184 Secukinumab provides sustained remission and low disease activity related to disease activity index for psoriatic arthritis: two year results from the FUTURE 2 study

Abstract Objectives Remission (REM) or low disease activity (LDA) is the treatment target in psoriatic arthritis (PsA). The objective of this study was to assess the reporting and prevalence of REM/LDA in published studies of PsA. Methods This was a systematic literature review of all clinical papers published in PubMed, EMBASE or Cochrane database in English between 2012 and 2019 in the field of PsA. Data were collected regarding reporting of REM/LDA by very low disease activity/minimal disease activity (VLDA/MDA), Disease Activity index for Psoriatic Arthritis (DAPSA), or Disease Activity Score 28 joints (DAS28). The pooled rates of REM and LDA by each definition were calculated by random effect meta-analysis. Results In all, 258 publications (corresponding to 114 651 patients), of which 81 (31%) were randomized controlled trials, were analysed: patients’ mean age was 49.4 ( 4.4) years; with a mean disease duration of 8.5 ( 3.8) years. REM/LDA was reported in 91/258 (35.3%) publications. VLDA/MDA was used in 61/91 (67.0%) studies, DAPSA in 27/91 (29.6%) and DAS28 in 28/91 (30.7%), with 40/91 (43.9%) papers reporting several of these definitions. The pooled prevalence (lower–upper limits) of REM was 13.1% (10.9–15.4), 23.1% (16.8–30.1) and 42.1% (33.9–50.4) using VLDA, DAPSA-REM and DAS28, respectively. For LDA the pooled prevalence was 36.3% (32.3–40.5), 52.8% (41.8–63.6) and 60.4% (52.5–68.0) using MDA, DAPSA-LDA and DAS28, respectively. Conclusion REM/LDA status was reported in only1/3 of recent studies on PsA, with important variations in the frequency of these outcomes according to the definition used: 13.1–42.1% for REM, and 36.3–60.4% for LDA. This highlights the need for consensus.

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Defining Low Disease Activity States in Psoriatic Arthritis using Novel Composite Disease Instruments

The Journal of Rheumatology ◽

10.3899/jrheum.150826 ◽

2015 ◽

Vol 43 (2) ◽

pp. 371-375 ◽

Cited By ~ 50

Author(s):

Laura C. Coates ◽

Philip S. Helliwell

Keyword(s):

Psoriatic Arthritis ◽

Disease Activity ◽

Disease Activity Score ◽

Activity Index ◽

Disease Activity Index ◽

Substantial Agreement ◽

Good Discrimination ◽

Low Disease Activity ◽

Minimal Disease ◽

The Relationship

Objective.To explore the relationship between minimal disease activity (MDA) and the low disease activity cutoffs of the Psoriatic ArthritiS Disease Activity Score (PASDAS) and the Composite Psoriatic Disease Activity Index (CPDAI).Methods.Data from the GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) composite exercise (GRACE) study were used for these analyses. Alternative definitions of low disease activity were used with 6/7 and 7/7 of MDA items, and a criteria set mandating the 2 articular items and 3/5 alternate items (MDA-joints). Two reference questions were used as anchors: physician’s global opinion of MDA, and patient’s opinion on their disease control.Results.Substantial agreement was found between MDA, MDA-joints, PASDAS, and CPDAI. Compared to the 2 reference questions, the various definitions of low disease activity gave sensitivities that were generally worse than specificities, the latter being high (> 0.9) in most cases. Both PASDAS and CPDAI demonstrated good discrimination between the “low” and “high” disease activity states by all the MDA definitions. Using these data, with an MDA of 7/7 to define a very low disease cutoff, the corresponding values for PASDAS and CPDAI were 1.9 and 2, respectively.Conclusion.An MDA score of 7/7 is proposed as very low disease activity in psoriatic arthritis. Using this definition, the equivalent cutoffs for PASDAS and CPDAI are 1.9 and 2, respectively.

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Rebound in Measures of Disease Activity and Symptoms in Corrona Registry Patients with Psoriatic Arthritis Who Discontinue Tumor Necrosis Factor Inhibitor Therapy after Achieving Low Disease Activity

The Journal of Rheumatology ◽

10.3899/jrheum.161567 ◽

2017 ◽

Vol 45 (1) ◽

pp. 78-82 ◽

Cited By ~ 4

Author(s):

Leslie R. Harrold ◽

Bradley S. Stolshek ◽

Sabrina Rebello ◽

David H. Collier ◽

Alex Mutebi ◽

...

