Background/Purpose: Minimal disease activity (MDA) is associated with reduced radiographic progression and improved quality of life among patients (pts) with PsA.¹ Clinical advances made MDA an attainable treatment target, yet it remains challenging for pts to achieve, and fewer achieve very low disease activity (VLDA).¹

Understanding the most commonly unmet MDA/VLDA criteria among pts may provide insight into unmet needs with current treatments.

Methods: Eligible pts with PsA in the CorEvitas PsA/SpA Registry (03/2013–10/2023) who initiated biologic/targeted synthetic DMARDs (b/tsDMARDs) had MDA/VLDA computed at treatment initiation (index) and 6 months (range: 5–9 months) post-index. Pts in MDA and VLDA at the index date were excluded from the MDA and VLDA cohorts, respectively, while the VLDA cohort included pts in MDA at index.

At 6 months, pts were classified by number of criteria met out of the 7 MDA/VLDA criteria: achievers (MDA: ≥5/7; VLDA: 7/7); all non-achievers (MDA: ≤4/7; VLDA: ≤6/7); non-achievers by 1 criterion (MDA: 4/7; VLDA: 6/7); and non-achievers by >1 criterion (MDA: ≤3/7; VLDA: ≤5/7). We report the proportion of pts not meeting each MDA/VLDA criterion at index and follow-up.

Results:

The MDA and VLDA cohorts had 2,093 and 2,491 pts, respectively. Most pts (65%) in both cohorts had prior b/tsDMARD experience at index. Baseline characteristics are summarized in the Table.

In the MDA cohort, 18% (n=370/2,093) of pts were MDA achievers and 82% (n=1,723/2,093) were non-achievers; 24% (n=398/1,686) of non-achievers (with all criteria available) missed 1 criterion to achieve MDA (Table). In the VLDA cohort, 8% (n=187/2,491) of pts were VLDA achievers and 92% (n=2,304/2,491) were non-achievers; 11% (n=236/2,242) of non‑achievers (with all criteria available) missed 1 criterion to achieve VLDA (Table).

At index, MDA and VLDA non-achievers were older, and a higher proportion were female, current smokers, obese, and had public insurance. They also had higher rates of depression, anxiety, and fibromyalgia, higher disease activity, and worse pt-reported outcomes (PROs) at index (Table).

The proportion of MDA achievers not meeting each criterion reduced drastically after 6 months (Figure 1). However, 40% of pts did not meet the pain threshold at 6 months despite achieving MDA (Figure 1). Among MDA non-achievers, the PRO MDA criterion of pain, Pt’s Global Assessment of disease activity (PGA), and Health Assessment Questionnaire (HAQ) were the least commonly achieved. Among MDA/VLDA non-achievers, these PROs had the least change in the proportion of pts not meeting the MDA/VLDA threshold at 6 months (Figures 1–2).

Among pts who missed 1 criterion to achieve MDA, the most commonly unmet criteria were pain (86%), PGA (75%), and HAQ (64%; Figure 1). Most pts who missed 1 criterion to achieve VLDA did not meet the pain (41%), tender joint count (12%), and HAQ (12%) criteria (Figure 2).

Conclusion: A small proportion of pts achieved MDA after 6 months of b/tsDMARD treatment. Despite achieving MDA, 40% of pts had residual pain. PRO criteria were the least likely to be met among MDA/VLDA non-achievers. A focus on treating pt-reported symptoms may improve achievement of MDA/VLDA.

References:

1. Ortolan A. Semin Arthritis Rheum 2023;62:152237.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/unmet-criteria-for-achieving-minimal-and-very-low-disease-activity-among-patients-with-psoriatic-arthritis-initiating-biologic-or-targeted-synthetic-disease-modifying-antirheumatic-drugs-in-the-corevi/