POS1056\u2005COMPARATIVE EFFICACY OF TNF INHIBITORS VERSUS OTHER CYTOKINE INHIBITOR bDMARDs ON PSORIATIC ARTHRITIS IMPACT OF DISEASE (PsAID) SCORE AND DOMAINS

Abstract

Psoriatic arthritis (PsA) has many consequences, reflecting musculoskeletal and skin inflammation, with the potential to adversely affect overall quality of life. Patient reported outcome measures (PROM) assess a holistic range of aspects of quality of life, including physical and mental components, and provide broad detailed information of the impact of disease. Biologic DMARDs (bDMARDs) targeting TNF have been used to treat PsA for over 10 years whereas inhibitors of IL-17, IL-12/23 and Janus kinases (JAK) have only been available more recently. They all target differing cytokines, including JAK inhibitors which inhibit IL-12 and IL-23 signaling but not TNF signaling. Their relative impact on PROMs is unknown.To assess, in routine care, the relative impact in PsA of TNF inhibitors (TNFi) versus non-TNFi bDMARDs, targeting IL-17, IL-12/23 and JAK, on PROMs.We performed a cross section analysis of PsA patients with established disease treated with bDMARDs and JAKi, under routine care at St George’s University Hospital, London, UK. Patients completed the 12-item psoriatic arthritis impact of disease (PsAID) tool. The total PsAID score was calculated using the on-line EULAR toolkit (see reference). The PsAID total and individual domain scores were compared between TNFi and non-TNFi groups using the Mann Whitney U test. A total PsAID score below 4 out of 10 is considered a ‘patient-acceptable state’.A total 95 patients (female n= 53, 56%) completed the PSAID; TNFi n=72 (female 50%, adalimumab n=41, Etanercept n= 24, Golimumab n=4, Infliximab n =2, Certolizumab n=1) and non-TNFi n= 23 (female 74%, Secukinumab n=9, Ixekizumab n=1, Ustekinumab n=9, Tofacitinib n=4). The mean age was 53.6 (TNFi 53.5, non-TNFi 53.7) years, and duration of time on bDMARD treatment was TNFi 49.5 (range 1- 141) months, non-TNFi 25.3 (range 4 -59) months. The total and individual domain PsAID scores are shown in the Table 1. A ‘patient acceptable state’ total score <4 was recorded in TNFi 36/72 (50%) and non-TNFi 11/23 (48%). There was no significant difference between TNFi and non-TNFi groups in the mean total PsAID score, or proportion achieving a patient acceptable state. Patients on TNFi had lower (better outcome) mean scores for all 12 domains except skin, and the differences, versus non-TNFi treated patients, were significant for pain, functional capacity, discomfort and depression.PSAID domainTNFiNon-TNFiP valueTotal score3.314.64N.S.Pain3.675.430.02Fatigue4.045.65N.S.Skin problems3.112.78N.S.Work/leisure activities3.564.78N.S.Functional capacity3.295.040.02Discomfort3.885.650.02Sleep disturbance3.424.78N.S.Coping3.014.09N.S.Anxiety, fear, uncertainty2.644.17N.S.Embarrassment/shame2.283.39N.S.Social participation2.63.48N.S.Depression2.113.910.03In PsA, TNFi appear to have a greater impact over non-TNFi bDMARDs on some aspects of quality of life, including pain and functional capacity. TNFi and non-TNFi were no different with respect to patients’ perspective on skin disease, embarrassment or shame, despite less good cutaneous responses in clinical trials from TNFi agents. Overall, the PsAID tool reveals an unmet burden on quality of life in PsA patients treated with all classes of bDMARDs and JAKi, as 50% fail to achieve a ‘patient acceptable state’. This should prompt scrutiny of the high scoring domains and utilization of additional treatment modalities to achieve better holistic outcomes for PsA patients in routine care.[1]PsAID tool: http://pitie-salpetriere.aphp.fr/psaid/raid_psaid_quest_home.phpAtif Rauf: None declared, Catherine Hughes: None declared, Diane Hill: None declared, Patrick Kiely Speakers bureau: Abbvie.