Comparing Predictors of DAPSA28, DAPSA66/68 and DAS28-CRP Remission at 6 Months in Bio-naive Patients with Psoriatic Arthritis Initiating a TNFi in Clinical Practice – Results from the EuroSpA Collaboration

Stylianos Georgiadis¹, Louise Linde², Lykke Ørnbjerg¹, Simon Horskjær Rasmussen¹, Johan Askling³, Brigitte Michelsen⁴, Daniela Di Giuseppe³, Johan Karlsson Wallman⁵, Bente Glintborg⁶, Anne Gitte Loft⁷, Miguel Bernardes⁸, Carolina Ochôa Matos⁹, Dan Nordstrom¹⁰, Laura Kuusalo¹¹, Burkhard Moeller¹², Michael Nissen¹³, Bjorn Gudbjornsson¹⁴, Thorvardur Love¹⁵, Florenzo Iannone¹⁶, Tore Kvien¹⁷, Ziga Rotar¹⁸, Isabel Castrejon¹⁹, Gary Macfarlane²⁰, Marleen van de Sande²¹, Merete Hetland¹ and Mikkel Østergaard²², ¹Copenhagen Center for Arthritis Research, Rigshospitalet, Copenhagen, Denmark, ²Rigshospitalet Glostrup, Glostrup, Denmark, ³Karolinska Institutet, Stockholm, Sweden, ⁴Rigshospitalet Glostrup; Diakonhjemmet Hospital; Sørlandet Hospital, Copenhagen, Denmark, ⁵Lund University and Skåne University Hospital, Lund, Sweden, ⁶Rigshospitalet Glostrup, University of Copenhagen, Virum, Denmark, ⁷Aarhus University, Horsens, Denmark, ⁸Rheumatology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal, ⁹Centro Académico de Medicina de Lisboa, Lisbon, Portugal, ¹⁰Helsinki University Hospital, Helsinki, Finland, ¹¹Centre for Rheumatology and Clinical Immunology, University of Turku and Turku University Hospital, Turku, Finland, ¹²Inselspital - University Hospital Bern, Bern, Switzerland, ¹³Geneva University Hospitals, Geneva, Switzerland, ¹⁴Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland, ¹⁵Landspitali University Hospital and the University of Iceland, Reykjavik, Iceland, ¹⁶Rheumatology Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro", Bari, Italy, ¹⁷Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway, ¹⁸University Medical Centre Ljubljana, Ljubljana, Slovenia, ¹⁹Universitario Gregorio Marañón, Madrid, Spain, ²⁰Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, United Kingdom, ²¹Amsterdam UMC, University of Amsterdam, Department of Rheumatology & Clinical Immunology and Department of Experimental Immunology, Amsterdam Infection & Immunity Institute; Amsterdam Rheumatology & Immunology Center (ARC), Academic Medical Center, Amsterdam, Netherlands, ²²Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet; University of Copenhagen, Copenhagen, Denmark

Meeting: ACR Convergence 2023

Keywords: Disease Activity, Outcome measures, Psoriatic arthritis, Statistical methods

Session Information

Date: Monday, November 13, 2023

Title: (0965–0992) Epidemiology & Public Health Poster II

Session Type: Poster Session B

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

Background/Purpose: The Disease Activity index for PSoriatic Arthritis based on 66/68 joints (DAPSA66/68) and the Disease Activity Score in 28 joints with C-reactive protein (DAS28-CRP) are two widely used disease activity scores to monitor patients with psoriatic arthritis (PsA). A modified DAPSA based on 28 joints (DAPSA28) has been proposed and validated in patients with PsA. We aimed to identify and compare predictors of clinical remission according to DAPSA28 (≤4), DAPSA66/68 (≤4) and DAS28-CRP (< 2.6) in a broader population of European patients with PsA initiating a first tumor necrosis factor inhibitor (TNFi).

Methods: Prospectively collected real-world data from PsA patients initiating a first TNFi between 2009 and 2018 from nine countries participating in the European Spondyloarthritis (EuroSpA) Research Collaboration Network were pooled. Patients with complete data on DAPSA28, DAPSA66/68 as well as DAS28-CRP at 6-month follow-up (from 90 to 270 days after treatment start date) constituted the study cohort. Logistic regression analyses on multiple imputed baseline data (20 imputed datasets) were used to identify predictors of DAPSA28, DAPSA66/68 and DAS28-CRP remission at 6 months. Fifteen baseline (from 30 days before to 30 days after treatment start date) demographic and clinical characteristics were included as potential predictors. For each remission outcome, variable selection was performed separately in each imputed dataset. Predictors that appeared in at least half of the datasets were included in the final model.

Results: Of 10,249 PsA patients, 3,159 (30.8%) had complete assessments of DAPSA28, DAPSA66/68 and DAS28-CRP at 6 months and were included in the analyses. Baseline characteristics of included patients were similar to those not included (Table 1). Among included patients, 896 (28.4%), 861 (27.3%), and 1,866 (59.1%) were in DAPSA28, DAPSA66/68 and DAS28-CRP remission at 6 months, respectively. The same eleven predictors were identified for DAPSA28 and DAPSA66/68 remission, while nine predictors were selected for DAS28-CRP remission (Table 2). Eight predictors were common for all three remission outcomes: male gender, longer disease duration and higher CRP were positive predictors, while older age, higher body mass index, patient global score, health assessment questionnaire and 68 tender joint count reduced the odds of remission (Table 2). The same predictors were identified when substituting 66/68-joint counts with 28-joint counts in the set of potential predictors (with 28 tender joint count replacing 68 tender joint count as a predictor).

