ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1557

Treatment Patterns in Psoriatic Arthritis: Experience from a Real-World Setting

Martin Brom1, Sebastian Moyano1, Florencia Beatriz Mollerach2, Luciano Fernando Lo Giudice3, Maria Laura Acosta Felquer1, Marina Scolnik4, Santiago Ruta4 and Enrique R Soriano5, 1Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, Instituto Universitario Hospital Italiano de Buenos Aires, and Fundacion PM Catoggio, Buenos Aires, Argentina, 2Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, 3Rheumatology section, Internal Medicine Unit, Hospital Italiano de Buenos Aires and Fundacion PM Catoggio, CABA, Argentina, 4Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, CABA, Argentina, 5Argentina, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: ,

Session Information

Date: Monday, November 6, 2017

Title: Spondyloarthropathies and Psoriatic Arthritis – Clinical Aspects and Treatment Poster II

Session Type: ACR Poster Session B

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

Background/Purpose:

Both EULAR (European League Against Rheumatism) and GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) recently published treatment guidelines for Psoriatic Arthritis (PsA). Despite them, it remains unclear how physicians approach the management of PsA since there are few studies in the real world.

The purpose of the study was to describe treatment patterns (treatment discontinuation, switches, and therapy add-ons) for PsA patients in a real-world setting.

Methods:

A Retrospective descriptive study was performed in a university hospital with its own health insurance and captive population. All patients fulfilling Classification Criteria for Psoriatic Arthritis (CASPAR) with at least 3 visits of follow-up were included. Electronic medical records were reviewed between 01/01/2000 and 05/31/2017.

Results:

A total of 275 patients with PsA were included, with a median follow-up of 5.3 years (IQR: 2.1-10.2). Demographical data can be found in Table 1.

First line treatment were NSAIDs in 9.45% of the patients, traditional DMARD (tDMARD) in 88%, being methotrexate the most frequent one (76%), and biologic DMARDs (bDMARD) in 2.18%. None received combination of tDMARDs. Reasons for switching or discontinuation were: lack of response 41%, adverse events 35%, remission 12% and suspension by the patient 12%.

bDMARD were used in 29.5% of the patients. As monotherapy in 55.4 % of the cases, and combined with methotrexate and leflunomide in 38.5 % and 6% respectively.

Survival rate of DMARDs at the end of follow up was 40% for tDMARD and 72% for bDMARD.

Additional information on both tDMARD and bDMARD can be found in Table 2.

At end of follow up mean DAS28 was 3.1 (SD: 1.4), mean HAQ: 0.42 (SD: 0.6), and 51% of patients fulfilled Minimal Disease Activity (MDA) criteria.

Conclusion:

In this real-world data, 40% of the patients continued with the first tDMARD after 5 years of follow up and only one third of patients required bDMARD. Drug survival was very good both for tDMARDs and bDMARDs.

 

Table 1

 

Total PsA patients

 275

Males, n (%)

162 (58.91)

Axial involvment, n (%)

40 (14.5%)

Median follow up time, years (IQR)

5.3 (2.1-10.2)

Mean age at diagnosis of Psoriasis, years (SD)

35.1 (16.9)

Mean age at diagnosis of PsA, years (SD)

48.3 (15.1)

Median time between diagnosis of Psoriasis and PsA, years (IQR)

13.1 (5.3-22.9)

Median time between first musculoskeletal symptom and diagnosis of PsA, years (IQR)

0.6 (0.2-2.1)

 

Table 2 

NSAIDs as first line, n (%)

26 (9.45)

tDMARD as first line, n (%)

243 (88%)

bDMARD as first line, n (%)

6 (2.18)

tDMARD ever, n (%)

249 (90.54)

 

Methotrexate, n (%)

218 (87.55)

 

Sulfasalazine, n (%)

15 (6.02)

 

Leflunomide, n (%)

15 (6.02)

 

Cyclosporine, n (%)

1 (0.4)

Median time from diagnosis to start of tDMARD, years (IQR)

0.3 (0.07-3.1)

Survival of first tDMARD at 3rd year, % (CI 95%)

52 (44-59)

Survival of first tDMARD at 5th year, % (CI 95%)

40 (32-48)

Combination of tDMARD ever, n (%)

13 (4.73)

bDMARD ever, n (%)

81 (29.5)

 

TNFi, n (%)

77 (95)

 

Anti-IL 17, n (%)

2 (2.47)

 

Anti-IL 12-23, n (%)

2 (2.47)

bDMARD in combination with tDMARD, n (%)

36 (44,6)

Median time from first tDMARD to first bDMARD, years (IQR)

3.4 (0.9-8)

Survival of first bDMARD at 3rd year, % (CI 95%)

81 (66-90)

Survival of first bDMARD at 5th year, % (CI 95%)

72 (54-85)

 

Disclosure: M. Brom, None; S. Moyano, None; F. B. Mollerach, None; L. F. Lo Giudice, None; M. L. Acosta Felquer, None; M. Scolnik, None; S. Ruta, None; E. R. Soriano, AbbVie, Janssen, Novartis, Pfizer Inc, UCB, 2,AbbVie, Janssen, Novartis, Pfizer Inc, UCB, 5,AbbVie, Bristol-Myers Squibb, Janssen, Novartis, Pfizer Inc, Roche, UCB, 8.

To cite this abstract in AMA style:

Brom M, Moyano S, Mollerach FB, Lo Giudice LF, Acosta Felquer ML, Scolnik M, Ruta S, Soriano ER. Treatment Patterns in Psoriatic Arthritis: Experience from a Real-World Setting [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/treatment-patterns-in-psoriatic-arthritis-experience-from-a-real-world-setting/. Accessed .

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