Keyword(s):

Psoriatic Arthritis ◽

Disease Activity ◽

Activity Index ◽

Tumor Necrosis Factor Inhibitor ◽

Disease Activity Index ◽

Tnf Inhibitor ◽

Low Disease Activity ◽

Patient Reports ◽

Factor Inhibitor ◽

Necrosis Factor

Objective.Rebound may occur in patients with psoriatic arthritis (PsA) who discontinue TNF inhibitor (TNFi) therapy in low disease activity (LDA).Methods.Using physician and patient reports, we quantified rebound following TNFi discontinuation [defined as Clinical Disease Activity Index (CDAI) score > 10 or TNFi restart] and time to rebound in adults with PsA in LDA (CDAI score ≤ 10) at TNFi discontinuation.Results.Rebound occurred in 73% (69/94) of patients soon after discontinuation (median time to rebound 8.0 mos, 95% CI 6.0–12.0).Conclusion.Rebound occurred frequently in patients with PsA after TNFi discontinuation. TNFi discontinuation after achieving LDA should be carefully considered.

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Patient’s Global Assessment as an Outcome Measure for Psoriatic Arthritis in Clinical Practice: A Surrogate for Measuring Low Disease Activity?

The Journal of Rheumatology ◽

10.3899/jrheum.150595 ◽

2015 ◽

Vol 42 (12) ◽

pp. 2332-2338 ◽

Cited By ~ 22

Author(s):

Ennio Lubrano ◽

Fabio Massimo Perrotta ◽

Wendy J. Parsons ◽

Antonio Marchesoni

Keyword(s):

Clinical Practice ◽

Psoriatic Arthritis ◽

Disease Activity ◽

Outcome Measures ◽

Global Assessment ◽

Outcome Measure ◽

Activity Index ◽

Disease Activity Index ◽

Secondary Outcome ◽

Low Disease Activity

Objective.To assess the low disease activity (LDA) in a group of patients with psoriatic arthritis (PsA) receiving antitumor necrosis factor-α (TNF-α) by using the patient’s global assessment (PtGA) in clinical practice, and to compare PtGA with minimal disease activity (MDA) and other outcome measures.Methods.Patients with PsA classified by the ClASsification for Psoriatic ARthritis (CASPAR) criteria and consecutively admitted to an outpatient clinic dedicated to biologic therapy were assessed during their routine followup. The primary outcome measure was the proportion of patients achieving a PtGA ≤ 20 at 4-, 8-, and 12-month followups. Secondary outcome measures included the proportion of patients achieving MDA and other outcome measures. Correlation of PtGA with MDA and other process and outcome measures were also performed.Results.During the period of observation, 124 patients were evaluated. PtGA ≤ 20 was achieved in 25.7% at 4 months, 48.9% at 8 months, and 65.3% at 12 months of followup. The percentage of PtGA ≤ 20 statistically improved throughout the 3 timepoint assessments and it was statistically correlated to MDA. A significant correlation with the Disease Activity index for PSoriatic Arthritis (DAPSA), Bath Ankylosing Spondylitis Disease Activity Index, and Health Assessment Questionnaire was also observed. MDA, DAPSA, and Disease Activity Score at 28 joints with C-reactive protein remission were achieved at 12 months in 64%, 36%, and 71% of patients, respectively.Conclusion.PtGA can estimate the LDA status and could be considered as a surrogate of outcome measures for the assessment of global disease activity in patients with PsA receiving anti-TNF therapy during routine clinical practice. These data suggest that PtGA might be used in outpatient settings, being a simple, reliable, and not time-consuming instrument.

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The relationship between patient acceptable symptom state and disease activity in patients with psoriatic arthritis

Rheumatology ◽

10.1093/rheumatology/kez202 ◽

2019 ◽

Vol 59 (1) ◽

pp. 69-76 ◽

Cited By ~ 2

Author(s):

Jeanie Z Fei ◽

Anthony V Perruccio ◽

Justine Y Ye ◽

Dafna D Gladman ◽

Vinod Chandran

Keyword(s):

