AB0442 SEQUENCE: EFFECTIVENESS OF SEQUENTIAL BIOLOGIC AND TARGETED SMALL MOLECULE DMARDs IN PSORIATIC ARTHRITIS IN THE UNITED KINGDOM

Gollins, C.; Smith, T.; Vivekanantham, A.; Brooke, M.; Coates, L.C.; Gullick, N.; Mchugh, N.; Fahy, C.; Chan, A.; Chauhan, C.; Das, D.; Sin, J.; Gudu, T.; Johnsson, H.; Mirjafari-Temple, H.; Mittal, G.; Packham, J.; Pande, I.; Rose-Parfitt, E.; Williams, E.; Yadagiri, R.; Tillett, W.

Abstract

Background:
Biologic and targeted small molecule DMARDs (b/tsDMARDs) have significantly improved outcomes for people with psoriatic arthritis (PsA). There remains a proportion of people with PsA who require multiple switches in b/tsDMARD over time, for reasons including inefficacy and adverse effects. There is good data indicating best response to first line b/tsDMARDs, but there is very limited evidence available on the effectiveness of b/tsDMARDs when used beyond third line in PsA[1]. In rationed healthcare systems, the number of lines of b/tsDMARDs permitted per patient can be limited, in part due to this lack of evidence.

Objectives:
To compare response to 2nd/3rd line b/tsDMARDs to that of 4th+ line b/tsDMARDs for the treatment of PsA.

Methods:
A multicentre, retrospective observational study of 22 hospitals in England, Northern Ireland, Scotland and Wales was undertaken. Retrospective data for patients commencing b/tsDMARDs during routine care was obtained via chart review and submitted on an online survey platform (REDCap™). Data collected included demographics, baseline and first follow up (3-6 months appointment) outcome measures (including a PsA Response Criteria (PsARC)) for each line of b/tsDMARD treatment a patient received. Sites submitted up to five patients per line of b/tsDMARD treatment. The sample size was determined to detect non-inferiority of the proportion of patients who achieve a PsARC response to 2nd/ 3rd line versus 4th + line therapy using adjusted and unadjusted logistic generalised estimating equations, to account for repeated observations across lines within patient. The PsARC was selected as this is the only routinely collected measure in clinics in the UK stipulated by the National Institute for Health and Care Excellence.

Results:
Data for 437 patients (163 male, 274 female) were collected including 437 1st line, 660 2nd/3rd line and 426 4th+ line treatment episodes. The age range of patients was 24-86 years (mean 53.7 years) and age at PsA diagnosis 10-80 years (mean 41.1 years). The most common comorbidities were hypertension (24%), depression (14%) and diabetes (13%). The crude odds ratio for achieving PsARC in 2nd/3rd line versus 4th+ line was 0.99 (95% CI 0.74, 1.31) and in 2nd/3rd line versus 1st line was 2.02 (95% CI 1.56, 2.61). The adjusted odds ratios, accounting for sex, age, disease duration and concurrent conventional DMARDs were similar: 2nd/ 3rd line vs 4th+ line: 0.996 (0.73, 1.35), 2nd/3rd line vs 1st line: 2.15 (1.61, 2.88). Adjusted odds ratios and confidence intervals for each line of treatment (2nd-7th) compared to 1st line is shown in Figure 1. Mean drug survival reduced with increasing lines of b/tsDMARD, from 27.1 months with 1st line to 6.3 months with 10th line.

Conclusion:
There was no significant difference in the chance of achieving PsARC at first follow up to 2nd/3rd line b/tsDMARDs compared to 4th+ line in a retrospective PsA UK cohort. This indicates that patients can continue to have a positive response to multiple lines of treatment over time, if required. The odds of achieving PsARC to 1st line compared to 2nd/3rd line b/tsDMARDs are twice as high. Further prospective research is required to develop understanding of response to sequential b/tsDMARDs in PsA.

Citation

Gollins, C., Smith, T., Vivekanantham, A., Brooke, M., Coates, L., Gullick, N., Mchugh, N., Fahy, C., Chan, A., Chauhan, C., Das, D., Sin, J., Gudu, T., Johnsson, H., Mirjafari-Temple, H., Mittal, G., Packham, J., Pande, I., Rose-Parfitt, E., Williams, E., …Tillett, W. AB0442 SEQUENCE: EFFECTIVENESS OF SEQUENTIAL BIOLOGIC AND TARGETED SMALL MOLECULE DMARDs IN PSORIATIC ARTHRITIS IN THE UNITED KINGDOM. Presented at EULAR 2024, Vienna, Austria

• Presentation Conference Type: Conference Abstract
• Conference Name: EULAR 2024
• Acceptance Date: Jun 1, 2024
• Online Publication Date: Jan 2, 2025
• Deposit Date: Jan 16, 2025
• Journal: Annals of the Rheumatic Diseases
• Print ISSN: 0003-4967
• Electronic ISSN: 1468-2060
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 83
• Pages: 1480-1481
• DOI: https://doi.org/10.1136/annrheumdis-2024-eular.3509
• Public URL: https://keele-repository.worktribe.com/output/1046943
• Publisher URL: https://www.sciencedirect.com/science/article/abs/pii/S0003496724171233