svr-congresos-xxii-congreso-svr-abril-2019-poster-33-biologicos-jakinib-02
IS THE CLINICAL AND THERAPEUTIC PROFILE RELATED TO SATISFACTORY RESPONSE TO APREMILAST IN PSORIATIC ARTHRITIS? De la Morena I. 1 , Espinosa M. 2 , Godoy H. 2 , Martinez À. 3 , Santos C. 4 , Martínez A. 5 , Fernández M. 6 , Fernández – Llanio N. 6 , Palma D. 7 , Moreno M.J. 7 , Haro A. 7 , Conesa A. 8 , Calvo J. 9 . 1 Hospital Clínico de Valencia, Valencia, Spain ; 2 Hospital Puerta de Hierro, Madrid, Spain ; 3 Hospital Doctor Peset, Valencia, Spain ; 4 Hospital Virgen de los Lirios, Alcoy, Spain ; 5 Hospital de la Ribera, Alcira, Spain ; 6 Hospital Arnau de Vilanova , Valencia, Spain ; 7 Hospital Rafael Méndez, Lorca, Spain ; 8 Hospital General de Castellón, Castellón, Spain ; 9 Hospital General de Valencia, Valencia, Spain . AIM: To identify the factors that are related with response to Apremilast (APR) in Psoriatic Arthritis ( PsA ). MATERIALS AND METHODS : An observational and analytical multicenter retrospective study . There are included all PsA patients treated with Apremilast (APR) in participants centers . Satisfactory response (yes / no) was defined by rheumatologist encharge of each patient . It was studied the assotiation with disease duration , previous treatments , cutaneous and joint involvement pattern defined as : joint exclusively , non joint and mixed ( by several domains combination ) using t Student , Chi square and multivariable logistic regression . It is also described : duration of treatment , tolerance , adverse events , and reason for APR choice . RESULTS : None of the factors studied showed a significant association with satisfactory response . Baseline characteristics N 89 Male , n (%) 46 (51.7%) Age , years (mean  SD) 53.99  12.3 PsA duration, years(mean  SD) 7.28  6.25 Previous treatment * None 7 (8%) Methotrexate 18 (20.7%) More than 1 bDMARD 15 (16.9%) Leflunomide 2 (2.3%) Sulphasalazine 3 (3.4%) Sequential cDMARD 22 (25.3%) Combination cDMARD 7 (8%) Several cDMARD & 1 bDMARD 13 (14.9%) * N= 2 non available . PsA pattern PsA Domains (n/89) 28 49 29 27 24 0 10 20 30 40 50 60 70 80 9% 24% 5% 62% Oligoarticular Polyarticular Enthesitis Mixed 33% 13% 54% Joint Non Joint Mixed The reason for APR choice was : intolerance or toxicity to cDMARD 13 patients, preference before bDMARD 28 , contraindication or caution to bDMARD 22 , inefficacy to cDMARD or bDMARD 18 , one because of intolerance to cDMARD and bDMRD , and one due to clinical profile 1 . In 6 patients it was not available . Persistence Ongoing Treatments and withdrawals (n/89) Efficacy * * N= 7 efficacy was not available . 16 17 56 0 10 20 30 40 50 60 70 80 Ongoing Inefficacy withdrawals Intolerance withdrawals – Average treatment duration with APR was 8 . 13 ( range 0 – 23 ) months . – 56 patients remain with APR a mean of 10 . 4 ( 2 – 23 ) months . 22 of them remain with APR among 1 and 2 years . – Withdrawals treatment duration was 4 . 3 ( 0 – 12 ) months . 74% 26% Global efficacy YES (61) NO (21) 54% 19% 27% Joint efficacy YES (44) Parcial (16) NO (22) CONCLUSION : In this series of cases of PsA we have not detected factors that allow us to predict satisfactory response to APR . Efficacy vs previous treatment Respoders Non responders Only cDMARD (n=55) 44 (80%) 11 (20%) 1 or more bDMARD (n=25) 16 (64%) 9 (36%) Chi – Square: 2.347 p = 0.165 Efficacy vs PsA Pattern Respoders Non responders Joint (n=24) 19 (79,2%) 5 (20,8%) Non joint (n=11) 8 (72,7%) 3 (27,3%) Mixed (n=47) 34 (72,3%) 13 (27,7%) Chi – Square: 0.407 p = 0.816 Multivariable logistic regression Variable Odds Ratio IC 95% p Value PsA duration 1.01 (0.99 – 1.01) 0.629 Sex 0.52 (0.19 – 1.42) 0.203 Age 0.97 (0.92 – 1.01) 0.151 Join Pattern 1.33 (0.11 – 16.47) 0.823 Non Joint Pattern 0.5 (0.28 – 8.95) 0.638 Mixed Pattern 0.92 (0.89 – 9.6) 0.951 Oligoarticular Domain 1.33 (0.42 – 4.21) 0.617 Poliarticular Domain 0.83 (0.29 – 2.28) 0.717 Enthesitis Domain 1.13 (0.38 – 3.36) 0.825 Dactilitis Domain 0.71 (0.24 – 2.08) 0.533 Axial Domain 0.97 (0.34 – 2.79) 0.963 Preference before bDMARD 0.45 (0.82 – 2.52) 0.368 Contraindication bDMARD 1.45 (0.18 – 11.93) 0.727 Inefficacy cDMARD & bDMARD 0.21 (0.34 – 1.21) 0.081