THU0332 Fatigue remains a dominatng symptom despite tumour necrosis factor inhibitor therapy in psoriatic arthritis: a population-based cohort study
Authors: T.S. Jørgensen, M. Skougaard, C. Ballegaard, P. Mease, V. Strand, L. Dreyer, L.E. Kristensen
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Psoriatic arthritis (PsA) is a chronic inflammatory disorder associated with fatigue, pain and impaired function. Tumour necrosis factor inhibitor (TNFi) therapy fails among half of patients with PsA treated in routine care. <h3>Objectives</h3> The objective of this population-based cohort study was to investigate the association of fatigue with disease activity and adherence to therapy in PsA patients receiving their first TNFi. <h3>Methods</h3> Data on patient characteristics, disease activity and treatment adherence were obtained from the DANBIO register. Information on comorbidities according to the Charlson Comorbidity Index (CCI) and psychiatric comorbidities was obtained through linkage with the Danish National Patient Register. We performed Kaplan-Meier plots and univariate Cox proportional hazard regression analysis. Percentages of patients achieving relevant clinical responses were calculated. <h3>Results</h3> From 2006 thru 2016, we identified 880 patients eligible for analyses. Patients with upper median fatigue scores had statistically significantly higher disease activity measures, higher pain and HAQ scores, more comorbidities and current smoking status at baseline compared with patients with lower median fatigue scores (table 1). After treatment initiation the mean VAS fatigue score decreased from 62 mm (SD 25) to 44 mm (SD 30) at six months (p&lt;0.001). Kaplan–Meier curves showed shorter adherence to treatment in patients with higher baseline fatigue scores compared with patients with lower fatigue scores (HR 1.43 [1.2 to 1.7], p&lt;0.001) (figure 1). ACR20, 50 and 70 responses at six months were 49%, 35% and 18% respectively. VASfatigue20, 50 and 70 responses were 57%, 39% and 20%, respectively. The kappa value between ACR20, 50, 70 and VASfatigue responses were 0.37, 0.40 and 0.48 (p&lt;0.001), respectively. <h3>Conclusions</h3> Fatigue remains a dominating symptom after TNFi treatment, and is associated with higher baseline disease activity, more comorbidities, smoking, higher pain and HAQ scores, and increased risk of TNFi treatment discontinuation in a cohort of Danish patients with PsA. The agreement between ACR responses and VASfatigue responses is weak to moderate suggesting heterogeneity between experienced fatigue and joint inflammation. <h3>Acknowledgements</h3> This study was supported by unrestricted grants from The Oak foundation, NordForsk and the DANBIO register. <h3>Disclosure of Interest</h3> T. S. Jørgensen Speakers bureau: Abbvie, Roche, UCB, Novartis, Pfizer, Biogen and Eli Lilly, M. Skougaard: None declared, C. Ballegaard Speakers bureau: Janssen Pharmaceuticals, P. Mease Consultant for: Abbvie, Amgen, BMS, Celgene, Janssen, Lilly, Novartis, Pfizer, SUN, UCB, Speakers bureau: Abbvie, Amgen, BMS, Celgene, Janssen, Novartis, Pfizer, UCB, V. Strand Consultant for: Abbvie, Amgen, BMS, Boehringer Ingelheim, Celltrion, Janssen, Lilly, Merck, Novartis, Pfizer, Samsung, Sandoz, UCB, L. Dreyer Speakers bureau: UCB, MSD, Janssen, L. E. Kristensen Speakers bureau: Pfizer, AbbVie, Amgen, UCB, Celgene, BMS, MSD, Novartis, Eli Lilly, Janssen Pharmaceuticals