Sustained Very Low Disease Activity and Remission in Psoriatic Arthritis Patients

Lubrano, Ennio; Perrotta, Fabio Massimo; Scriffignano, Silvia; Coates, Laura C.; Helliwell, Philip S.

doi:10.1007/s40744-019-00171-w

Cited by 24 publications

(18 citation statements)

References 20 publications

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“…Measuring disease activity has been a challenge owing to the diverse manifestations of the disease, including the skin and the musculoskeletal system 3 . Currently, different composite indices have been developed specifically for PsA, most focusing on multiple domains considered important to assess the disease activity states 4 . However, few data have been published on comparing these measures 5 .…”

mentioning

confidence: 99%

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

Queiró¹,

Cañete²,

Montilla³

et al. 2019

J Rheumatol

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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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confidence: 99%

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

Queiró¹,

Cañete²,

Montilla³

et al. 2019

J Rheumatol

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“…Different tools, such as Disease Activity Score (DAS) and American College of Rheumatology (ACR) response criteria, which primarily focus on peripheral joint manifestations and were validated in patients with rheumatoid arthritis, have been used for measuring joint responses in PsA. However, outcome measures borrowed from rheumatoid arthritis, such as ACR response criteria and DAS28-CRP, do not reflect the variety of disease manifestations [ 3 , 4 ]. One of the overarching principles of the treat-to-target recommendations for patients with PsA by international task forces [ 5 ], the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) [ 6 ], and the European League Against Rheumatism (EULAR) [ 7 ] is to achieve the lowest possible level of disease activity across all domains of disease.…”

Section: Introductionmentioning

confidence: 99%

“…One of the overarching principles of the treat-to-target recommendations for patients with PsA by international task forces [ 5 ], the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) [ 6 ], and the European League Against Rheumatism (EULAR) [ 7 ] is to achieve the lowest possible level of disease activity across all domains of disease. Disease remission and low/minimal disease activity are defined by the minimal disease activity (MDA), which measures all domains of the disease, or Disease Activity Index for Psoriatic Arthritis (DAPSA), which measures peripheral arthritis and acute-phase reactants [ 4 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Secukinumab provides sustained PASDAS-defined remission in psoriatic arthritis and improves health-related quality of life in patients achieving remission: 2-year results from the phase III FUTURE 2 study

et al. 2018

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BackgroundSecukinumab has demonstrated sustained improvement in the signs and symptoms of psoriatic arthritis (PsA) over 2 years in the FUTURE 2 study (NCT01752634). This post hoc analysis assessed the ability of secukinumab to achieve Psoriatic Arthritis Disease Activity Score (PASDAS)-based remission or low disease activity (LDA) through 2 years among patients with PsA in the FUTURE 2 study.MethodsPASDAS (cut-off scores: remission ≤ 1.9; LDA > 1.9 and < 3.2; Moderate Disease Activity ≥ 3.2 and < 5.4; and high disease activity [HDA] ≥ 5.4) was assessed in the overall population (tumour necrosis factor inhibitor [TNFi]-naïve and TNFi-experienced), in patients stratified by prior TNFi use and by disease duration at weeks 16, 52 and 104. The impact of secukinumab on individual PASDAS core components and on the relationship between PASDAS states and patient-reported outcomes (PROs), including physical function, health-related quality of life (HRQoL) and work productivity, were also assessed. Data for the approved doses of secukinumab (300 and 150 mg) are reported. PASDAS scores and core components were reported as observed, and PROs were analysed using mixed models for repeated measures.ResultsIn the overall population, PASDAS remission and LDA were achieved in 15.6% and 22.9%, respectively, of patients treated with secukinumab 300 mg and in 15.2% and 19.2%, respectively, in the secukinumab 150 mg group versus 2.3% and 13.8%, respectively, with placebo at week 16. In the TNFi-naïve group, a higher proportion of patients achieved remission + LDA at week 16 with secukinumab 300 and 150 mg (46.2% and 42.9%, respectively) versus placebo (17.5%), with corresponding responses in TNFi-experienced patients being 22.6% and 19.4% versus 13.3%. Remission/LDA responses with secukinumab were sustained through 2 years. Patients achieving remission/LDA reported greater improvements in PROs than patients in HDA through 2 years.ConclusionsSecukinumab-treated patients achieved higher PASDAS-defined remissions or LDA compared with placebo at week 16, which were sustained through 2 years. Remission/LDA was achieved by both TNFi-naïve and TNFi-experienced patients treated with secukinumab, with higher rates in TNFi-naïve patients. Secukinumab-treated patients achieving remission/LDA reported significantly greater improvements in PROs, including physical function and different dimensions of health-related quality of life and work, than patients in HDA.Trial registrationClinicalTrials.gov, NCT01752634. Registered on December 19, 2012.EUDRACT, 2012-004439-22. Registered on December 12, 2012.

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“…Clinical assessment encompassed the number of tender joints (of the 68 assessed joints) and swollen joints (total of 66 joints), enthesitis and dactylitis. Enthesitis was assessed using the Leeds Enthesitis Index (LEI),26 and dactylitis assessed as present or absent, as published elsewhere 27. Skin assessment was performed using the body surface area (BSA).…”

Section: Methodsmentioning

confidence: 99%

Assessment of the Patient Acceptable Symptom State (PASS) in psoriatic arthritis: association with disease activity and quality of life indices

et al. 2020

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ObjectiveThe aim of this study was to evaluate the discriminant capability of the Patient Acceptable Symptom State (PASS) according to disease activity, remission/low disease activity indices and quality of life indices in patients with psoriatic arthritis (PsA).MethodsConsecutive patients with PsA were enrolled in this cross-sectional study. At each visit, the patients underwent a complete physical examination and their clinical/laboratory data were collected. Disease activity was assessed using the Disease Activity Score for Psoriatic Arthritis (DAPSA) and remission/low disease activity using the DAPSA minimal disease activity (MDA) and very low disease activity (VLDA) criteria. The Psoriatic Arthritis Impact of Disease (PsAID) and the Health Assessment Questionnaire-Disability Index scores were also collected. Finally, PASS was assessed by asking all patients to answer yes or no to a single question.ResultsPatients who answered yes to PASS showed a significantly better overall mean DAPSA score than those who were not in PASS. Furthermore, patients in PASS showed a significantly lower level of systemic inflammation, lower Leeds Enthesitis Index score, a significantly lower impact of disease (PsAID), lower pain and better function than patients who answered no to PASS. A moderate to good agreement was found between PASS, MDA, DAPSA low disease activity and PsAID score ≤4. Good sensitivity and specificity were found with PASS with respect to DAPSA low disease activity, and although PASS is sensitive in the identification of patients with MDA, DAPSA remission and VLDA it lacks of specificity.DiscussionThis study showed that PASS might be used as an alternative to determine disease activity in patients with PsA in real clinical practice, mainly in patients with low disease activity according to DAPSA criteria.

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Sustained Very Low Disease Activity and Remission in Psoriatic Arthritis Patients

Cited by 24 publications

References 20 publications

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

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

Secukinumab provides sustained PASDAS-defined remission in psoriatic arthritis and improves health-related quality of life in patients achieving remission: 2-year results from the phase III FUTURE 2 study

Assessment of the Patient Acceptable Symptom State (PASS) in psoriatic arthritis: association with disease activity and quality of life indices

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