POS1057 DISCONNECT BETWEEN TREATMENT SWITCHES AND DISEASE ACTIVITY STATE IN EARLY PSORIATIC ARTHRITIS
Authors: J. Luime, M. Kok, I. Tchetverikov, M. Vis, C. Collaboration of Rheumatologists
Journal: Annals of the Rheumatic Diseases (2021)

Background: Receiving adequate treatment early in the disease course is one of the most important prognostic factors to achieve optimal disease outcome in most rheumatological conditions. Treat-to-target strategies and early step-up of treatment are important ingredients to accomplish this. While for Rheumatoid Arthritis this is common practice on accepted targets, for Psoriatic Arthritis (PsA) this is less outspoken practice. In PsA multiple domains must be taken into account and also there is a less established practice to use PsA specific targets, such as MDA, although this is associated with a better quality of life.[1,2] Whether this affects optimal disease outcome is not well described Objectives: To describe treatment strategies in newly diagnosed PsA with at least one synovitis and, treatment switches over time in those that not achieved MDA. Methods: For this study we used data from the DEPAR study between August 2013 and February 2019. The DEPAR study is a cohort that includes newly diagnosed PsA patients and follows them for up to 6 years. Patients are classified at baseline according to their prominent features: mono-, oligo-, polyarthritis, enthesitis, dactylitis or axial phenotype. For this study we used the data from the first 2 years for the patients with an articular phenotype. Methotrexate (MTX) and MTX plus another s-DMARD or GCs were addressed separately as they form the cornerstone of treatment in PsA. Next treatment was grouped in the usual drug classes: sDMARD (conventional), bDMARD and Glucocorticoids (GCs). Descriptive statistics were applied in STATA16 and Tableau 2020.3 Results: Out of 620 patients, 478 patients had at least one swollen joint at baseline and were included in this analysis. 349 (73%) had data at 1 year and 267 (56%) at 2 years. Average age was 50.3 years(sd 14.1), and 50% was female. Half of the patients had oligo-arthritis, 30% poly-arthritis and 20% mono-arthritis. At baseline, clinical characteristics were 3.8 swollen joints (sd 4.9), 5.5 tender joints (sd 6.2), 3.1 PASI points (sd 3.7, skin), 0.8 entheseal points (LEI; sd 1.2) and 0.1 dacylitis count (basic count of digits; sd 0.6). Treatment was initiated with Monotherapy MTX in 51% of the patients, while 25% did not start any DMARD, 10% started a combination of s-DMARDs, 9% a single s-DMARD, 3% a b-DMARD and 2% GCs. This differed for the different phenotypes as shown in Table 1. Minimal Disease Activity (MDA) was achieved by 32% after 3 months increasing to 58% at 24 months. Treatment switches in the non-MDA mono-, oligo- and polyarthritis groups are shown in Figure 1. In the patients not in MDA treatment was not switch in: 70% of patients with mono-arthritis, 50-66% with oligo-arthritis and 50% poly-arthritis. Similar observations were found when using the DAS28(&lt;=3.2) or DAPSA(&lt;14), both including only articular disease activity (data not shown). Conclusion: Achieving MDA is associated with a better quality of life, though it is not yet common practice to make treatment adjustments based on MDA. Of the newly diagnosed PsA patients not in MDA, more than half of the clinical evaluations did not result in a switch of medication. References: [1]Wervers, K, et al ART 2019 [2]Coates, L, et al. Lancet 2015 Figure 1. Medication change in patients not in MDA at each timepoint (dark bars = change and light bars = no change ) Disclosure of Interests: Jolanda Luime: None declared, Marc Kok Grant/research support from: Pfizer, Novartis, BMS, Abbvie, Ilja Tchetverikov: None declared, Marijn Vis Grant/research support from: Novartis, CICERO collaboration of rheumatologists: None declared.