SAT0365 SECULAR CHANGES IN PSORIATIC ARTHRITIS PATIENTS STARTING FIRST COURSE OF BIOLOGIC THERAPIES – INFLAMMATORY HALLMARKS OF LESSER PROMINENCE: A NORDIC POPULATION-BASED COHORT STUDY
Authors: Rebekka L. Hansen, Tanja Schjødt Jørgensen, Lene Dreyer, Björn Gudbjornsson, Johan Askling, Merete L. Hetland, Bente Glintborg, Daniela DI Giuseppe, Lennart T.H. Jacobsson, Tore K. Kvien, Dan Nordström, Kalle Aaltonen, Sella Aarrestad Provan, Eirik Kristianslund, Johan K. Wallman, Thorvardur Jon Love, Lars Erik Kristensen
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Psoriatic arthritis (PsA) is a chronic inflammatory disorder associated with skin and joint manifestations, several extra-articular symptoms, various comorbidities, and disability[1,2]. The emergence of tumour necrosis factor inhibitor (TNFi) therapy has dramatically changed the course of disease. Additional TNFi therapies (certolizumab pegol and golimumab) have been marketed, and recently ustekinumab has become available for PsA. <h3>Objectives</h3> To assess the use of biological agents (bDMARDs) in PsA from 2006-2017, using data from the Nordic Rheumatology registers. <h3>Methods</h3> Based on data from the registers DANBIO, ICEBIO, NOR-DMARD, ROB-FIN, and SRQ, PsA patients initiating bDMARDs or biosimilars, as a first or subsequent biological therapy were identified. Adalimumab, etanercept and infliximab were grouped as <i>1st generation therapies</i>; certolizumab pegol, golimumab were grouped as <i>2nd generation therapies</i> and biosimilar treatments were grouped. Treatments with ustekinumab were also identified. Pearson correlation tests were calculated and p&gt;0.05 were considered significant. R<sup>2</sup>≈1 showed a strong correlation between the baseline characteristics. <h3>Results</h3> A total of 18,089 treatment initiations were identified (DANBIO 4,361, ICEBIO 449, NOR-DMARD 1,948, ROB-FIN 1,069, SRQ 10,262). 53.68% of the patients were female. Overall, 6,198 patients initiated <i>1st generation therapies</i>, 1,447 <i>2nd generation therapies</i>, 1,353 biosimilars and 52 ustekinumab, as their first course of bDMARDs. Initiations of second or subsequent bDMARDs were 4,560, 1,630, 2,176 and 376 patients, respectively. The total of first course bDMARD initiators increased significantly from 2006-2017 (p&lt;0.001), similar to patients switching therapy (p&lt;0.001). Ustekinumab was primarily used as a second or subsequent bDMARD. The figure shows the secular trends of baseline characteristics collected from the Nordic countries with the subcategories of CRP, disease duration, HAQ score, VAS patient pain, swollen joint count and tender joint count from 2006-2017. All five countries showed trends of decreasing CRP, SJC and TJC values over time. Other parameters only showed slight or no correlation. <h3>Conclusion</h3> Across the Nordic countries the prescription pattern for biological therapies for PsA has changed significantly over time. The decreasing levels of both CRP scores and SJC suggest that PsA patients who initiate bDMARD treatment have changed towards a less active inflammatory phenotype from 2006-2017. Collaboration across registers will allow for robust assessment of the uptake of newer biological therapies. Overall the number of prescribed therapies increased during the observational period, indicating a previously unmet need for biological therapies in the Nordic population. <h3>References</h3> [1] Ballegaard C, Kristensen L. E, et al. Impact of comorbidities on tumour necrosis factor inhibitor therapy in psoriatic arthritis: a population-based cohort study. Arthritis. 2018;70(4):592-599. [2] Kristensen L. E, Jørgensen T. S, et al, Societal costs and patients' experience of health inequities before and after diagnosis of psoriatic arthritis: a Danish cohort study. Ann Rheum Dis. 2017;(76):1495-1501. <h3>Acknowledgement</h3> This study was partly funded by a grant from NordForsk and FOREUM <h3>Disclosure of Interests</h3> Rebekka L. Hansen: None declared, Tanja Schjødt Jørgensen Consultant for: Abbvie, Roche, Novartis, UCB, Biogen, Eli Lilly., Speakers bureau: Abbvie, Roche, Novartis, UCB, Biogen, Eli Lilly., Lene Dreyer Consultant for: MSD, UCB and Janssen Pharmaceuticals, Speakers bureau: MSD, UCB and Janssen Pharmaceuticals, Speakers bureau: UCB, MSD, Eli Lilly and Janssen Pharmaceuticals., Björn Gudbjornsson: None declared, Johan Askling Grant/research support from: Karolinska Institutet (JA) has or has had research agreements with the following pharmaceutical companies, mainly in the context of the ATRIS national safety monitoring programme for rheumatology biologicals: Abbvie, BMS, MSD, Eli Lilly, Pfizer, Roche, Samsung Bioepis, and UCB., Consultant for: Karolinska Institutet has received remuneration for JA participating in ad boards arranged by Lilly, Novartis, and Pfizer., Merete L. Hetland Grant/research support from: BMS, MSD, AbbVie, Roche, Novartis, Biogen, Pfizer, Consultant for: Eli Lilly, Speakers bureau: Orion Pharma, Biogen, Pfizer, CellTrion, Merck, Samsung Bioepis, Bente Glintborg Grant/research support from: Biogen, Pfizer, AbbVie, Daniela Di Giuseppe: None declared, Lennart T.H. Jacobsson Consultant for: LJ has received lecture and consulting fees from Pfizer, Abbvie, Novartis, Eli-Lily and Janssen, Tore K. Kvien Grant/research support from: AbbVie, BMS, MSD, Pfizer, Roche and UCB., Consultant for: AbbVie, Biogen, BMS, Boehringer Ingelheim, Celgene, Celltrion, Eli Lilly, Hospira, Merck-Serono, MSD, Novartis, Oktal, Orion Pharma, Pfizer, Roche, Sandoz, Sanofi, Mylan and UCB, Speakers bureau: AbbVie, Biogen, BMS, Boehringer Ingelheim, Celgene, Celltrion, Eli Lilly, Hospira, Merck-Serono, MSD, Novartis, Oktal, Orion Pharma, Pfizer, Roche, Sandoz, Sanofi and UCB, Dan Nordström Grant/research support from: MSD, Pfizer, Consultant for: AbbVie, BMS, MSD, Novartis, Roche, Pfizer, UCB, Speakers bureau: Novartis, UCB, Kalle Aaltonen: None declared, Sella Aarrestad Provan Consultant for: Novartis, Speakers bureau: Lilly, Eirik kristianslund: None declared, Johan K Wallman Consultant for: Consultant for AbbVie, Celgene, Eli Lilly, Novartis, and UCB Pharma., Thorvardur Jon Love Consultant for: Received reimbursment from Celgene for speaking about guidelines for the treatment of psoriatic arthritis, Lars Erik Kristensen Grant/research support from: UCB, Biogen, Janssen Pharmaceuticals, and Novartis, Consultant for: Consultant for AbbVie, Amgen, Biogen, BMS, Celgene, Eli Lilly, Janssen Pharmaceuticals, MSD, Novartis, Pfizer, Roche, Sanofi, and UCB Pharma., Speakers bureau: Pfizer, AbbVie, Amgen, UCB, BMS, Biogen, MSD, Novartis, Eli Lilly and Company, and Janssen Pharmaceuticals