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Abstract Number: 698

Performance of Modified Minimal Disease Activity (MDA) in Patients with Peripheral Spondyloarthritis

Laura C. Coates1, Sonya Abraham2, William Tillett3, Philip J Mease4, Sofia Ramiro5, Yinglin Xia6, Xin Wang7, Aileen L. Pangan7 and In-Ho Song7, 1University of Leeds, Leeds, United Kingdom, 2NIHR/Wellcome CRF, Imperial College Healthcare NHS Trust, London, United Kingdom, 3Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, United Kingdom, 4Swedish Medical Center and University of Washington, Seattle, WA, 5Leiden University Medical Center, Leiden, Netherlands, 6University of Illinois at Chicago, Chicago, IL, 7AbbVie Inc., North Chicago, IL

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Adalimumab, Psoriatic arthritis and spondylarthritis

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Session Information

Date: Sunday, November 13, 2016

Session Title: Spondylarthropathies and Psoriatic Arthritis – Clinical Aspects and Treatment - Poster I: Axial and Peripheral Spondyloarthritis – Clinical Aspects, Imaging and Treatment

Session Type: ACR Poster Session A

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

Background/Purpose: Due to lack of validated outcome measures in non-psoriatic peripheral spondyloarthritis (pSpA), recent studies in this patient (pt) population have used varying endpoints [1]. Thus, developing new pSpA-specific indices may be worthwhile. Minimal Disease Activity (MDA) has been validated in psoriatic arthritis but not in pSpA. The objective of this study is to evaluate the performance of a modification of the MDA criteria (excluding psoriasis) in pSpA patients (pts) from the ABILITY-2 study [2].

Methods: This post-hoc analysis evaluated the validity of a modified MDA (mMDA) in pSpA. ABILITY-2 was a 12-week trial comparing adalimumab (ADA) with placebo (PBO) in pSpA followed by a 144 week extension. The mMDA for pSpA was defined as achieving at least 4 or 5 out of the following 6 criteria: (1) tender joint count (TJC, 78 joints) ≤ 1; (2) swollen joint count (SJC, 76 joints) ≤ 1; (3) pt pain visual analog scale (VAS) ≤ 15 of 100 mm; (4) pt global activity (PtGA) VAS ≤ 20 of 100 mm; (5) health assessment questionnaire–disability index (HAQ-DI)≤ 0.5; and (6) tender entheseal points ≤ 1. Enthesitis was assessed by the Leeds Enthesitis Index (LEI) or the Spondyloarthritis Research Consortium of Canada (SPARCC) Enthesitis Index for this analysis. The proportion of pts achieving the 4 different versions of mMDA were evaluated (either 4 or 5 of 6 using LEI and either 4 or 5 of 6 using SPARCC). The correlations between mMDA and the novel pSpA response criteria [PSpARC] remission from ABILITY-2 and Ankylosing Spondylitis Disease Activity Score Inactive Disease [ASDAS ID] were evaluated by tetrachoric correlation (rtet).

Results: Of the 163 pts (82 ADA, 81 PBO) who completed wk 12, significantly greater proportion of pts receiving ADA achieved mMDA (regardless of the definition) compared with PBO (P<0.001 for all comparisons, Table 1a). The proportion of mMDA responders at yrs 1, 2, and 3 was numerically higher in pts initially randomized to ADA. The mMDA response showed a stronger positive correlation with PSpARC remission (rtet > 0.9) than ASDAS ID (rtet > 0.75) at wk 12, and yrs 1-3. Among pts who fulfilled the 4/6 criteria (LEI or SPARCC), approximately 20-30% of pts did not meet TJC and SJC criterion (Table 1b). However, the 5/6 criteria (LEI or SPARCC) were more stringent with approximately 5% and 13% not meeting the TJC and SJC criterion, respectively.

Conclusion: All 4 versions of mMDA discriminated between ADA and PBO treatment groups; both entheseal indices performed similarly. The mMDA (particularly the 5/6 versions which closely represents the concept of MDA) could be an appropriate treatment target in pSpA pts. References:

1.      Turina, M.C., et al., Ann Rheum Dis, 2015. (doi: 10.1136/annrheumdis-2014-207235).

2.      Mease, P., et al., Arthritis Rheumatol, 2015. 67(4): p. 914-23.


Disclosure: L. C. Coates, AbbVie, BMS, BI, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Sun Pharma and UCB, 2,AbbVie, BMS, BI, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Sun Pharma and UCB, 5,AbbVie, BMS, BI, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Sun Pharma and UCB, 8; S. Abraham, AbbVie, Celgene, Novartis, Pfizer, and UCB, 2,AbbVie, Celgene, Novartis, Pfizer, and UCB, 5,AbbVie, Celgene, Novartis, Pfizer, and UCB, 8; W. Tillett, AbbVie, Celgene, Pfizer, and UCB, 2,AbbVie, Celgene, Pfizer, and UCB, 5,AbbVie, Celgene, Pfizer, and UCB, 8; P. J. Mease, AbbVie, Amgen, Bristol Myers, Celgene, Genentech, Janssen, Lilly, Merck, Novartis, Pfizer, and UCB, 2,AbbVie, Amgen, Bristol Myers, Celgene, Genentech, Janssen, Lilly, Merck, Novartis, Pfizer, and UCB, 5,AbbVie, Amgen, Bristol Myers, Celgene, Genentech, Janssen, Lilly, Merck, Novartis, Pfizer, and UCB, 8; S. Ramiro, None; Y. Xia, AbbVie, 9; X. Wang, AbbVie, 1,AbbVie, 3; A. L. Pangan, AbbVie, 1,AbbVie, 3; I. H. Song, AbbVie, 1,AbbVie, 3.

To cite this abstract in AMA style:

Coates LC, Abraham S, Tillett W, Mease PJ, Ramiro S, Xia Y, Wang X, Pangan AL, Song IH. Performance of Modified Minimal Disease Activity (MDA) in Patients with Peripheral Spondyloarthritis [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/performance-of-modified-minimal-disease-activity-mda-in-patients-with-peripheral-spondyloarthritis/. Accessed December 7, 2019.
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