Systematic Screening of Comorbidities Improves Vaccination Rates, Skin Cancer Screening and Vitamin D Supplementation in Patients with Axial Spondyloarthritis: Results of a Prospective, Controlled ,One Year Randomised Trial

Anna Molto¹, Adrien Etcheto², Serge Poiraudeau³, Laure Gossec⁴, Pascal Claudepierre⁵, Martin Soubrier⁶, Françoise Fayet⁷, Daniel Wendling⁸, Philippe Gaudin⁹, Emmanuelle Dernis¹⁰, Sandrine Guis¹¹, Sophie Pouplin¹², Adeline Ruyssen-Witrand¹³ and Maxime Dougados¹⁴, ¹Hôpital Cochin, Department of Rheumatology, Paris Descartes University, Paris, France, ²Department of Rheumatology, Paris Descartes University, Hôpital Cochin, Paris, France, ³Univ. Paris Descartes, PRES Sorbonne Paris, INSERM UMR-S 1153 et Institut fédératif de recherche sur le handicap, Paris, France, Paris, France, ⁴Rhumatologie, Médecine Sorbonne Université, Pitié-Salpétrière Hospital, Paris, France, ⁵Hôpital Henri Mondor, Créteil, France, ⁶Rheumatology, Department of Rheumatology, CHU Gabriel Montpied, Clermont-Ferrand, France, ⁷CHU Gabriel Montpied, Clermont Ferrand, France, ⁸Rheumatology, University Hospital - Bourgogne Franche Comté University, Besançon, France, ⁹Grenoble University Hospital, France, Grenoble, France, ¹⁰Service de Rhumatologie, CH du Mans, Le Mans, France, ¹¹Rheumatology Department, CHU, Marseile, France, ¹²Rheumatology Department & Inserm 905, Department of Rheumatology, Rouen University Hospital & Inserm 905, Institute for Biomedical Research, University of Rouen, Rouen, France, ¹³Rheumatology, Purpan Hospital, Toulouse III University, Toulouse, France, ¹⁴Paris Descartes University, Hôpital Cochin, Paris, France

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Co-morbidities, nurse practitioners, prevention, spondylarthritis and vaccines

Session Information

Date: Monday, October 22, 2018

Session Title: Spondyloarthritis Including Psoriatic Arthritis – Clinical Poster II: Clinical/Epidemiology Studies

Session Type: ACR Poster Session B

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

Background/Purpose: Specific recommendations for the detection/prevention of comorbidities have been proposed for patients with SpA. However, we know that often a gap exists between recommendation and their implementation in daily practice. The objective was to evaluate the impact of a program of systematic screening of comorbidities and its management (detection/prevention).

Methods: Prospective, randomized controlled open, 12-month trial (COMEDSPA, NCT02374749). Patients: Axial SpA (according to rheumatologist). Study treatment: Collection of data by the nurse during a specific out-patient visit for the 5 studied SpA comorbidities (i.e. cardiovascular disease (CVD), osteoporosis, cancer, infection and peptic ulcer) according to the recommendations of the French Society of Rheumatology. In the event of non-agreement with the recommendation the patient was informed. A report summarizing the results of this program prepared by the nurse was sent to the patient’s attending physician and rheumatologist. Treatment allocation: After written informed consent, the study treatment was allocated randomly. Outcome variables: the main outcome was the change after one year of a comorbidity score. This weighted composite comorbidity score ranged from 0 to 100, where 0= optimal management of the 5 studied comorbidities and its weights were derived from the percentage of attributed mortality in SpA to each comorbidity in the literature. , i.e. 40 points for CV disease, 20 points for cancer and infection, 10 points for osteoporosis and 10 points for peptic ulcer. The number of patients with actions undertaken against comorbidities according to the recommendations during the 12 months following this program were defined as secondary variables

Results:

There were no differences in the baseline characteristics of the 502 recruited patients (252 and 250 in the active and control groups, respectively): Age: 46.7±12.2 years, male gender: 62.7%, disease duration: 13.7±11.0y, Xray sacroiliitis 62.8%, MRI sacroiliitis 65.7%, current biologic treatment: 78.3%, ASDAS-CRP: 1.9 ± 0.8, BASFI: 25.6±22.3. During the 1year follow-up period, the comorbidity score decreased more in the active group, but this difference was not significant (-3,20 vs. -1.85).

The number of actions per patient was statistically higher in the group comorbidities : 4.54 ± 2.08 vs 2.65 ± 1.57 (p< 0.001); the number of patients with actions performed to be in agreement with recommendations during the 12-months follow-up was higher in the active group for infections (flu vaccination : 28.6% vs. 9.9%, p<0.01; pneumococcal vaccination:40.0% vs. 21.1%,p=0.04), skin cancer screening (36.3% vs. 17.2%; p=0.04), and osteoporosis (BMD performed: 22.6% vs. 8.7%, p<0.01; Vitamin D supplementation initiation: 51.9% vs. 9.4%, p<0.01).

Conclusion: This study highly suggests the short-term benefit of program on the systematic screening of comorbidities for its management in agreement with recommendations, even if this young age population of axSpA patients.

Disclosure: A. Molto, None; A. Etcheto, None; S. Poiraudeau, None; L. Gossec, Lilly France, BMs France, Pfizer France, Orange IMT, 2; P. Claudepierre, None; M. Soubrier, None; F. Fayet, None; D. Wendling, None; P. Gaudin, None; E. Dernis, None; S. Guis, None; S. Pouplin, None; A. Ruyssen-Witrand, None; M. Dougados, Abbvie, Pfizer, Eli Lilly and Company, Novartis, UCB, Merck, Roche, BMS , UCB, 2, 5.

To cite this abstract in AMA style:

Molto A, Etcheto A, Poiraudeau S, Gossec L, Claudepierre P, Soubrier M, Fayet F, Wendling D, Gaudin P, Dernis E, Guis S, Pouplin S, Ruyssen-Witrand A, Dougados M. Systematic Screening of Comorbidities Improves Vaccination Rates, Skin Cancer Screening and Vitamin D Supplementation in Patients with Axial Spondyloarthritis: Results of a Prospective, Controlled ,One Year Randomised Trial [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/systematic-screening-of-comorbidities-improves-vaccination-rates-skin-cancer-screening-and-vitamin-d-supplementation-in-patients-with-axial-spondyloarthritis-results-of-a-prospective-controlle/. Accessed July 2, 2022.

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