SAT0427 COMPARATIVE EFFECTIVENESS OF TOFACITINIB (TF) AND ADALIMUMAB (ADA) IN PSORIATIC ARTHRITIS (PsA) PATIENTS IN REAL CLINICAL PRACTICE.
Authors: E. Loginova, T. Korotaeva, E. Gubar, Y. Korsakova, S. Glukhova, E. Vasilenko, A. Vasilenko, N. Kuznetsova, I. Patrikeeva
Journal: Annals of the Rheumatic Diseases (2020)

Background: Tofacitinib (TF) is an oral Janus kinase inhibitor approved for PsA treatment. It has demonstrated comparable to ADA efficacy in RCT in reducing PsA clinical symptoms 1,2 . There is currently no data concerning comparative effectiveness of TF and ADA in clinical practice. The Russian PsA RegisTry (RU-PsART) collected data from 43 rheumatology centers of the Russian Federation. Objectives: to study responses to TF or ADA over a period of 6 months (mo) treatment in patients (pts) with active PsA in real clinical practice. Methods: 77 (M/F=43/34) PsA pts fulfilling the CASPAR criteria from the RU-PsART cohort were divided into two groups according to the treatment given. 41pts (M/F=24 (58.5%)/17 (41.5%), mean age 42.4±10,3 years (yrs), median (Me) PsA duration 72 [35;120] mo were treated with TF 5 mg twice daily. 36 pts (M/F=19 (52.8%)/17 (47.2%), mean age 44±11.5 yrs, Me PsA duration 59 [22;102] mo were treated with ADA 40 mg/2 weeks, subcutaneous, as a first-line bDMARD. In TF/ADA groups 89%/52.8% pts accordingly were given combination therapy with Methotrexate (MTX). At baseline (BL) and at 6 mo of therapy PsA activity by DAPSA, BASDAI, the number of pts (NPts) with dactylitis, enthesitis by LEI, BSA, HAQ were evaluated in both groups. At 6 mo of therapy the NPts who achieved remission by DAPSA (≤4)/Low activity (LA)≤14) and Minimal disease activity (MDA, 5 of 7) were calculated in both groups. M±SD, Me [Q25; Q75], Min-Max, %, t-test, Pierson-χ 2 , Manna-Whitney, Wilcoxon tests were performed. All p&lt;0.05, were considered to indicate statistical significance. Results: At BL TF pts had higher PsA activity by DAPSA compared to ADA group: 44.2[37.8; 55.3]/35.8 [21.1; 52] accordingly (p=0.03). At 6 mo of treatment DAPSA significantly decreased in TF/ADA groups - to 11 [4,3; 17,3]/9,1[6; 19,6] (p&lt;0,001) accordingly. At 6 mo of therapy there were no significant differences between groups in achieving MDA, DAPSA LA/Remission (table 1). At 6 mo of treatment in TF-treated group the NPts with dactylitis significantly decreased from 22 (53,7%) to 5 (13,2%) pts (p&lt;0.001), and in ADA-treated group no significant differences were found in NPts with dactylitis [despite a quantitative decrease from 13 (36,1%) to 6 (20%) pts (p=0.15)]. The NPts with enthesitis in both TF/ADA groups decreased significantly: from 27 (69,2%) to 12 (30,8%) (p&lt;0,002) and from 16 (72,7%) to 5 (38,5%) (p&lt;0.046) pts accordingly. In TF/ADA-treated pts BASDAI improved from 6 [4.2;7] to 1.4 [0.6; 3.2] (p&lt;0.001)/from 4.4 [1.9;5.8] to 3 [0.8;4.5] accordingly (p&lt;0.046); HAQ significantly decreased from 1 [0.625;1.5] to 0,5 [0; 0.875] and from 0.875 [0.5;1.38] to 0.5 [0; 0.875] accordingly. The NPts with BSA&gt;3% significantly reduced in the TF group: from 20 (51,3%) to 8 (26,7%) pts (p&lt;0,002), but not in the ADA group. Table 1. MDA, DAPSA LA/Remission in TF/ADA at 6 mo TF ADA Study Events Subjects Events Subjects OR (95% CI) P DAPSA remission abs, % achieved 11 (26,8%) 41 6 (20,8%) 29 1,406 (0,453-4,366) 0.556 DAPSA LA abs, % achieved 15 (36,6%) 41 13 (44,8%) 29 0,710 (0,269-1,872) 0.489 MDA abs, % achieved 16 (40%) 40 9 (30%) 30 1,556 (0,569-4,249) 0.389 Conclusion: In real clinical practice TF and ADA demonstrated comparable effectiveness in all clinical domains of active PsA and showed equal result in achievement of MDA/LA/Remission according to DAPSA. References: [1]Mease P, Hall S, FitzGerald O, et al. N Engl J Med 2017;377:1537–50. [2]Gladman D, Rigby W, Azevedo VF, et al. N Engl J Med 2017;377:1525–36. Acknowledgments: no Disclosure of Interests: Elena Loginova Speakers bureau: Janssen, Tatiana Korotaeva Consultant of: Pfizer, MSD, Novartis, AbbVie, Celgene, JSC BIOCAD, Janssen, UCB, Lilly and Novartis-Sandoz, Speakers bureau: Pfizer, MSD, Novartis, AbbVie, Celgene, JSC BIOCAD, Janssen, UCB, Lilly and Novartis-Sandoz, ELENA GUBAR: None declared, Yulia Korsakova: None declared, Svetlana Glukhova: None declared, Elizaveta Vasilenko: None declared, Aleksey Vasilenko: None declared, Natalia Kuznetsova: None declared, Irina Patrikeeva: None declared