Psoriatic Arthritis ◽

Disease Activity ◽

Activity Index ◽

Area Under The Curve ◽

Disease Activity Index ◽

High Disease Activity ◽

Operating Characteristics ◽

Low Disease Activity ◽

Patient Reported ◽

Patient Acceptable Symptom State

Abstract Objectives The Psoriatic Arthritis Disease Activity Score (PASDAS) and Disease Activity Index for Psoriatic Arthritis (DAPSA) are composite PsA disease activity measures. We sought to identify the PASDAS and DAPSA cut-off points consistent with patient acceptable symptom state (PASS), the threshold of symptoms beyond which patients consider themselves well, and examine PASS across published PASDAS and DAPSA thresholds for low, moderate and high disease activity. Methods We used a standard protocol including physician assessment and patient-reported outcomes to prospectively record measures required to calculate PASDAS and DAPSA. We identified PASS thresholds for the PASDAS and DAPSA using receiver operating characteristics curve analyses. We assessed the frequency of reporting acceptable symptom state across disease activity thresholds for PASDAS and DAPSA scores. Results A total of 229 patients (58.5% male, mean age 55.5 years, mean disease duration 17.1 years) were recruited. The PASS threshold for the PASDAS was 3.79 [area under the curve (AUC) 0.86, sensitivity 0.75, specificity 0.82] and for the DAPSA was 11.10 (AUC 0.91, sensitivity 0.89, specificity 0.82). With the PASDAS, 90% of patients defined as having low disease activity considered their symptom state acceptable, compared with 55% and 17% among those with moderate and high disease activity, respectively. With the DAPSA, 98% of patients in disease remission considered their symptom state acceptable compared with 85, 22 and 18% among those with low, moderate and high disease activity, respectively. Conclusion We have defined PASS thresholds for PASDAS and DAPSA. The PASDAS target for low disease activity and DAPSA targets of low disease activity or remission align well with PASS.

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Very Low Disease Activity, DAPSA Remission, and Impact of Disease in a Spanish Population with Psoriatic Arthritis

The Journal of Rheumatology ◽

10.3899/jrheum.180460 ◽

2019 ◽

Vol 46 (7) ◽

pp. 710-715 ◽

Cited By ~ 4

Author(s):

Ruben Queiro ◽

Juan D. Cañete ◽

Carlos Montilla ◽

Miguel Angel Abad ◽

María Montoro ◽

...

Keyword(s):

Clinical Practice ◽

Psoriatic Arthritis ◽

Disease Activity ◽

Activity Index ◽

Disease Activity Index ◽

Routine Clinical Practice ◽

Cross Sectional ◽

Low Disease Activity ◽

Moderate Agreement ◽

Minimal Disease

Objective.To examine the grade of agreement between very low disease activity (VLDA) and Disease Activity Index for Psoriatic Arthritis (DAPSA) remission, as well as their association with the effect of the disease as assessed by the Psoriatic Arthritis Impact of Disease (PsAID) questionnaire in patients with psoriatic arthritis in routine clinical practice.Methods.Posthoc analysis of data from a cross-sectional multicenter study. Patients were included who fulfilled the Classification for Psoriatic Arthritis (CASPAR) criteria with at least 1 year of disease duration and were treated with biological and/or conventional synthetic disease-modifying antirheumatic drugs according to routine clinical practice in Spain. Patients were considered in VLDA if they met 7/7 of the minimal disease activity criteria. DAPSA and clinical (c)DAPSA score ≤ 4 identified remissions.Results.Of the 227 patients included in the original study, 26 (11.5%), 52 (22.9%), and 65 (28.6%) were in VLDA, DAPSA remission, and cDAPSA remission, respectively. There was a moderate agreement between VLDA and DAPSA remission (κ = 0.52) or cDAPSA remission (κ = 0.42). Patients with VLDA had less effect of the disease as measured by PsAID [mean total score (SD): VLDA 1.1 (1.2); DAPSA remission 1.3 (1.5); cDAPSA remission 1.7 (1.6)]. There was a moderate agreement between DAPSA remission or cDAPSA remission and PsAID < 4 (κ = 0.46 and κ = 0.58 respectively), while poor agreement (κ = 0.18) was found between VLDA and PsAID < 4.Conclusion.VLDA criteria seem to be more stringent for assessing a status of remission; however, DAPSA remission shows better correlation with a patient-acceptable symptoms state than VLDA does.

