AB0787 TREATMENT TRENDS IN PSORIATIC ARTHRITIS IN A REAL-WORLD SETTING; RESULTS FROM A HEALTH PROVIDER DATABASE OF THE PSORIATIC ARTHRITIS PATIENTS
Authors: Amir Haddad, Faten Tatour, Tal Gazitt, Ilan Feldhamer, Irina Bergman, Arnon Cohen, Devy Zisman
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Emerging Psoriatic arthritis (PsA) treatments have had a great impact on treatment strategies and healthcare costs in PsA disease management. Therefore, investigating changes in therapy is important to patients, healthcare providers, and healthcare payers alike. <h3>Objectives:</h3> To describe changes in treatment strategies and management of PsA patients in a real-world setting over the years 2000-2017 since the introduction of diverse novel biologic disease modifying anti-rheumatic drugs (bDMARDS). <h3>Methods:</h3> A retrospective study was performed using the previously-tested and validated database of Clalit Health Services, the database of the largest healthcare provider in Israel. The database includes continuous real-time input from pharmaceutical and medical digital systems regarding prescribed and dispensed medications. In this study, data on all conventional DMARDs (cDMARDs) and bDMARDs dispensed to the PsA patient cohort from 2000-2017 was retrieved. In Israel, all patients are eligible for bDMARDS following treatment failure of at least 2 cDMARDS with bDMARDs used in different sequences and/or combinations based on patient and physician preference. Of note, Etanercept and infliximab are available on the Israeli market since 2000, adalimumab since 2002, Golimumab since 2006 and Ustekinumab since 2014. Descriptive statistics, including means (standard deviations) for continuous variables and frequencies (%) for categorical variables, were used. <h3>Results:</h3> The study included 5062 PsA patients. Data showed an increase in use of bDMARDs in recent years (Fig 1). The trend in increasing use of bDMARDS was not affected by age, sex, and ethnicity. Etanercept was the most commonly used bDMARD (10.1%) over time, whereas, methotrexate was the most commonly used cDMARD (25.9%). A decrease in use of infliximab was noted along with the introduction of adimumab, golimumab and ustekinumab. Notably, a decrease in the utilization of cDMARDs, but not corticosteroid use, was seen with the advent of bDMARDs (Fig 2). However, this decrease in cDMARD use was not observed in patients treated with infliximab [Correlation Coefficient 2.69% (-47.5%, 51.6%), P=0.921]. <h3>Conclusion:</h3> More PsA patients are using bDMARDs in recent years in lieu of cDMRADS. This change in PsA management highlights a need for further research on the relative safety efficacy and cost of biologic agents to better guide evidence-based treatment decisions. <h3>Disclosure of interests:</h3> amir Haddad: None declared, Faten Tatour: None declared, Tal Gazitt: None declared, Ilan Feldhamer: None declared, Irina Bergman: None declared, arnon Cohen Grant/research support from: Prof. Arnon Cohen received research grants from Janssen, Novartis and abbVie and Sanofi, Consultant for: Prof. Arnon Cohen served as a consultant, advisor for abbVie; amgen; Boehringer ingelheim; Dexcel pharma; Janssen, Lilly; Neopharm; Novartis, Perrigo; Pfizer; Rafa; Sanofi, Speakers bureau: Prof. Arnon Cohen served as speaker for abbVie; amgen; Boehringer ingelheim; Dexcel pharma; Janssen, Lilly; Neopharm; Novartis, Perrigo; Pfizer; Rafa; Sanofi, Devy Zisman Grant/research support from: Dr D Zisman received research grants from Pfizer, Janssen, Consultant for: Dr D Zisman served as a consultant, for Pfizer, abbvie, Novartis, Ellie-Lilly, Sanofi, Speakers bureau: Dr D Zisman served as a speaker for abbVie, Janssen, Lilly, Novartis, Pfizer, Sanofi