Background Achievement of minimal disease activity (MDA) may represent an objective target for treatment for patients with psoriatic arthritis (PsA).1 A patient is considered to have achieved MDA when 5 of the following 7 criteria are met: tender joint count (TJC) ≤1, swollen joint count (SJC) ≤1, affected body surface area (BSA) ≤3%, patient pain VAS ≤15, patient global activity VAS ≤20, HAQ score ≤0.5 and tender entheseal points ≤1.1
Objectives To retrospectively report the MDA and patient-reported outcomes (PROs) over time (baseline vs first follow-up [FU] visit vs second FU visit) that may contribute to achievement of MDA in responders versus non-responders to biologic treatment.
Methods This analysis included all patients with PsA in the Corrona registry aged ≥18 years between March 2013 and March 2016 who received biologics (index biologics) at enrollment (baseline) and had ≥2 FU visits (at ≈ 6-month intervals, mean [SD] 2nd FU visit: 15.7 [3.7] months). Responders were defined as patients who achieved MDA at the second FU visit and remained on their index biologic. Demographics, clinical characteristics, PROs and treatment history were collected at enrollment and at both FU visits. Trend tests of MDA over time were performed using the Wilcoxon rank-sum nonparametric test for responders and non-responders separately.
Results Of 148 patients who met the inclusion criteria (mean [SD] age, 54.7 [11.0] years; mean [SD] disease duration, 11.8 [10.1] years), 34 patients (23%) were classified as responders and 114 patients (77%) were non-responders at the second FU visit. The core components of MDA in these patients are shown in Table 1. Among responders, there were significant improvements in clinical characteristics and PROs such as mean TJC (3.4 vs 2.1 vs 0.6; P=0.004), SJC (2.5 vs 0.8 vs 0.5; P<0.0001), percentage of affected BSA (5.6% vs 2.4% vs 1.4%; P=0.03), patient pain (34.7 vs 26.1 vs 21.9; P=0.007) and HAQ scores (0.6 vs 0.4 vs 0.3; P=0.04); however, there were no significant changes over time for patient global assessment or enthesitis counts (P>0.05). Non-responders failed to have a significant improvement from baseline to the first and second FU visits in TJC, SJC, enthesitis, pain, patient global assessment and percentage of affected BSA (all P>0.05).
Conclusions Only 23% of patients achieved MDA on their index biologic at the second FU visit and were considered responders. Over time, responders showed significant improvements in TJC and SJC, percentage of affected BSA, patient pain and HAQ scores; these most likely contributed to achievement of MDA response. A treat-to-target approach may be considered given the low number of patients in MDA.
Coates, LC et al. Ann Rheum Dis. 2010;69(1):48–53.
Acknowledgements Corrona, LLC, has been supported through contracted subscriptions in the last 2 years by AbbVie, Amgen, BMS, Crescendo, Eli Lilly and Company, GSK, Horizon Pharma USA, Janssen, Momenta Pharmaceuticals, Novartis, Pfizer, Roche and UCB.
Disclosure of Interest P. Mease Grant/research support from: Celgene, Novartis, AbbVie, Amgen, BMS, Lilly, Pfizer, UCB, Consultant for: Celgene, Corrona, Novartis, AbbVie, Amgen, BMS, Crescendo, Genentech, Janssen, Lilly, Merck, Pfizer, UCB, C. Karki Employee of: Corrona, LLC, M. Liu Employee of: Corrona, LLC, A. Kavanaugh Grant/research support from: Amgen, AbbVie, Janssen, Pfizer, Novartis, C. Ritchlin Grant/research support from: Amgen, Janssen, UCB, Consultant for: AbbVie, Amgen, Janssen, Regeneron, UCB, D. Hunyh Speakers bureau: AbbVie, BMS, R. Pandurengan Employee of: Corrona, LLC, J. Palmer Employee of: Novartis, J. Greenberg Shareholder of: Corrona, LLC, Consultant for: Lilly, Genentech, Janssen, Novartis, Pfizer, Employee of: Corrona, LLC