Interim 2-year analysis from SERENA: A real-world study in patients with psoriatic arthritis or ankylosing spondylitis treated with secukinumab

Introduction: Sustained improvement of high degree in clinical outcomes have been demonstrated in phase 3 trials with secukinumab in both psoriatic arthritis (PsA) and ankylosing spondylitis (AS). The objective of the SERENA study was to evaluate the effectiveness, retention rates, and safety of secukinumab in patients with PsA and AS. Methods: SERENA is an ongoing, longitudinal, real-world observational study involving patients with moderate-to-severe psoriasis, PsA, or AS. Patients had received at least 16 weeks of secukinumab treatment before recruitment to the study. Retention rate was defined as percentage of patients who continued secukinumab treatment over the course of study. Effectiveness of secukinumab in AS and PsA cohorts was assessed using descriptive statistics. Results: The current interim analysis included 1004 patients with PsA or AS. Overall secukinumab retention rates at 2 years after enrolment were 74.9 and 78.9% in patients with PsA and AS, respectively. At baseline and at 2 years, swollen joint count [3.3 (5.8) vs. 2.9 (5.8)], tender joint count [6.3 (9.4) vs. 5.6 (7.2)] in patients with PsA and BASDAI scores [3.2 (2.3) vs. 2.9 (2.3)] in patients with AS, suggest sustained effectiveness for patients remaining on secukinumab for at least 2 years after enrolment. A total of 73 patients had treatment interruption; 78% of these patients reinitiated secukinumab without a loading dose. No new or unexpected safety signals were reported. Conclusions: After more than 2 years since initiation, secukinumab demonstrated high retention rates and favorable safety profile as well as sustained effectiveness in patients who continued secukinumab treatment

How do patient-reported outcome measures affect treatment intensification and patient satisfaction in the management of psoriatic arthritis? A cross sectional study of 503 patients

Objectives The AsseSSing Impact in pSoriatic Treatment (ASSIST) study investigated prescribing in routine PsA care and whether the patient-reported outcome—PsA Impact of Disease questionnaire (PsAID-12)—impacted treatment. This study also assessed a range of patient and clinician factors and their relationship to PsAID-12 scoring and treatment modification. Methods Patients with PsA were selected across the UK and Europe between July 2021 and March 2022. Patients completed the PsAID questionnaire and the results were shared with their physician. Patient characteristics, disease activity, current treatment methods, treatment strategies, medication changes and patient satisfaction scores were recorded. Results A total of 503 patients were recruited. Some 36.2% had changes made to treatment, and 88.8% of these had treatment escalation. Overall, the mean PsAID-12 score was higher for patients with treatment escalation; increase in PSAID-12 score is associated with increased odds of treatment escalation (odds ratio 1.58; P < 0.0001). However, most clinicians reported that PsAID-12 did not impact their decision to escalate treatment, instead supporting treatment reduction decisions. Physician’s assessment of disease activity had the most statistically significant effect on likelihood of treatment escalation (odds ratio 2.68, per 1-point score increase). Escalation was more likely in patients not treated with biologic therapies. Additional factors associated with treatment escalation included: patient characteristics, physician characteristics, disease activity and disease impact. Conclusion This study highlights multiple factors impacting treatment decision-making for individuals with PsA. PsAID-12 scoring correlates with multiple measures of disease severity and odds of treatment escalation. However, most clinicians reported that the PsAID-12 did not influence treatment escalation decisions. Psoriatic Arthritis Impact of Disease (PsAID) scoring could be used to increase confidence in treatment de-escalation

An international multicentre analysis of current prescribing practices and shared decision-making in psoriatic arthritis

