Background/Purpose: Previous studies have suggested that treating patients earlier with biologics could improve disease outcomes. The aim of this analysis was to assess the impact of disease duration on clinical and patient-reported outcomes in patients with psoriatic arthritis (PsA) or ankylosing spondylitis (AS) treated with subcutaneous golimumab (GLM) in Canadian routine practice.

Methods: BioTRAC is an ongoing, prospective registry of patients initiating treatment with infliximab or GLM for rheumatoid arthritis, AS, or PsA, or with ustekinumab for PsA. Eligible patients for this analysis included PsA and AS patients initiating GLM treatment since 2010. Disease duration at entry in the registry was categorized by tertiles as early (PsA: <2 years; AS: <1 year), mid (PsA: 2-5 years; AS: 1-2 years) and long-term (PsA: ≥6 years; AS: ≥3 years) duration. Standard outcomes were assessed; key outcomes of interest were low disease activity (LDA), remission (based on DAS28-ESR <2.6 and CDAI≤2.8), and minimal disease activity (MDA) achievement for PsA patients, and inactive disease (ASDAS <1.3) for AS patients. In order to determine the impact of disease duration on disease activity at 12 and 24 months, multivariate logistic regression and general linear models adjusted for age, gender, prior biologic treatment, and baseline disease parameters were utilized.

Results: A total of 253 PsA patients (54.4% female) and 376 AS patients (58.6% male) were included with a mean (SD) age of 52.7 (13.2) and 44.7 (13.3) years, respectively.  Most patients were biologic naïve (PsA: 95.3%; AS: 95.5%). The mean (SD) duration of PsA and AS at baseline was 5.7 (7.7) and of 5.4 (9.8) years, respectively.

In the PsA patient group, significantly greater improvements in MD global assessment (MDGA) and pain from baseline to month 24 were observed amongst patients treated at early term (Table 1). Based on multivariate logistic regression analyses, patients treated at later stage disease were significantly less likely than patients treated early to achieve MDA (OR: 0.10; p=0.025) and CDAI LDAS (OR: 0.06; p=0.002) at 24-month. There was no association between PsA duration and LDA, remission and MDA achievement at 12 months.

Among AS patients treated at early term, significantly greater improvements in BASFI from baseline to month 24 were observed (Table 1). Based on multivariate logistic regression analyses, AS patients treated at mid- and long-term were significantly less likely than patients treated at early term to achieve inactive disease based on ASDAS at 12 months, with odds ratios of 0.21 (p=0.028) and 0.12 (p=0.003), respectively. Disease duration was not associated with AS inactivity at 24-month.

Conclusion: The results of this analysis demonstrate that earlier treatment of PsA and AS with GLM in real-world is associated with improved outcomes, particularly in selected patient-reported outcomes at 12 and 24 months.