FRI0449 EFFECTIVENESS OF BIOLOGIC DRUGS WITH DIFFERENT MECHANISM OF ACTION IN PSORIATIC ARTHRITIS. AN APPRAISAL FROM THE APULIAN REGISTRY BIOPURE

Abstract

Background In the last decade, the number of drugs available for patients affected with psoriatic arthritis (PsA) is increased and rheumatologists have multiple choices to manage PsA refractory to conventional disease modifying anti-rheumatic drugs (cDMARDs). However, the possibility of identifying disease’s or patient’s related characteristics to drive the optimal choice is still under investigation. Objectives We aimed at evaluating the effectiveness and drug survival of the biological drugs (bDMARDs) and apremilast indicated for the treatment of PsA patients with inadequate response to cDMARDs. To this purpose, PsA patients on treatment with bDMARs or Apremilast recorded into the Apulian BIOPURE registry have been retrospectively analyzed. Methods We retrospectively assessed PsA patients, fulfilling CASPAR criteria, starting a biologic drug or apremilast from June 2016 through December 2017. At baseline and at last observation within the time frame of the study, DAPSA, PASI, ASDAS-CRP, the presence of enthesitis and dactylitis were collected. Rate of patients achieving DAPSA based remission was assessed at last observation. The persistence on the first treatment was evaluated by Kaplan-Meier survival curves. Estimated hazard ratios (HRs) of discontinuing therapy or achieving remission were assessed by multivariate stepwise backward Cox regression models, adjusting for patient demographics (gender, age) and disease characteristics (disease duration, number of prior bDMARDs, baseline DAPSA, PASI, presence of enthesitis and dactylitis, type of current drug). Results We recruited 450 PsA patients (268, 60% female) with mean age 53 (±11) years, disease duration 19 (±13) months, 337 (75%) naïve to bDMARDs. At baseline, 404 had peripheral joint involvement and 46 axial disease, DAPSA was 18 (±10), PASI 1.6 (±3), ASDAS-CRP 2.5 (±1), 48/355 (13.5) had dactylitis and 78/231 (33%) showed enthesitis. Table 1 shows the type of drugs. At last observation, the rate of patients who achieved the DAPSA remission was significantly higher in naïve patients (25%) than in those bDMARDs experienced (14%, p=0.02). The rate of drug survival was not significantly different among drugs (Figure 1). Cox-regression multivariate models showed that independent baseline factors negatively associated to drug persistence were prior bDMARD treatment (HR 0.70, 0.50-0.97 (95% CI), p=0.03) and the absence of axial disease (HR 0.56, 0.35-0.91 (95% CI), p=0.02). Negative predictors of DAPSA remission were prior bDMARD treatment (HR 0.40, 0.19-0.83 (95% CI), p=0.01), gender female (HR 0.51, 0.29-0.91 (95% CI), p=0.02), and the absence of dactylitis(HR 0.36, 0.19-0.68 (95% CI), p=0.002). Conclusion A good rate of DAPSA remission is achievable with all the current available drugs in PsA in settings of real life. Predictors of remission and persistence on treatment were being male and naïve to prior bDMARDs. No difference among drugs was detected.View this table:View inline View popup Table 1 TreatmentsDownload figure Open in new tab Download powerpoint Figure 1 Kaplan-Meier curves of drug survival of PsA patients on different therapies. Disclosure of Interests Nicola Maruotti Speakers bureau: N Maruotti has received speaker honoraria from Pfizer outside this work, Giorgio Carlino Consultant for: G Carlino had has received consultancy fees from Pfizer, Janssen, AbbVie, MSD, BMS., Leonardo Santo Consultant for: L Santo has received consultancy fees and/or speaker honoraria from AbbVie, MSD, Novartis UCB outside this work, Speakers bureau: L Santo has received consultancy fees and/or speaker honoraria from AbbVie, MSD, Novartis UCB outside this work, Laura Quarta: None declared, Romano Bucci Consultant for: R Bucci has received consultancy fees and/or speaker honoraria from Pfizer, Sanofi, MSD, BMS, Speakers bureau: R Bucci has received consultancy fees and/or speaker honoraria from Pfizer, Sanofi, MSD, BMS, Carmelo Zuccaro Consultant for: C Zuccaro has received consultancy fees and/or speaker honoraria from MSD, AbbVie, Novartis, Pfizer, Janssen outside this work, Speakers bureau: C Zuccaro has received consultancy fees and/or speaker honoraria from MSD, AbbVie, Novartis, Pfizer, Janssen outside this work, Angelo Semeraro Speakers bureau: A Semeraro has received speaker honoraria from Sanofi, Roche, AbbVie, BMS, MSD, Novartis, Antonio Marsico: None declared, Daniela Mazzotta: None declared, Paola Chiara Francesca Falappone Consultant for: PC Falappone had received consultancy fees and/or speaker honoraria from Amgen, Abbott, MSD, BMS, outside this work, Speakers bureau: PC Falappone had received consultancy fees and/or speaker honoraria from Amgen, Abbott, MSD, BMS, outside this work, Florenzo Iannone Consultant for: F Iannone has received consultancy fees and/or speaker honoraria from Pfizer, AbbVie, MSD, BMS, Novartis, Lilly, UCB outside this work, Speakers bureau: F Iannone has received consultancy fees and/or speaker honoraria from Pfizer, AbbVie, MSD, BMS, Novartis, Lilly, UCB outside this work