Prodromalphase der Psoriasis-Arthritis?

Bis zu 30% der Patienten mit Psoriasis sind von Psoriasis-Arthritis (PsA) betroffen. Eine verzögerte Diagnosestellung ist mit mehr Gelenkschäden und einer schlechteren körperlichen Funktion verbunden. Für PsA gibt es allerdings keinen zuverlässigen Biomarker. Lässt sich dennoch eine Prodromalphase der PsA anhand bestimmter Daten charakterisieren? Eine kanadische Studie prüfte dazu die Inanspruchnahme von Gesundheitsleistungen.

Secukinumab wirksam bei axialen Manifestationen der Psoriasis-Arthritis

Secukinumab zeigte sich bereits in verschiedenen klinischen Bereichen bei aktiver Psoriasis-Arthritis (PsA) als signifikant und nachhaltig wirksam. Der Effekt des Interleukin-17A-Hemmers speziell auf axiale Manifestationen bei Patienten mit PsA wurde nun erstmals in einer randomisierten kontrollierten Studie aus Deutschland untersucht.

Biologicals bei RA und PsA: niedrige Krankheitsaktivität nach einem Jahr sagt Langzeitansprechen voraus

Biologicals haben die Behandlungserfolge von Patienten mit rheumatoider Arthritis (RA) und Psoriasis-Arthritis (PsA) verbessert. Jedoch fehlen Prädikatoren zur Vorhersage der Langzeit-Remission. Irische Wissenschaftler haben Patienten mit beiden Erkrankungen unter Biological-Therapie über zwölf Jahre beobachtet.

Psoriasis-Arthritis: Hürden bei der Implementierung von Treat to target

Bei sogenannten Treat-to-Target-Ansätzen (T2T) werden bestimmte Therapieziele definiert und Therapiefortschritte durch regelmäßige Kontrollen überprüft. Wenn nötig, können Behandlungen individuell angepasst werden. Bei der Psoriasis-Arthritis (PsA) verbessert T2T klinische und Patienten-berichtete Outcomes. Obwohl es in europäischen Leitlinien empfohlen wird, wird T2T bei der Behandlung von PsA selten angewendet. Eine neue Studie untersucht Barrieren der Implementierung.

POS1451 DEVELOPING A TOOL TO MEASURE THE LEARNING CURVE: ENTHESITIS ULTRASOUND IN PSORIASIS ARTHRITIS

Background:Enthesitis is defined as inflammation of the tendon inserting the bone encompassing the adjacent trabecular bone network, the fascia and surrounding soft tissues as the cartilage, the bursa and the fat pad. In enthesitis clinical examination alone is a method with significant limitations in terms of diagnostic accuracy and does not correlate strongly with imaging diagnostics (1,2).Ultrasound (US) is a widely used imaging technique in Rheumatology. But while learning curricula and standardization for joint US are available, other US techniques as vascular-, enthesis- or serosa-US gets usually less attention in rheumatologic US curricula. Though both OMERACT (4) and GRAPPA (3) have recently published qualitative and semi quantitative criteria in enthesitis US, few publications explicitly address the learning curves in these particular domain.Objectives:To describe the development of a tool to measure the learning curve for enthesitis US.Methods:3237 US images of 561 enthesis were obtained by one experienced ultrasonographer (PMA) in B- and color Doppler (CD) mode in longstanding psoriasis arthritis patients of different disease activity. Due to duplicity and poorer image quality 2115 images were eliminated. The remaining fully anonymized 1122 images (561 enthesis) were afterward implemented in a random multiple choice algorithm presenting a B-mode and a CD image of the same enthesis at the same time without timely limitation. Rating follows qualitative GRAPPA criteria as well as semiquantitative OMERACT criteria (3, 4). The enthesitis scoring application was than written in.NET/ C#, TypeScript and ReactJS and is hosted in Azure Cloud platform. The scoring is stored in a database allowing extraction to SPSS for statistical analysis.Results:The interface of the functional program is shown in image 1 (Screenshot). In a next step the program will be presented to different raters of different ultrasound experience (>10 years, 5-10 years, 1-5 years, <1 years). The program will be presented a multitude of times in different order to every rater to adjust for inter-rater reliability. Correlation between raters will be given to depict a learning curve on enthesitis ultrasound assuming the rater with the highest experience as gold standard.Image 1.Screenshot of grafical user interface of the scoring program.Conclusion:In this presentation we outline the successful development of a tool to measure the learning curve in enthesitis. We hypothesize that knowledge about the learning curve and inter-rater reliability in enthesitis US obtained by our tool might contribute to future US curricula, structured reporting and deep learning algorithms.References:[1]Achilles enthesitis defined by ultrasound is not associated with clinical enthesitis in patients with psoriatic arthritis, Brigitte Michelsen et al. RMD Open 2017;3[2]Ultrasonographic evaluation in psoriatic arthritis is of major importance in evaluating disease activity Brigitte Michelsen et al. Annals of the Rheumatic Diseases 12(2108-2113)[3]Development of a Preliminary Ultrasonographic Enthesitis Score in Psoriatic Arthritis -GRAPPA Ultrasound Working Group, Stephanie Tom et al. The Journal of Rheumatology; 4(384-390)[4]Reliability of a consensus-based ultrasound definition and scoring for enthesitis in spondyloarthritis and psoriatic arthritis: an OMERACT US initiative, Peter V Balint et al. Annals of the Rheumatic Diseases, 12(1730-1735)Disclosure of Interests:None declared