Objectives Shared decision-making (SDM) is advocated to improve patient outcomes in PsA. We analysed current prescribing practices and the extent of SDM in PsA across Europe. Methods The ASSIST study was a cross-sectional observational study of PsA patients ≥18 years of age attending face-to-face appointments between July 2021 and March 2022. Patient demographics, current treatment and treatment decisions were recorded. SDM was measured by the clinician’s effort to collaborate (CollaboRATE questionnaire) and patient communication confidence (PEPPI-5 tool). Results A total of 503 patients were included from 24 centres across the UK, France, Germany, Italy and Spain. Physician- and patient-reported measures of disease activity were highest in the UK. Conventional synthetic DMARDs constituted a higher percentage of current PsA treatment in the UK than continental Europe (66.4% vs 44.9%), which differed from biologic DMARDs (36.4% vs 64.4%). Implementing treatment escalation was most common in the UK. CollaboRATE and PEPPI-5 scores were high across centres. Of 31 patients with low CollaboRATE scores (<4.5), no patients with low PsAID-12 scores (<5) had treatment escalation. However, of 465 patients with CollaboRATE scores ≥4.5, 59 patients with low PsAID-12 scores received treatment escalation. Conclusions Higher rates of treatment escalation seen in the UK may be explained by higher disease activity and a younger cohort. High levels of collaboration in face-to-face PsA consultations suggests effective implementation of the SDM approach. Our data indicate that in patients with mild disease activity, only those with higher perceived collaboration underwent treatment escalation. Prospective studies should examine the impact of SDM on PsA patient outcomes

Uveitis in Patients with Axial Spondyloarthritis or Psoriatic Arthritis: Baseline Characteristics and Incidence Rates During Secukinumab and Placebo Comparative Phase: A Post Hoc Analysis

Brandt-Juergens J, Rudwaleit M, Behrens F, et al. Uveitis in Patients with Axial Spondyloarthritis or Psoriatic Arthritis: Baseline Characteristics and Incidence Rates During Secukinumab and Placebo Comparative Phase: A Post Hoc Analysis. In: American College of Rheumatology, ed. ABSTRACT SUPPLEMENT ACR Convergence 2022, November 10–14, 2022, Philadelphia, PA. Arthritis &amp; Rheumatology. Vol 74. Hoboken: Wiley; 2022: 2074-2076

Development of a set of ASAS quality standards for adults with axial spondyloarthritis

Background: There is wide variation in the management of patients with axial spondyloarthritis (axSpA) worldwide with significant unmet needs such as delayed diagnosis. A major goal of the international organization Assessment of SpondyloArthritis international Society (ASAS) is to improve quality of care and health outcomes in axSpA. One way to achieve this is to define quality standards (QS) in order to identify resources and processes which may need to be optimized. Such standards must be specific, measurable, aspirational and achievable in daily care. Objectives: To develop ASAS QS to ultimately improve the quality of care for adults with axSpA. Methods: The ASAS QS group, established in 2015, developed a step-wise approach starting with (I) an overview and open discussions resulting in a proposal for possible key areas for quality improvement. Thereafter, (II) ASAS members and invited patients discussed and commented on a provisional list via a web-based survey with the possibility to propose additional key areas for quality improvement. (III) The complete list was then evaluated by ASAS members and invited patients. (IV) Then, the ASAS QS group prioritized key areas for which quality statements and measures are to be developed, and (V) phrased QS for the most important key areas. Finally (VI), a draft version was commented on, discussed and finally agreed by the ASAS members at the Annual ASAS Meeting 2019. Results: The ASAS QS group, consisting of 20 rheumatologists, 2 physiotherapists and 2 patients, provided 34 potentially key areas for quality improvement which were commented by 140 participants (86 physicians, 42 patients). Within that process 3 new key areas were proposed and all 37 key areas for improvement were again evaluated by 120 participants (86 physicians, 29 patients). Five key areas were identified to be most important to phrase QS: referral, rheumatologic assessment, treatment, education/self-management and comorbidities. Altogether, 9 QS, each accompanied by a rationale and a measure (figure), were endorsed by ASAS. Conclusion: ASAS successfully developed the first QS set for improvement of health care provided for adults with axSpA. All QS are achievable in daily care in an optimized situation and intend to minimize variation in quality of care. It is emphasized that ASAS is well aware that all QS are ideal visions of an optimal care which may currently not be realistic in many countries