Differences and Similarities Between the EULAR/ASAS-EULAR Recommendations and National Recommendations for Treatment of Patients with Psoriatic Arthritis and Axial Spondyloarthritis Across Europe

Brigitte Michelsen¹, Mikkel Østergaard², Michael Nissen³, Adrian Ciurea⁴, Burkhard Moeller⁵, Lykke Ørnbjerg⁶, Jakub Zavada⁷, Bente Glintborg⁸, Alan MacDonald⁹, Karin Laas¹⁰, Dan Nordstrom¹¹, Bjorn Gudbjornsson¹², Florenzo Iannone¹³, Pasoon Hellamand¹⁴, Tore Kvien¹⁵, Ana Maria Rodrigues¹⁶, Catalin Codreanu¹⁷, Ziga Rotar¹⁸, Isabel Castrejon¹⁹, Johan Karlsson Wallman²⁰, Jiri Vencovsky²¹, Anne Gitte Loft²², Maureen Heddle²³, Sigrid Vorobjov²⁴, Anna-Mari Hokkanen²⁵, Gerdur Maria Grondal²⁶, Marco Sebastiani²⁷, Marleen van de Sande²⁸, Eirik Kristianslund²⁹, Maria Jose Santos³⁰, Corina Mogosan³¹, Matija Tomsic³², Jose Federico Diaz-Gonzalez³³, Daniela Di Giuseppe³⁴ and Merete Hetland⁶, ¹Rigshospitalet Glostrup; Diakonhjemmet Hospital; Sørlandet Hospital, Copenhagen, Denmark, ²Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet; University of Copenhagen, Copenhagen, Denmark, ³Geneva University Hospitals, Geneva, Switzerland, ⁴University Hospital Zurich, Zürich, Switzerland, ⁵Inselspital - University Hospital Bern, Bern, Switzerland, ⁶Copenhagen Center for Arthritis Research, Rigshospitalet, Copenhagen, Denmark, ⁷Institute of Rheumatology; Charles University, Prague, Czech Republic, ⁸Rigshospitalet Glostrup, University of Copenhagen, Virum, Denmark, ⁹NHS Grampian, Aberdeen, United Kingdom, ¹⁰Department of Rheumatology, East-Tallinn Central Hospital, Tallinn, Estonia, ¹¹Helsinki University Hospital, Helsinki, Finland, ¹²Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland, ¹³Rheumatology Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro", Bari, Italy, ¹⁴Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands, ¹⁵Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway, ¹⁶Sociedade Portuguesa de Reumatologia; Nova Medical School; Hospital dos Lusíadas, Lisbon, Portugal, ¹⁷Center for Rheumatic Diseases, Bucharest, Romania, ¹⁸University Medical Centre Ljubljana, Ljubljana, Slovenia, ¹⁹Hospital General Universitario Gregorio Marañón, Madrid, Spain, ²⁰Lund University and Skåne University Hospital, Lund, Sweden, ²¹Institute of Rheumatology, Prague, Czech Republic, Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic, ²²Aarhus University, Horsens, Denmark, ²³Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, United Kingdom, ²⁴National Institute for Health Development, Tallinn, Estonia, ²⁵Helsinki University and Helsinki University Hospital, Helsinki, Finland, ²⁶Department for Rheumatology, Landspitali University Hospital, Reykjavik, Iceland, ²⁷Azienda Policlinico di Modena, Modena, Italy, ²⁸Amsterdam 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, ²⁹Diakonhjemmet Hospital, Oslo, Norway, ³⁰Hospital Garcia de Orta, Almada, Lisboa, Portugal, ³¹University of Medicine and Pharmacy, Bucharest, Romania, ³²University Medical Centre Ljubljana; Universitiy of Ljubljana, Ljubliana, Slovenia, ³³Hospital Universitario de Canarias, La Laguna, Spain, ³⁴Karolinska Institutet, Stockholm, Sweden

Meeting: ACR Convergence 2023

Keywords: Health Care, Health policy, Health Services Research, Psoriatic arthritis, spondyloarthritis

Session Information

Date: Sunday, November 12, 2023

Title: (0155–0175) Health Services Research Poster I

Session Type: Poster Session A

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

Background/Purpose: National treatment recommendations are often used to optimize patient care and may differ from international recommendations. The aim of this study was to assess differences and similarities between the EULAR and ASAS-EULAR recommendations for the treatment of patients with PsA and axSpA, respectively, versus national PsA and axSpA treatment recommendations across Europe.

Methods: Rheumatologists from 15 European countries (Czech Republic, Denmark, Estonia, Finland, Iceland, Italy, Netherlands, Norway, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom) compared the most recent national treatment recommendations for PsA and axSpA with the “EULAR recommendations for the management of PsA with pharmacological therapies: 2019 update”¹ and the “2016 update of the ASAS-EULAR recommendations for axSpA”², in an online survey conducted between October 2021 and April 2022. The study was an initiative of the European Spondyloarthritis Research Collaboration Network (EuroSpA RCN).³

Results: Three countries (Czech Republic, Netherlands, and Spain) followed all EULAR recommendations for treating patients with PsA and four countries (Czech Republic, Italy, Spain, and Switzerland) all ASAS-EULAR recommendations for axSpA. Five countries had no national treatment recommendations for PsA and/or axSpA, but had other rules or regulations to follow, for which the comparisons in this study were performed. In six countries, the national treatment recommendations for PsA predated the 2019 EULAR recommendations and in one country the national treatment recommendations for axSpA predated the 2016 ASAS-EULAR recommendations. More differences were seen between the EULAR and the national treatment recommendations for PsA than between the ASAS-EULAR and the national treatment recommendations for axSpA (Figure 1a,b).