AB0556 COMPARING EFFICACY OF GUSELKUMAB VERSUS USTEKINUMAB IN PATIENTS WITH PSORIASIS ARTHRITIS: AN ADJUSTED COMPARISON USING INDIVIDUAL PATIENT DATA FROM DISCOVER 1&2 AND PSUMMIT TRIALS

Background:Guselkumab is an anti-interleukin (IL)-23 monoclonal antibody recently approved for a treatment of Psoriasis arthritis (PsA). In two large Phase III trials of patients with PsA (DISCOVER -1 & -2) guselkumab has shown to be superior versus placebo. In this indication no direct comparison is available between guselkumab and ustekinumab, a monoclonal antibody targeting IL-12 and IL-23. Indirect comparisons based on relative treatment effects versus a common comparator (placebo) only allow for analyses up to week 24 due to cross-over to active arms in available PsA trials.Objectives:To compare indirectly joint and skin efficacy of guselkumab versus ustekinumab up to week 52, using pooled patient-level trial data from DISCOVER 1&2 and PSUMMIT 1&2, adjusting for cross-trial population differences.Methods:Patient level data, including baseline characteristics and outcome data on American College of Rheumatology (ACR) response, Psoriasis Area Severity Index (PASI) response from the guselkumab arms of DISCOVER -1 & -2 were pooled with the data from the ustekinumab trials PSUMMIT -1&-2. Analyses were performed for bio-naïve and bio-experienced populations separately. Differences in patient characteristics across trial populations were adjusted for using multivariate logistic regression, including: gender, age, body mass index, previous TNF use, disease duration, PASI level, number of swollen and tender joints. This method of indirect comparisons allows for analysis of comparative efficacy beyond controlled induction period and odds ratios’ resulting from this model were translated into predicted response rates for ustekinumab, assuming same patient population, as enrolled in the guselkumab trial arms.Results:Majority of baseline characteristics for patients on guselkumab (100mg q8w; 100mg q4w) were comparable to patients on ustekinumab 45/90mg, in both in bio-naïve and bio-experienced group of patients. The probability of reaching a ACR 20 in both the bio-naïve & bio-experienced population was significantly higher for guselkumab vs ustekinumab at weeks 52 for both dosing regimens of guselkumab (bio-naïve ACR 20: q8w OR= 1.88 [1.28;2.76]), q4w (OR= 1.92 [1.29;2.86]; bio experienced ACR20 q8w OR= 2.72[1.17;6.31], q4w OR=4.77 [1.95;11.63]). Similarly guselkumab was superior over ustekinumab on PASI 90 outcome at week 52 in both bio-naïve & bio-experienced patients with BSA ≥3 % at baseline (bio-naïve: q8w OR= 2.59 [1.68;3.99]), q4w OR= 3.19 [2.03;5.00], and bio-experienced q8w OR= 3.96[1.39,11.27], q4w OR=13.10[4.18,41.04]). Figure 1 represents unadjusted pooled DISCOVER 1&2 trial results and estimated proportions of ustekinumab treated patient group achieving ACR 20 in bio-naïve patient group up to week 52 using the method described above.Conclusion:An adjusted comparison using patient level data from pivotal Phase III studies demonstrates both dosages of guselkumab to be significantly more effective versus ustekinumab in both skin and joint outcomes in both bio-naïve & bio experienced patients up to week 52.Disclosure of Interests:Joris Diels Shareholder of: Janssen, Employee of: Janssen, Pushpike Thilakarathne Employee of: Janssen, Agata Schubert Shareholder of: Janssen, Employee of: Janssen, Fareen Hassan Shareholder of: Janssen, Employee of: Janssen, Steve Peterson Shareholder of: Janssen, Employee of: Janssen, Wim Noel Shareholder of: Janssen, Employee of: Janssen.