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Residual Disease Activity and Associated Factors in Psoriatic Arthritis

The Journal of Rheumatology ◽

10.3899/jrheum.190679 ◽

2019 ◽

Vol 47 (10) ◽

pp. 1490-1495 ◽

Cited By ~ 1

Author(s):

Ennio Lubrano ◽

Silvia Scriffignano ◽

Fabio Massimo Perrotta

Keyword(s):

Psoriatic Arthritis ◽

Disease Activity ◽

Associated Factors ◽

Residual Disease ◽

Activity Index ◽

Composite Index ◽

Disease Activity Index ◽

Psoriasis Area Severity Index ◽

Low Disease Activity ◽

Patient Reported

ObjectiveRemission or low disease activity should be the treatment target of psoriatic arthritis (PsA). However, residual disease activity (RDA) in some domains could persist. The aim of this study was to assess RDA and its associated factors in a group of patients with PsA.MethodsPatients with PsA were enrolled if they satisfied ClASsification for Psoriatic ARthritis (CASPAR) criteria with > 6 months’ followup and achieved a status of low disease activity (LDA), minimal disease activity (MDA), or remission [Disease Activity Index for PsA (DAPSA) remission or very low disease activity (VLDA)]. RDA was assessed by the percentage of patients who had, although in LDA or remission, tender and/or swollen joints > 1, Leeds Enthesitis Index > 1, Health Assessment Questionnaire > 0.5, Psoriasis Area Severity Index (PASI) > 1, patient’s global assessment > 20, physician visual analog scale (VAS) > 20, and VAS pain > 15. Associated factors of RDA were also assessed.ResultsOf 113 enrolled patients, 78 (69%) were in MDA. Moreover, DAPSA remission was observed in 46 (40.7%) while VLDA only in 32 (28.3%) of patients with PsA. VLDA seems to be the most stringent criterion, with a minimal RDA only in the VAS physician in 1 patient (3.1%) and none in the different domains, while patients in MDA had RDA in tender joints (14.1%), VAS pain (29.4%) and PASI > 1 or body surface area (BSA) > 3% (17.9%). Of note, although patients in DAPSA remission show a very low rate of RDA in almost all domains, 12 (26%) of them show a PASI > 1 or BSA > 3%. Finally, LDA shows RDA in higher percentages, mainly in patient-reported outcomes, tender joints, and skin domain.ConclusionRDA can be recognized in patients with PsA. VLDA seems to be the most stringent composite index to identify patients in the absence of RDA.

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SAT0462 Secukinumab provides sustained pasdas related low disease activity in psoriatic arthritis: 2 year results from the future 2 study

10.1136/annrheumdis-2017-eular.1458 ◽

2017 ◽

Author(s):

LC Coates ◽

DD Gladman ◽

P Nash ◽

O Fitzgerald ◽

A Kavanaugh ◽

...

Keyword(s):

Psoriatic Arthritis ◽

Disease Activity ◽

Low Disease Activity ◽

The Future ◽

Future 2

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Is ASDAS better than BASDAI as a measure of disease activity in axial psoriatic arthritis?

Annals of the Rheumatic Diseases ◽

10.1136/ard.2010.129726 ◽

2010 ◽

Vol 69 (12) ◽

pp. 2160-2164 ◽

Cited By ~ 51

Author(s):

Lihi Eder ◽

Vinod Chandran ◽

Hua Shen ◽

Richard J Cook ◽

Dafna D Gladman

Keyword(s):

Psoriatic Arthritis ◽

Ankylosing Spondylitis ◽

Disease Activity ◽

Activity Index ◽

Disease Activity Index ◽

Physician Global Assessment ◽

Global Score ◽

Discriminative Ability ◽

Low Disease Activity ◽

Axial Psoriatic Arthritis

ObjectiveTo assess the discriminative ability and correlation of the Ankylosing Spondylitis Disease Activity Score (ASDAS) and Bath Ankylosing Spondylitis Activity Disease Activity Index (BASDAI) with disease activity in axial psoriatic arthritis (AxPsA).MethodsPatients with AxPsA were selected from a large prospective cohort study of psoriatic arthritis. Patient and physician global scores were used as constructs of disease activity. Patients were categorised into high and low disease activity states based on patient and physician global assessment scores and physician's decision to change treatment. Statistical analysis included descriptive statistics, linear and logistic regression.Results201 patients with AxPsA were included in the study. ASDAS and BASDAI showed good correlation with disease activity as reflected by the patient global score (correlation coefficients (r) for BASDAI 0.84, ASDAS-B 0.77, ASDAS-C 0.81, p<0.001) and the physician global score (r=0.53 for BASDAI, r=0.50 for ASDAS-B, r=0.55 for ASDAS-C, p<0.001). Both scores showed good discriminative ability between high and low disease activity states. However, there were no significant differences between areas under the curve for the models that compared ASDAS with BASDAI for each definition of disease activity state.ConclusionsIn patients with AxPsA, ASDAS and BASDAI scores show similar good to moderate discriminative ability and correlation with different constructs of disease activity. ASDAS was not superior to BASDAI in its ability to discriminate between high and low disease activity states in AxPsA.

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