ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1149

Are There Country Differences in Disease Activity and Life Impact of Psoriatic Arthritis? An Analysis of 436 Patients from 14 Countries

Laure Gossec1, Juan Cañete 2, Ana-Maria Orbai 3, Ying-Ying Leung 4, Penelope Palominos 5, Rossana Scrivo 6, Andra Balanescu 7, Emmanuelle Dernis 8, Sandra Talli 9, Adeline Ruyssen-Witrand 10, Martin SOUBRIER 11, Sibel Zehra Aydin 12, Lihi Eder 13, Inna Gaydukova 14, Laura Coates 15, Umut Kalyoncu 16, Pascal Richette 17, M. Elaine Husni 18, Maarten de Wit 19, Josef Smolen 20, Ennio Lubrano 21 and Uta Kiltz 22, 1Sorbonne Université and Hôpital Pitié-Salpêtrière, Paris, France, 2Department of Rheumatology, Hospital Clínic, Barcelona, Barcelona, Spain, 3Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, 4Department of Rheumatology and Immunology, Singapore General Hospital,, Singapore, Singapore, 5Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul,, Porto Alegra, Brazil, 6Rheumatology Unit, Department of Internal Medicine and Medical Specialties, Sapienza Università di Roma,, Rome, Italy, 7Sf Maria Hospital, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania, 8Rheumatology Department, Le Mans Central Hospital, Le Mans, France, 9Rheumatology Department, East-Tallinn Central Hospital, Tallinn, Estonia, 10Rheumatology Unit, Toulouse university Hospital, UMR 1027, Inserm, Université Paul Sabatier Toulouse III, Toulouse, France, 11CHU Gabriel Montpied, Clermont Ferrand, Auvergne, France, 12University of Ottawa Faculty of Medicine, Rheumatology,Ottawa Hospital Research Institute, 1967 Riverside Drive, Ottawa, ON, K1H 7W9, CANADA, Ottawa, Canada, 13Women’s College Hospital and the Department of Medicine, University of Toronto, Toronto, Canada, 14North-western State medical university, St Petersburg, Russia, 15University of Oxford, Oxford, United Kingdom, 16Hacettepe University Department of Rheumatology, Ankara, Turkey, 17Department of Rheumatology, AP-HP Lariboisiere Hospital, Paris, France, 18Department of Rheumatologic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, 19Department of Medical Humanities, Amsterdam Public Health (APH), Amsterdam University Medical Centre, Amsterdam, Netherlands, 20Medical University of Vienna, Vienna, Austria, 2115. Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute ’Vincenzo Tiberio’, University of Molise, Campobasso, Italy, 22Rheumazentrum Ruhrgebiet/Ruhr University Bochum, Herne, Germany, Herne, Germany

Meeting: 2019 ACR/ARP Annual Meeting

Keywords:

Session Information

Date: Monday, November 11, 2019

Title: Healthcare Disparities In Rheumatology Poster

Session Type: Poster Session (Monday)

Session Time: 9:00AM-11:00AM

Background/Purpose: In psoriatic arthritis (PsA), there is a substantial life impact perceived by patients, although many treatments are now available at least in countries with access to more costly drugs (ref 1,2). Country of patient care, and in particular  Gross Domestic Product (GDP) may be linked to PsA outcomes. The lack of large international registries has not up to now allowed any comparison of outcomes according to the country.

The objective was to explore potential differences in disease activity, disease impact and treatments across countries in PsA.

Methods: This was a cross-sectional analysis of an observational study (ReFlap, NCT03119805, ref3), which included adult patients with PsA with ≥ 2 years disease duration from 14 countries. Countries of inclusion were analysed separately, and classified into tertiles by GDP/capita (lowest tertile, Brazil, Turkey, Russia, Romania, Estonia; middle tertile: Spain, Italy, UK, France; highest tertile, Canada, Germany, Austria, USA and Singapore). Patient demographics, treatments prescribed (conventional synthetic DMARDs, biological DMARDs, glucocorticoids), disease impact (though patient global assessment, PGA, HAQ and the Psoriatic Arthritis Impact of Disease questionnaire, PSAID-12) and PsA disease activity (assessed through swollen and tender joint counts (of 66/68), CRP, entheseal points, psoriasis body surface area and the composite scores DAPSA and MDA) were analysed per coutrny and compared between the 3 tertiles of GDP/capita by non-parametric tests.

Results: Of the 466 patients, 436 had complete data available and were analysed: mean age 52.3 (SD 12.5) years, mean disease duration 10.1 (8.1) years, 218 (50.8%) male.

In countries with a lower GDP/capita, patients were slightly older, with a longer disease duration. There was a similar use of biologics (overall mean 60.5%) and of oral glucocorticoids (18.6%) but use of methotrexate was different (67.0% in the lowest GDP/capita tertile, versus 47.3% in the second and 53.4% in the highest tertile, p=0.007). Disease activity and impact were overall higher in the lowest GDP/capita countries (Table and Figure). The middle and highest GDP/capita tertiles had similar outcomes.

Conclusion: In this exploratory comparison of disease patterns and treatments choices in 14 countries, we relied on a relatively small and selected population from tertiary centers which is a limitation. We observed a similar use of biologics but more use of methotrexate in countries with a lower GDP/capita, though glucocorticoid use was similar. Both disease activity and disease impact appeared more important in the lower GDP/capita countries. This raises questions on the link between disease activity, disease impact, treatment choices and other (external) society and culture related elements such as lifestyle/diet or health care systems.