Conclusion: Identical variables were found as predictors of both DAPSA28 and DAPSA66/68 remission in patients treated with a first TNFi. The majority of these variables also predicted DAS28-CRP remission, although DAS28-CRP remission was more commonly achieved. Our findings suggest that baseline determinants of remission according to different disease activity scores are similar and support the use of DAPSA28 in datasets where only 28-joint counts are available.

Table 1. Baseline characteristics of PsA patients starting a first TNFi among patients included and excluded from the analyses

Table 2. Univariable and final multivariable analyses for predicting DAPSA28, DAPSA66/68 and DAS28-CRP remission at 6 months (n=3,159)

Disclosures: S. Georgiadis: Novartis, 5; L. Linde: Novartis, 5, UCB, 5; L. Ørnbjerg: Novartis, 5; S. Horskjær Rasmussen: Novartis, 5; J. Askling: Abbvie, 5, Bristol-Myers Squibb(BMS), 5, Eli Lilly, 5, Galapagos, 5, Merck/MSD, 5, Pfizer, 5, Samsung bioepis, 5, Sanofi, 5; B. Michelsen: Novartis, 5; D. Di Giuseppe: None; J. Karlsson Wallman: AbbVie, 5, 6, Amgen, 5, 6, Eli Lilly, 5, Novartis, 5, Pfizer, 5; B. Glintborg: AbbVie/Abbott, 5, Bristol-Myers Squibb(BMS), 5, Sandoz, 5; A. Loft: Ucb, 1, 6, 12, Congress participation; M. Bernardes: None; C. Ochôa Matos: None; D. Nordstrom: AbbVie/Abbott, 2, BMS, 2, Lilly, 2, MSD, 2, Novartis, 2, Pfizer, 2, UCB, 2; L. Kuusalo: None; B. Moeller: None; M. Nissen: AbbVie/Abbott, 2, Eli Lilly, 2, 12, Involved in Clinical Trial, Janssen, 2, Novartis, 6, 12, research funding paid to institution, Pfizer, 6, UCB, 2, 12, funding support to attend EULAR 2023, paid to institution; B. Gudbjornsson: Nordic-Pharma, 6, Novartis, 2, 6; T. Love: None; F. Iannone: Abbvie, 2, 5, BMS, 2, 5, Janssen, 2, 5, Lilly, 2, 5, MSD, 2, 5, Novartis, 2, 5, Pfizer, 2, 5, Roche, 2, 5, UCB, 2, 5; T. Kvien: AbbVie/Abbott, 1, 2, 6, Bristol-Myers Squibb(BMS), 5, Galapagos, 2, 5, Gilead, 2, grunenthal, 6, Janssen, 2, 6, Novartis, 5, Pfizer, 2, 5, sandoz, 2, 6, UCB, 2, 5, 6; Z. Rotar: None; I. Castrejon: None; G. Macfarlane: None; M. van de Sande: AbbVie, 2, Eli Lilly, 5, Janssen, 6, Novartis, 2, 5, 6, UCB Pharma, 2, 5, 6; M. Hetland: AbbVie/Abbott, 1, 5, Bristol-Myers Squibb(BMS), 5, Danbio, 12, Chari of Danbio registry, Eli Lilly, 5, MEDAC, 6, Novartis, 5, Pfizer, 5, 6, Sandoz, 5, 6; M. Østergaard: AbbVie, 2, 5, 6, Amgen, 5, Boehringer-Ingelheim, 2, 6, Bristol-Myers Squibb(BMS), 2, 5, 6, Celgene, 2, 5, 6, Eli Lilly, 2, 6, Galapagos, 2, 6, Gilead, 2, 6, Hospira, 2, 6, Janssen, 2, 6, MEDAC, 6, Merck, 2, 5, 6, Novartis, 2, 5, 6, Novo Nordisk, 2, 6, Orion, 2, 6, Pfizer, 2, 6, Regeneron, 2, 6, Roche, 2, 6, Sandoz, 2, 6, Sanofi, 2, 6, UCB, 2, 6.

To cite this abstract in AMA style:

Georgiadis S, Linde L, Ørnbjerg L, Horskjær Rasmussen S, Askling J, Michelsen B, Di Giuseppe D, Karlsson Wallman J, Glintborg B, Loft A, Bernardes M, Ochôa Matos C, Nordstrom D, Kuusalo L, Moeller B, Nissen M, Gudbjornsson B, Love T, Iannone F, Kvien T, Rotar Z, Castrejon I, Macfarlane G, van de Sande M, Hetland M, Østergaard M. Comparing Predictors of DAPSA28, DAPSA66/68 and DAS28-CRP Remission at 6 Months in Bio-naive Patients with Psoriatic Arthritis Initiating a TNFi in Clinical Practice – Results from the EuroSpA Collaboration [abstract]. Arthritis Rheumatol. 2023; 75 (suppl 9). https://acrabstracts.org/abstract/comparing-predictors-of-dapsa28-dapsa66-68-and-das28-crp-remission-at-6-months-in-bio-naive-patients-with-psoriatic-arthritis-initiating-a-tnfi-in-clinical-practice-results-from-the-eurospa/. Accessed .

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