SAT0378\u2005DRIVERS OF DISCORDANCE IN PSORIATIC ARTHRITIS WHEN ANALYZING THE LINK BETWEEN PATIENT-PERCEIVED GOOD STATUS AND THE DISEASE ACTIVITY IN PSORIATIC ARTHRITIS (DAPSA) COMPOSITE SCORE: AN ANALYSIS OF 436 PATIENTS FROM THE INTERNATIONAL REFLAP OBSERVATIONAL STUDY

Abstract

Background In Psoriatic arthritis (PsA), the objective of treatment is remission or low disease which can be defined using the Disease Activity in PSoriatic Arthritis (DAPSA) (ref1). We previously showed DAPSA was associated to patient-perceived good status (i.e., self-assessed remission or low disease, yes/no) (ref2). However, some discordance was noted between patient-perceived status and the composite score. This discordance may be linked to demographic elements (such as age, gender or country), disease activity components (such as skin involvement which is not assessed in DAPSA) or patient-reported outcomes (such as fatigue or depressive affects). A better understanding of this discordance would be helpful in the context of shared decision-making. Objectives To explore the drivers of discordance between patient-perceived remission or low disease and DAPSA-defined remission or low disease. Methods This is an analysis of the first visit of ReFlap (NCT03119805, ref2), an observational study in 14 countries of consecutive adult patients with definite PsA >2 years of disease duration. Discordance in assessment of remission/low disease status was defined as a disagreement between a specific patient question (are you in remission or low disease, yes/no) and DAPSA-defined remission/low disease (i.e., score <=14, yes/no). Potential drivers of this discordance were analysed through univariable then stepwise multivariable logistic regression. Variables analysed were demographic (age, gender, disease duration, gross domestic product of country of origin), disease-related (joint counts, psoriasis BSA, enthesitis, CRP) and patient-reported outcomes (pain, fatigue, depressive affect and anxiety). There was no imputation of missing data. Results Among 436 patients, mean age 52.3 (SD 12.5) years, mean disease duration 10.1 (8.1) years, 218 (50.8%) male; 259 (63.5%) were taking a conventional DMARD and 247 (60.5%) a biologic. Disease activity was moderate: 36.1% had no current psoriasis skin lesions and mean swollen joint count was 2.2 (7.1). Remission or low disease was frequent both using the patient question (N=286, 65.6%) and using DAPSA (N=246, 56.4%). Discordance between patient-reported status and DAPSA concerned 112 (25.7%) patients, of whom 76 (17.4% of 436) self-reporting REM/LDA, and 36 (8.3% of 436) reporting not being in REM/LDA. When exploring drivers of this discordance in univariate analyses, tender joint count, CRP, pain, fatigue and depression were significant. The multivariate analysis found CRP, pain and depression to be independent drivers of discordance (Table).Table Factors associated to discordance between DAPSA-defined remission or low disease, and patient-defined remission or low disease, in multivariable regression. Characteristic Value in discordant patients, mean (SD) Value in concordant patients, mean (SD) Odds ratio (95% CI) Model 1 CRP, mg/l 2.8 (9.1) 1.1 (3.1) 1.06 (1.01, 1.12) Pain (0-10) 4.9 (2.3) 3.9 (2.9) 1.14 (1.05, 1.23) Model 2 without pain CRP, mg/l 2.8 (9.1) 1.1 (3.1) 1.06 (1.01, 1.12) Depression (0-10) 2.8 (3.2) 2.1 (2.8) 1.08 (1.01, 1.16) Conclusion Remission or low disease appears to be an attainable outcome in PsA. Patients widely self-reported themselves as being in a similar status as the status indicated by the DAPSA score. Discordance in assessment concerned 25.7% patients and was mainly related to CRP (driving higher DAPSA), pain and fatigue (driving patient assessments). When faced with discordance in assessment, the health professional should assess these elements carefully. Reference [1] Schoels MM, et al. Ann Rheum Dis. 2016;75(5):811-8. 2. Gorlier C, et al. Ann Rheum Dis. 2019;78(2):201-208. Acknowledgement This study was funded by Pfizer through an investigator-initiated grant. Disclosure of Interests Laure Gossec Grant/research support from: AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis-Sandoz, Pfizer, Sanofi, and UCB, Consultant for: AbbVie, Biogen, BMS, Celgene, Janssen, Lilly, MSD, Nordic Pharma, Novartis-Sandoz, Pfizer, Roche, Sanofi, and UCB, Consultant for: L Gossec has received honoraria from Celgene as investigator for this study, Maarten de Wit: None declared, Laura C Coates Grant/research support from: AbbVie, Celgene, Lilly, Novartis and Pfizer, Consultant for: AbbVie, Amgen, BMS, Celgene, Galapagos, Gilead Sciences Inc., Janssen, Lilly, Novartis, Pfizer, Prothena Corp and UCB, Umut Kalyoncu Grant/research support from: MSD, Roche, UCB, Novartis and Pfizer, Consultant for: MSD, Abbvie, Roche, UCB, Novartis, Pfizer and Abdi Ibrahim, Speakers bureau: MSD, Abbvie, Roche, UCB, Novartis, Pfizer and Abdi Ibrahim, Emmanuelle Dernis: None declared, Adeline Ruyssen-Witrand: None declared, Ying Ying Leung Grant/research support from: Abbvie, Novartis, Speakers bureau: Abbvie and Novartis, Speakers bureau: Novartis, Rossana Scrivo: None declared, Juan D. Cañete: None declared, Penelope Palominos: None declared, Sandra Tälli: None declared, Uta Kiltz Grant/research support from: AbbVie, Chugai, Eli Lilly, Grünenthal, Janssen, MSD, Novartis, Pfizer, Roche, and UCB., Consultant for: AbbVie, Chugai, Eli Lilly, Grünenthal, Janssen, MSD, Novartis, Pfizer, Roche, and UCB., Martin SOUBRIER: None declared, Lihi Eder Grant/research support from: AbbVie, Eli Lilly and Company, Amgen, Celgene, UCB, Janssen, Novartis, and Pfizer, Consultant for: AbbVie, Eli Lilly and Company, Amgen, Celgene, UCB, Janssen, Novartis, and Pfizer, Ana-Maria Orbai Grant/research support from: AbbVie, Celgene, Horizon Pharma, Janssen, Lilly, and Novartis, Consultant for: Lilly, Janssen, Novartis, Pfizer, and UCB, Josef S. Smolen Grant/research support from: AbbVie, Eli Lilly, Janssen, MSD, Pfizer Inc, Roche, Consultant for: AbbVie, Amgen, AstraZeneca, Astro, Celgene, Celtrion, Eli Lilly, GlaxoSmithKline, ILTOO, Janssen, Medimmune, MSD, Novartis-Sandoz, Pfizer Inc, Roche, Samsung, Sanofi, UCB, Speakers bureau: AbbVie, Amgen, AstraZeneca, Astro, Celgene, Celtrion, Eli Lilly, GlaxoSmithKline, ILTOO, Janssen, Medimmune, MSD, Novartis-Sandoz, Pfizer Inc, Roche, Samsung, Sanofi, UCB