AB0841 TARGET OUTCOMES IN PsA: SIMULTANEOUS ACHIEVEMENT of ACR50-PASI100 AND BEYOND: INSIGHTS FROM SPIRIT-H2H AT WEEK 24

Abstract

Background: Psoriatic Arthritis (PsA) treatment should aim to achieve robust improvement of arthritis as well as control of extra‐articular manifestations like the skin. SPIRIT‐H2H evaluated the efficacy of ixekizumab (IXE) and adalimumab (ADA) in patients with active PsA and psoriasis, and naive to biologic Disease‐Modifying Anti‐Rheumatic Drugs (bDMARDs). At week 24 (W24), IXE showed superiority to ADA in simultaneous achievement of ACR50 and PASI100 as well as significant improvement of treat‐to‐target and other extra‐articular outcomes. Objectives: To examine and to compare PsA efficacy outcomes in patients beyond achievement of the primary endpoint of the SPIRIT‐H2H trial at W24, irrespective of treatment allocation. Methods: All patients recruited had active PsA (defined as tender joint count ≥3/68, swollen joint count ≥3/66 and body surface area [BSA] ≥3%), and inadequate response to conventional synthetic (cs)‐DMARDs. Patients were randomised 1:1 to open‐label, assessor‐blinded IXE or ADA. We conducted post‐hoc analysis of SPIRIT‐H2H (NCT03151551), categorizing patients into four independent groups based on the achievement of the primary outcome (ACR50 & PASI100), ACR50 only, PASI100 only or none of them after 24 weeks of treatment. Statistical analyses consisted of mixed model for repeated measurement and logistic regression models using non‐response imputation. Results: At week 24, patients reaching simultaneously ACR50 and PASI100 had a statistically significant higher response in most treat‐to‐target endpoints than those meeting ACR50 only (p<0.05). In this latter group, a high response rate was observed in ACR70, MDA, DAPSA remission and PASI90 response (48.9%, 60.6%, 35.1%, 36.2%, respectively). In patients that did not achieve either ACR50 or PASI100, up to 1/3 of the patients did achieve ACR20, DAPSA score ≤14, or no physical impairment. Conclusion: Reflecting the complexity of PsA, different degrees of improvement were observed across all treat‐to‐target outcomes with greater improvements in patients that met ACR50 response regardless of skin resolution. These findings at week 24 need to be confirmed with a longer duration of treatment.