AB0541 PREDICTING THE INITIATION OF BIOLOGIC DMARDS IN EARLY PSORIATIC ARTHRITIS WITHIN 1-YEAR OF TREAT-TO-TARGET STRATEGY
Authors: E. Loginova, T. Korotaeva, E. Gubar, Y. Korsakova, S. Glukhova
Journal: Annals of the Rheumatic Diseases (2021)

Background: According to the EULAR recommendations and treat-to-target (T2T) strategy synthetic (s) DMARDs are the first-line of PsA therapy and biologic (b) DMARDs are the second one [1]. The value of early intervention by bDMARDs in PsA has been demonstrated recently [2]. But factors which can predict bDMARDs initiation have not been evaluated yet. Objectives: To identify prognostic factors for initiation of bDMARDs within 1-year of T2T strategy in early PsA. Methods: 70 patients (pts) (M/F=35/35) with active early PsA fulfilling the CASPAR criteria treated by T2T strategy were included. Mean age 36.9±10.2 years (yrs), PsA duration 11.3±10.6 months (mos.), psoriasis duration 80.6±89.9 mos. Median DAPSA= 29.4 [23.1;36.0]. At baseline (BL) all pts were given therapy with Methotrexate (MTX) s/c with escalating dose from 5 to 25 mg/wk, then over a period of 12 mos pts with ineffectiveness of MTX were added bDMARDs. At BL and every 3 month of therapy all pts underwent standard clinical examinations of PsA activity. DAPSA, ESR (mm/h), CRP (mg/l), the number of pts with dactylitis, enthesitis by LEI and plantar fascia, BSA (%), HAQ and fatigue by FACIT (Functional Assessment of Chronic Illness Therapy) Fatigue Scale (Version 4), BMI (kg/m 2 ) were evaluated. DAPSA &gt; 28 indicate high activity, a score FACIT &lt; 30 - severe fatigue, BMI &gt;25 overweight and obese. At 12 mos. pts were divided into two groups. Group 1 included 42 pts who were treated with MTX only and group 2 - 28 pts those with added bDMARDs during 12 mos. Multi-dimensional step-by-step discriminant analysis was used to identify a group of signs associated with the need to initiate bDMARDs within 12 mos. Results: Comparative analysis of two groups showed the following features proved to be the most informative at BL and at 3 mos. of sDMARDs therapy with MTX: high PsA activity by DAPSA ≥ 30 (р = 0.009), BMI (kg/m 2 ) ≥ 27 (р = 0.019), entesitis ≥ 1 (p= 0.005), ESR ≥ 20 mm/h (p= 0.007), FACIT &lt; 30 (p= 0.074), male sex (р = 0.098). Early PsA pts with combination of these features at the first visit and at 3 mos. of MTX monotherapy have more chance to initiate bDMARDs in comparison to pts without them. Area Under ROC Curve (AUC) 0.892; 95% CI (0.818-0.966). Sensitivity/ Specificity of model 82% / 76% accordingly. (Figure 1). Figure 1. Conclusion: It is a combination of features from first visit to clinic and at 3 mos. of MTX monotherapy – high PsA activity by DAPSA, male gender, persistent entesitis, obesity, ESR increase and severe fatigue by FACIT - that constitutes a prognostic factor for the initiation of bDMARDs at an early-stage of PsA. These factors should be considered in clinical practice to avoid losing time for the early initiation of bDMARDs and improved outcomes of PsA. References: [1]Gossec L, et al. Ann Rheum Dis. 2020;79:700–712. doi:10.1136/annrheumdis-2020-217159. 2. van Mens LJJ, et al. Ann Rheum Dis 2019;78:610–616. doi:10.1136/annrheumdis-2018-214746 Disclosure of Interests: None declared.