Pos0985 disease Control Perception by Physicians and Patients With Ankylosing Spondylitis and Psoriatic Arthritis in Real Clinical Practice in Spain: Midas Study Results

Abstract

Background:There are few published data regarding physician’ and patient’ perception of the disease control for ankylosing spondylitis (AS) and psoriatic arthritis (PsA).Objectives:To evaluate the relationship between physician’ and patient’ disease control perception compared to clinical outcomes for controlled disease (BASDAI<4 in AS or DAPSA≤14 in PsA).Methods:MIDAS is an observational, non-interventional, cross-sectional, multicenter study. Patients ≥18 years with ≥6 months AS or PsA diagnosis according to ASAS and modified New York criteria or CASPAR criteria, respectively, undergoing treatment ≥3 months before inclusion. The endpoint of this analysis was the relationship between disease control perception by physicians and patients and disease control (BASDAI<4 in AS or DAPSA≤14 in PsA).Results:313 AS patients included: 75.7% male, 78.5% HLA-B*27+, a mean (SD) age of 50.4 (12.0) years, a mean (SD) disease duration of 15.5 (11.6) years and a mean (SD) CRP of 5.1 (8.2) mg/l. 313 PsA patients included: 54.3% male, 17.95% HLA-B*27+, a mean (SD) age of 54.1 (12.2) years, a mean (SD) disease duration of 10.5 (9.0) years and a mean (SD) CRP of 4.91 (7.3) mg/l. AS group: in 95.5% of AS patients with BASDAI<4, physician’s perception matched the clinical evaluation, while only 42.3% of the patients with BASDAI≥4 matched physician’s perception. Positive Predictive Value (PPV) was 75.1%, Negative Predictive Value (NPV) was 83.9% and precision was 76.7%. Patients perceived their own disease as controlled in 95.0% of cases with BASDAI scores <4 and as not controlled in 29.7% of cases with BASDAI score ≥4. PPV was 71.1%, NPV was 76.7% and precision was 71.9%. The same trend was observed when assessing disease control through ASDAS-CRP index. PsA group: in 96.2% of patients with DAPSA≤14, physician’s perception matched the clinical evaluation, while only 47.6% of patients with DAPSA>14 matched the physician’s perception. PPV was 73.1%, NPV was 89.6% and precision was 76.4%. Patients perceived their own disease as controlled in 93.5% of the cases with DAPSA scores ≤14 and as not controlled in 32.3% of the cases with DAPSA>14. PPV was 66.8%, NPV was 77.4% and precision was 68.4%. The same trend was observed when assessing disease control through the MDA criteria (Table 1).Table 1.Physician’s and patient’s perception of the disease control related to disease control variables in AS and PsAControlled disease by physician’s perception?Controlled disease by patient’s perception?Valid NYesN (%)NoN (%)Valid NYesN (%)NoN (%)ASDisease control(BASDAI)Controlled(BASDAI<4)202 (100%)193 (95.5%)9 (4.5%)202 (100%)192 (95.0%)10 (5.0%)Not controlled(BASDAI≥4)111 (100%)64 (57.7%)47 (42.3%)111 (100%)78 (70.3%)33 (29.7%)Disease activity(ASDAS-CRP)Inactive(ASDAS-CRP<1.3)92 (100%)90 (97.8%)2 (2.2%)92 (100%)91 (98.9%)1 (1.1%)Active(ASDAS-CRP≥1.3)221 (100%)167 (75.6%)54 (24.4%)221 (100%)179 (81.0%)42 (19.0%)PsADisease control(DAPSA)Controlled(DAPSA≤14)186 (100%)179 (96.2%)7 (3.8%)185 (100%)173 (93.5%)12 (6.5%)Not controlled(DAPSA>14)126 (100%)66 (52.4%)60 (47.6%)127 (100%)86 (67.7%)41 (32.3%)Active disease (MDA)Inactive(MDA criteria ≥5)161 (100%)154 (95.7%)7 (4.3%)160 (100%)152 (95.0%)8 (5.0%)Active(MDA criteria<5)151 (100%)91 (60.3%)60 (39.7%)152 (100%)107 (70.4%)45 (29.6%)AS, ankylosing spondylitis; ASDAS-CRP, Ankylosing Spondylitis Disease Activity Score- C-reactive protein; BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; DAPSA, Disease Activity in Psoriatic Arthritis; MDA, Minimal Disease Activity; PsA, psoriatic arthritis.Conclusion:A higher agreement between physician’s and patient’ perception with the current clinical evaluation was observed when patients were controlled. MiDAS study showed that in real clinical practice in Spain, physicians perceived more disease control than the patientsAcknowledgements:We thank to MIDAS group investigators and patients included in the study.Disclosure of Interests:José Luis Pablos Speakers bureau: Janssen, Pfizer, Lilly, Novartis, Roche, Celgene, Bristol, Abbvie, Sanofi, Consultant of: Janssen, Pfizer, Lilly, Novartis, Roche, Celgene, Bristol, Abbvie, Sanofi, Gilead, Galápagos, Xavier Juanola Speakers bureau: Novartis, Abbvie, Pfizer, Lilly, Consultant of: Novartis, Lilly, Abbvie, Ceferino Barbazán Speakers bureau: Sanofi, Pfizer, Novartis, Amgen, Abbvie, Roche, Galápagos, Lilly, BMS, Biogen, UCB, Consultant of: Sanofi, Pfizer, Novartis, Amgen, Abbvie, Roche, Galápagos, Lilly, BMS, Biogen, UCB, María L. García Vivar Speakers bureau: Lilly, Novartis, Pfizer, Amgen, Bristol, Abbvie, Sanofi, Janssen and UCB, Consultant of: Lilly, Novartis, Pfizer, Amgen, Bristol, Abbvie, Sanofi, Janssen and UCB, Ana Cruz Valenciano Speakers bureau: Novartis, Consultant of: Novartis, Carlos Rodriguez-Lozano: None declared, Maria Estadella Employee of: I’m employed at Syneos Health providing services for Novartis., Ana Venegas Employee of: employee at Novartis, Cristina Sanabra Employee of: Novartis employee, Carlos Sastré Employee of: Novartis employee.

Maintained activity in ankylosing spondylitis patients treated with TNFi and/or NSAID for at least 12 weeks: a cross-sectional study in Brazil

“…In this study, there was a slight patient-physician discrepancy regarding the perception of AS disease activity. The patients perceived their disease to be more active than the physicians; this is in keeping with data from a systematic review of literature [38,44]. A plausible explanation could be, patients solely subjective perception of pain and discomfort, so they tend to perceive more severe disease not only due to the disease status but also psychological distress and comorbidities [44].…”

“…Even though included patients were on assumed great care, many still presented with disease activity, bringing to the attention that there might be very complex mechanisms for patients to be unable to achieve adequate treatment. Some possible explanations for treatment failure may be due to [1] non-compliance and non-adherence by patients -studies have shown that lack of knowledge about the disease and consequences of poor compliance could be the reason for this patient behavior; [2] sporadic and not routine use of PROs by healthcare providers -it has been reported that time constraint, insufficient knowledge and lack of integration of PROs into clinical system, are some of the barriers for the implementation of PROs in the clinical practice [35]; [3] lack of effective communication between healthcare providers and patients [36] -healthcare providers, including physician, improving communication with patients can further improve overall management of the disease [37,38]; and [4] clinical inertia -failure of physicians to initiate, change or intensify therapy when required especially when there is evidence of disease activity for chronic disease such as AS [39,40].…”