Session Type: ACR Concurrent Abstract Session
Session Time: 11:00AM-12:30PM
Background/Purpose : Patients (pts) with psoriatic arthritis (PsA) may experience structural damage and irreversible functional impairment if not treated appropriately. Treatment with TNF inhibitors in rheumatoid arthritis (RA) pts showed inhibition of radiographic progression larger than expected based on the control of clinical disease activity.1 Preliminary results showed that such a disconnect phenomenon may also be observed in PsA pts following treatment with adalimumab (ADA).2 The objective of this analysis was to further examine the relationship between inhibition of radiographic progression and control of clinical disease activity using different disease activity measures following treatment with originator ADA versus placebo (PBO) in pts with active PsA.
Methods : ADEPT3 was a 24-week (wk), randomized, double-blind trial comparing the safety and efficacy of ADA with PBO in pts with active PsA. In this post hoc analysis, radiographic progression, defined as change from baseline (BL) to wk 24 in modified total Sharp score (ΔmTSS) >0.5, was calculated in pts with evaluable radiographs at both time points. Pts were classified based on achieving minimal disease activity (MDA) and different subcategories of disease activity (remission, low, moderate, or high) based on time-averaged (TA) DAS28(CRP), DAPSA, and PASDAS. The associations between ΔmTSS and disease activity were assessed by Pearson (rp) or Phi (rϕ) correlation coefficients.
Results : Of the 296 pts (ADA, N=144; PBO, N=152) included in this analysis, higher proportions of pts receiving ADA compared with PBO achieved MDA and remission/low disease activity status across all the outcome measures. There was a significant interaction between treatment and disease activity status with respect to radiographic progression (P<0.001 for all outcome measures). In addition, treatment with ADA for 24 wks compared with PBO resulted in significantly lower mean ΔmTSS even in pts with moderate or high disease activity (TA-DAPSA or TA-PASDAS) or not achieving MDA (Table). Radiographic progression showed a weak, but significant correlation with disease activity status in pts treated with PBO (rp ≥0.3, P<.001 for TA-DAS[CRP], TA-DAPSA, and TA-PASDAS; rϕ= –0.14 [95% CI:–0.20 to –0.09 for MDA), but not ADA.
Conclusion : The results showed that the relationship between disease activity as determined by various outcome measures differed between ADA and PBO treated pts. ADA provided inhibition of radiographic progression which was somewhat larger and independent of the control of clinical disease activity. This supports the disconnect phenomenon in PsA following ADA treatment.
1. Landewé R, et al. Arthritis Rheum. 2006;54:3119-3125.
2. Mease PJ, et al. Arthritis Rheum. 2010;62(suppl 10).
3. Mease PJ, et al. Arthritis Rheum. 2005;52:3279-89.
To cite this abstract in AMA style:Landewé RBM, Ritchlin CT, Coates LC, Aletaha D, Guérette B, Zhang Y, Ganz F, Hojnik M. Inhibition of Radiographic Progression in Psoriatic Arthritis By Adalimumab Independent of the Control of Clinical Disease Activity [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/inhibition-of-radiographic-progression-in-psoriatic-arthritis-by-adalimumab-independent-of-the-control-of-clinical-disease-activity/. Accessed January 19, 2020.
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