AB0776 RATES OF MYOCARDIAL INFARCTION, STROKE AND REVASCULARIZATION AMONG PATIENTS WITH PSORIATIC ARTHRITIS TREATED WITH APREMILAST, BIOLOGICS, DMARDS AND CORTICOSTEROIDS IN THE US MARKETSCAN DATABASE
Authors: Rebecca Persson, Katrina Wilcox Hagberg, Ellen Qian, Catherine Vasilakis-Scaramozza, Steve Niemcryk, Michael Peng, Maria Paris, Anders Lindholm, Susan Jick
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Patients with psoriatic arthritis (PsA) are at increased risk for cardiovascular events, but different treatment options may not have the same rates of cardiovascular events.<sup>1,2</sup> <h3>Objectives:</h3> To compare rates of myocardial infarction (MI), stroke and revascularization by treatment type in patients with PsA. <h3>Methods:</h3> We conducted a population-based cohort study of treated PsA patients in the MarketScan database in 2014-2016. The cohort entry was the date of the first prescription for a study drug (apremilast only or in combination with ≥1 other study drugs, anti-TNF-α biologics only, other biologics and DMARDs [OBDs] only, corticosteroids only, OBDs + corticosteroids and anti-TNF-α biologics with OBDs and/or corticosteroids) after March 21, 2014, the date on which apremilast was approved. Patients were followed from cohort entry through censor date, defined as the first of the following: index date (date patient became a case), end of record or end of study period (December 31, 2016). MI and stroke cases required 1 inpatient diagnosis plus 2 additional diagnoses on separate days; revascularization required a procedure code for revascularization without MI or stroke; all ≥7 days after cohort entry. A patient was considered currently exposed from the prescription date through the prescription duration + 30 days. We calculated incidence rates (IRs) and 95% confidence intervals (CIs) for each outcome per 100 patient-years among the entire population and in the subgroup of patients with no history of serious cardiovascular disease (CVD). <h3>Results:</h3> The study population included 51,971 patients (median age: 52 years, 52% female, 4.0% serious CVD history). IRs were low for all outcomes, and differences between treatments did not reach statistical significance (95% CIs for IRs were overlapping). Among the 187 MI cases, IRs (95% CIs) were as follows: for apremilast only, 0.10 (0.01, 0.35); anti-TNF-α biologics only, 0.13 (0.09, 0.19); anti-TNF-α biologics with OBDs and/or corticosteroids, 0.31 (0.22, 0.43); OBDs only, 0.32 (0.23, 0.44); corticosteroids only, 0.44 (0.27, 0.68); OBDs + corticosteroids, 0.45 (0.24, 0.76); and apremilast in combination, 0.49 (0.20, 1.02). Among the 79 stroke cases, IRs (95% CIs) were as follows: for corticosteroids only, 0.08 (0.02, 0.22); anti-TNF-α biologics only, 0.09 (0.06, 0.13); for OBDs only, 0.10 (0.05, 0.17); anti-TNF-α biologics with OBDs and/or corticosteroids, 0.12 (0.06, 0.20); apremilast only, 0.15 (0.03, 0.43), or in combination, 0.14 (0.02, 0.51); and OBDs + corticosteroids, 0.21 (0.08, 0.45). Among the 292 revascularization cases, IRs (95% CIs) were as follows: for apremilast only, 0.25 (0.08, 0.57), anti-TNF-α biologics only, 0.36 (0.29, 0.44); anti-TNF-α biologics with OBDs and/or corticosteroids, 0.37 (0.27, 0.50); OBDs + corticosteroids, 0.38 (0.19, 0.68); apremilast in combination, 0.42 (0.15, 0.92); OBDs only, 0.48 (0.36, 0.61); and corticosteroids only, 0.49 (0.31, 0.73). Among patients with no serious CVD history, IRs were generally lower but results were not materially different from the main analyses. <h3>Conclusion:</h3> Rates of MI, stroke and revascularization were low for treated PsA patients and were similar across treatments. <h3>References</h3> [1] Jamnitski a, et al. Ann Rheum Dis. 2013;72:211-6. 2. Ogdie a, et al. Curr Opin Rheumatol. 2015;27:118-26. <h3>Disclosure of interests:</h3> Rebecca Persson Grant/research support from: Celgene Corporation, Katrina Wilcox Hagberg Grant/research support from: Celgene Corporation, Ellen Qian Employee of: Boston Collaborative Drug Surveillance Program, Catherine Vasilakis-Scaramozza Grant/research support from: Celgene Corporation, Steve Niemcryk Employee of: Celgene Corporation, Michael Peng Employee of: Celgene Corporation, Maria Paris Employee of: Celgene Corporation, anders Lindholm Employee of: Celgene Corporation, Susan Jick: None declared