Discrepancies between international and national treatment recommendations included: Entry criteria for start of a biologic/targeted synthetic disease-modifying anti-rheumatic drug (b/tsDMARD) varied and were the most stringent in Romania, where DAPSA >28 for PsA and BASDAI >6 and ASDAS ≥2.5 for axSpA were required for the start of a bDMARD. Regarding PsA, in two countries (Finland and Switzerland) a conventional synthetic DMARD should be initiated before a b/tsDMARD including in patients with predominantly enthesal or axial disease. In several countries, no preference for interleukin-17 inhibitors was given for PsA patients with significant skin involvement. The positioning of Janus Kinase inhibitors (JAKi) differed across countries, e.g. in Estonia JAKi were indicated after failure of two tumor necrosis factor inhibitors and in Romania JAKi were positioned at the same level as bDMARDs. Phosphodiesterase-4 inhibitors were not in use or not reimbursed in most countries. Analgesics were not specifically mentioned in several of the national treatment recommendations.

Conclusion: Only a few European countries incorporated all EULAR and ASAS/EULAR treatment recommendations in their national recommendations. The potential impact of this on access to b/tsDMARD treatments needs to be further explored.

Figure 1a, Differences and similarities between EULAR and national treatment recommendations for patients with PsA

Figure 1b, Differences and similarities between ASAS-EULAR and national treatment recommendations for patients with axSpA

Disclosures: B. Michelsen: Novartis, 5; 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; 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; A. Ciurea: None; B. Moeller: None; L. Ørnbjerg: Novartis, 5; J. Zavada: None; B. Glintborg: AbbVie/Abbott, 5, Bristol-Myers Squibb(BMS), 5, Sandoz, 5; A. MacDonald: Galapagos, 6; K. Laas: None; D. Nordstrom: AbbVie/Abbott, 2, BMS, 2, Lilly, 2, MSD, 2, Novartis, 2, Pfizer, 2, UCB, 2; B. Gudbjornsson: Nordic-Pharma, 6, Novartis, 2, 6; 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; P. Hellamand: Novartis, 12, Research grant to employer (not to me); 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; A. Rodrigues: AbbVie/Abbott, 5, Amgen, 5, 6, Novartis, 5, Pfizer, 5; C. Codreanu: AbbVie/Abbott, 2, 6, Amgen, 1, 6, Boehringer-Ingelheim, 1, 6, Eli Lilly, 1, 6, Novartis, 1, 6, Pfizer, 1, 6; Z. Rotar: None; I. Castrejon: None; J. Karlsson Wallman: AbbVie, 5, 6, Amgen, 5, 6, Eli Lilly, 5, Novartis, 5, Pfizer, 5; J. Vencovsky: Argenx, 2, Eli Lilly, 6, Galapagos, 2, Horizon, 2, Merck, 2; A. Loft: Ucb, 1, 6, 12, Congress participation; M. Heddle: None; S. Vorobjov: None; A. Hokkanen: AbbVie/Abbott, 12, Travel cost, Janssen, 12, Travel cost, Merck/MSD, 5, UCB, 12, Travel grant; G. Grondal: None; M. Sebastiani: None; M. van de Sande: AbbVie, 2, Eli Lilly, 5, Janssen, 6, Novartis, 2, 5, 6, UCB Pharma, 2, 5, 6; E. Kristianslund: None; M. Santos: None; C. Mogosan: None; M. Tomsic: AbbVie/Abbott, 2, 6, Amgen, 2, 6, Eli Lilly, 2, 6, Janssen, 2, 6, Merck/MSD, 2, 6, Novartis, 2, 6, Pfizer, 2, 6; J. Diaz-Gonzalez: None; D. Di Giuseppe: None; 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.

To cite this abstract in AMA style:

Michelsen B, Østergaard M, Nissen M, Ciurea A, Moeller B, Ørnbjerg L, Zavada J, Glintborg B, MacDonald A, Laas K, Nordstrom D, Gudbjornsson B, Iannone F, Hellamand P, Kvien T, Rodrigues A, Codreanu C, Rotar Z, Castrejon I, Karlsson Wallman J, Vencovsky J, Loft A, Heddle M, Vorobjov S, Hokkanen A, Grondal G, Sebastiani M, van de Sande M, Kristianslund E, Santos M, Mogosan C, Tomsic M, Diaz-Gonzalez J, Di Giuseppe D, Hetland M. Differences and Similarities Between the EULAR/ASAS-EULAR Recommendations and National Recommendations for Treatment of Patients with Psoriatic Arthritis and Axial Spondyloarthritis Across Europe [abstract]. Arthritis Rheumatol. 2023; 75 (suppl 9). https://acrabstracts.org/abstract/differences-and-similarities-between-the-eular-asas-eular-recommendations-and-national-recommendations-for-treatment-of-patients-with-psoriatic-arthritis-and-axial-spondyloarthritis-across-europe/. Accessed .

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