Table


Figure

Disclosure: L. Gossec, Abbvie, 5, AbbVie, 5, Abbvie, Biogen, BMS, Celgene, Lilly, Novartis, Pfizer, SAnofi-Aventis, UCB, 5, Amgen, 5, Biogen, 5, BMS, 2, 5, Celgene, 5, Celgene Corporation, 2, Janssen, 5, Lilly, 2, 5, MSD, 5, Nordic Pharma, 5, Novartis, 5, Pfizer, 2, 5, Sanofi, 5, Sanofi-Aventis, 5, UCB, 5; J. Cañete, Eli Lilly and Company, 5, Janssen, 5, 8, Novartis, 5, 8, Mylan, 5, Pfizer, 5, UCB, 5; A. Orbai, AbbVie, 2, Celgene, 2, Eli Lilly, 2, 5, Horizon, 2, Janssen, 2, 5, Lilly, 2, 5, Novartis, 2, 5, Pfizer, 5, UCB, 5; Y. Leung, None; P. Palominos, None; R. Scrivo, None; A. Balanescu, None; E. Dernis, None; S. Talli, None; A. Ruyssen-Witrand, None; M. SOUBRIER, None; S. Aydin, None; L. Eder, Abbvie, 2, 5, 8, Celgene, 5, Janssen, 5, Lily, 2, 5, Novartis, 2, 5, Pfizer, 2, 8, UCB, 2; I. Gaydukova, None; L. Coates, Abbvie, 2, 5, 8, AbbVie, 2, 5, 8, AbbVie, Amgen, BMS, Celgene Corporation, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Pfizer, Prothena, Sun Pharma, UCB, 5, Abbvie, Amgen, Celgene, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, UCB, 5, Abbvie, Amgen, Lilly, Novartis, Pfizer, UCB, 8, AbbVie, Celgene Corporation, Eli Lilly, Janssen, Novartis, UCB, 8, AbbVie, Celgene Corporation, Eli Lilly, Novartis, Pfizer, 2, AbbVie, Celgene Corporation, Novartis, Pfizer, 2, Abbvie, Celgene, Novartis, Pfizer, Lilly, 2, Amgen, 5, 8, Biogen, 8, Bristol-Myers Squibb, 5, Celgene, 2, 5, 8, Eli Lilly, 2, 5, 8, Galapagos, 5, Gilead, 5, Janssen, 2, 5, 8, Janssen Research & Development, LLC, Lilly, 2, 5, 8, MSD, 5, Novartis, 2, 5, 8, Pfizer, 2, 5, 8, Pfizer Inc, 2, 5, 8, Prothena, 5, Sun Pharma, 5, UCB, 5, 8, UCB Pharma, 5; U. Kalyoncu, UCB, 5; P. Richette, Janssen, 8; M. Husni, Abbvie, 5, AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer, Regeneron, Sanofi-Genzyme, UCB, 5, Abbvie, Amgen, Janssen, Novartis, Lilly, Regeneron, Pfizer and UCB, 5, Bristol-Myers Squibb, 5, Eli Lilly, 5, Genentech, 5, Janssen, 5, Janssen Research & Development, LLC, 2, 3, Novartis, 5, PASE questionnaires, 7, Pfizer, 5, Sanofi-Genzyme, 5, UCB, 5; M. de Wit, Abbvie, 5, 8, BMS, 5, 8, Celgene, 5, 8, Eli Lilly, 5, 8, Janssen-Cilag, 5, 8, Novartis, 5, 8, Pfizer, 5, 8, Roche, 5, 8; J. Smolen, AbbVie, 2, 5, 8, Abbvie, 2, 5, Amgen, 5, 8, AstraZeneca, 2, 5, 8, Astra-Zeneca, 5, Astro, 5, 8, BMS, 5, Celgene, 5, 8, Celltrion, 5, Celtrion, 5, 8, Chugai, 5, Eli Lilly and Company, 2, 5, Gilead, 5, GlaxoSmithKline, 5, 8, ILTOO, 5, 8, ILTOO Janssen, 5, Janssen, 2, 5, 8, Lilly, 2, 5, 8, Medimmune, 5, 8, MSD, 2, 5, 8, Novartis, 2, 5, Novartis- Sandoz, 5, Novartis-Sandoz, 2, 5, 8, Pfizer, 2, 5, 8, Pfizer Inc, 5, Roche, 2, 5, Roche;, 2, 5, 8, Samsung, 5, 8, Sanofi, 5, 8, Sanofi-Aventis, 5, UCB, 5, 8; E. Lubrano, None; U. Kiltz, AbbVie, 2, 5, 8, ABBVIE, NOVARTIS, CHUGAI, JANSEN, MSD, UCB, 8, ABBVIE, NOVARTIS, LILLY,BIOCAD, GRUNENTHAL,UCB, 5, ABBVIE, NOVARTIS, PFIZER,BIOGEN, 2, Biocad, 2, 5, Biogen, 2, 5, Chugai, 2, 5, 8, Eli Lilly, 2, 5, Eli Lilly and Company, 5, Grünenthal, 2, 5, 8, Janssen, 8, Jasnssen, 2, 5, MSD, 2, 5, 8, Novartis, 2, 5, 8, Pfizer, 2, 5, Roche, 2, 5, 8, UCB, 2, 5, 8.

To cite this abstract in AMA style:

Gossec L, Cañete J, Orbai A, Leung Y, Palominos P, Scrivo R, Balanescu A, Dernis E, Talli S, Ruyssen-Witrand A, SOUBRIER M, Aydin S, Eder L, Gaydukova I, Coates L, Kalyoncu U, Richette P, Husni M, de Wit M, Smolen J, Lubrano E, Kiltz U. Are There Country Differences in Disease Activity and Life Impact of Psoriatic Arthritis? An Analysis of 436 Patients from 14 Countries [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/are-there-country-differences-in-disease-activity-and-life-impact-of-psoriatic-arthritis-an-analysis-of-436-patients-from-14-countries/. Accessed .

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