Ab1114 musculoskeletal Ultrasound Baseline Assessment Improves the Response to Apremilast in Patients With Psoriatic Arthritis: Results From a Multicenter Study

Abstract

BackgroundPsoriatic arthritis (PsA) is an inflammatory rheumatic disease characterized by different phenotypes in terms of joint involvement. Apremilast, PDE4 competitive inhibitor, has been introduced in the treatment of adult psoriatic arthritis (PsA) with moderate disease activity. Musculoskeletal ultrasound (MUS) is useful in the assessment of disease, treatment response and follow up in PsA patients. Choosing an effective and safe treatment over time is an increasingly urgent goal given the greater availability of indicated drugs.ObjectivesThe aim of this study is to evaluate if MUS assessment before apremilast treatment can improvement its retention rate.MethodsWe enrolled consecutive patients affected by PsA (according to the CASPAR Criteria) from 15 rheumatology centers. The following data were recorded for each patient: age, gender, duration of disease, DAPSA; smoke, comorbilities; concomitant treatment; duration of therapy with apremilast; reason of sospensione, PsA phenotype (poliarticular or oligoarticular) (Table 1). All patients were divided in two subset according to the presence of a MUS assessment before apremilast treatment. The differentes between two groups were calculated by means of the Mann-Whitney and Chi-quadro tests. The Kaplan Meier curve and Cox analysis assessed the retention rate and associated factors. P values < 0.05 were considered statistically significant.ResultsON Three hundred and fifty patients (m/f: 198/152; median age 60 years, IQR 52-67 years), 40% received MUS examination. In the MUS group there was a moderate disease (medium 22,9 IQR 18,2-29 vs 26,9 IQR 20,3-33,9; p=0,0006) and a prevalence of the oligoarticular pattern (73% vs 44%, p<0,0001). The retention rate was statistically higher in MUS group (Figure 1) (HR 0,57 IC95% 0,35-0,95; p=0,03).Table 1.No USYes USP-valueNumber216140-Age (years)61[54-69]58[50-65]0,0016Gender (M:F)85:13167:73NssSmoke (%)23,434,80,0198BMI (kg/m^2)25,7[23,4-29,8]26,1[23,7-29,0]nssDuration of disese PsA (months)44[13-95]37[12-78]nssDuration of disese PsO (months)13[0-83]30[0-93}nssComorbility (%)47,739,3nssSwollen joints8[4-12]4[3-7]<0,000001Tender joints3[2-5]2,5[2-4]0,0434PCR (mg/dl)2,9[0,8-5,2]1,0[0,7-3,0]0,0057DAPSA27,0[20,4-34,2]22,9[18,2-29,0]0,0004Concomitant treatment (%)13,427,10,0012Naive biologic (%)80,668,60,0100Oligoarticolar pattern (%)36,163,6<0,0001Figure 1.A: Psoriatic arthritis. Longitudinal volar scan of the interphalageal prossimal joint. Tenosinovitis of the flexor tendons()B: Psoriatic arthritis. Transversal volar scan of the interphalageal prossimal joint. Tenosinovitis of the flexor tendons ()ConclusionIn PSA patients treated with apremilast, MUS assessment at baseline was associated with an higher retetion rate. MUS could be useful in the PsA treatment algorithm in order to better identify those patients whose characteristics are favourable to apremilast response.References[1]\Ramona Lucchetti et al. IMAJ 2021 JULY;23(7): 412-415.[2]\Fulvia Ceccarelli et al. Clin Rheumatol. 2019 Nov;38(11):3145-3151Acknowledgements:NIL.Disclosure of InterestsNone Declared.