Background/Purpose:

Biologicals revolutionized the management of PsA. Since the introduction of the first TNF inhibitor (TNFi) in the early 2000s, therapeutic options for PsA are increasing steadily and a new generation of biologicals allows distinct targeted approaches.

Purpose:

To investigate whether PsA patient population (demographic and clinical characteristics), selected for biological treatment in daily practice, changed over time.

Methods:

PsA patients (CASPAR criteria) were included in the KU Leuven BioSPAR register, a prospective cohort treated with biologicals and apremilast. Demographics, prior drug use, disease characteristics and activity parameters were recorded at the initiation of biological treatment.

Tree treatment periods were defined: First period: from the date the 1st patient started TNFi therapy (infliximab, etanercept or adalimumab) until the “second generation” of anti-TNF (golimumab and certolizumab) were available: 09/15/2000-06/03/2006. Second period: end of period 1 until the “third generation” of biologicals (ustekinumab, secukinumab) or apremilast were available: 06/04/2006- 03/22/2016. Third period: after period 2: 03/23/2016-02/28/2018. Statistical analysis was performed using SPSS statistical software, version 24.0 withdescriptive statistics, one-way ANOVA, Kruskal-Wallis or Chi-square tests as appropriate.

Results:

The PsA cohort includes 185 Caucasian patients. We found no difference in the age of patients, mean weight or BMI at the time of biological initiation in 3 time groups. Proportion of male/female patients was also similar. Disease duration was significantly longer in the 1st, compared to the 2nd (p=0.006) and 3rd (p=0.017) time periods. However, there was no difference in disease duration between period 2 and 3 (p=0.19). Further, patients in period 1 had more tender joints than patients in period 3 (p=0.012). But the difference in TJC68 was not significant between period 1 and 3 or period 2 and 3. Number of swollen joints in the period 1 was significantly higher than in patients in the second and third time periods (p=0.0001). Skin and nail psoriasis were more frequent in earlier compared to the later treatment periods (p<0.0001 for both). In our study population, the proportion of patients with dactylitis or enthesitis was similar in tree time periods.

CRP levels, but not ESR, significantly differed between the groups, being higher in period 1 compared 2 (p=0.006) and 3 (p= 0.023). Clinical scores for psoriasis, enthesitis and disease activity did not reach statistical difference between the three time periods.

Conclusion:

The population of patients, selected for treatment escalation, changed significantly over time since the introduction of biologicals. Although patient characteristics were similar in all time periods, disease duration and objective disease activity characteristics (swollen and tender joints, psoriatic nail and skin involvement, CRP) were lower in the later time periods. Our results suggest that with years of experience, PsA patients might be considered earlier and with less active disease for therapy intensification, to obtain a tight disease control and to prevent long term damage.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/evolution-of-patient-characteristics-in-the-era-of-biological-treatment-of-psoriatic-arthritis-18-year-belgian-experience-from-leuven-spondyloarthritis-biologics-cohort-biospar/