, Prothena Corp and UCB