Clinical response in PsA meaningful captured by treat-to-target metrics
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PHILADELPHIA — Patients with psoriatic arthritis who achieved clinical disease control demonstrated clinically meaningful improvements across a broad range of patient-reported outcomes, including pain, fatigue, physical function and work productivity.
The findings from a post hoc analysis were presented at ACR Convergence 2022.
“We were interested in examining the association between achieving disease control and patient-reported outcomes,” Alexis Ogdie, MD, associate professor of medicine and epidemiology at the University of Pennsylvania and deputy director of the Penn Center for Clinical Epidemiology and Biostatistics, said during the presentation.
The researchers analyzed data from the KEEPSAKE 1 and 2 trials, which investigated the efficacy of risankizumab (Skyrizi, AbbVie), compared with placebo among patients with active PsA who experienced an inadequate response to conventional synthetic disease modifying anti-rheumatic drugs (and/or biologics.
The measures of disease control included a minimal disease activity of the achievement 5 or more of a tender joint count one or less; a swollen joint count of one or less; a Psoriasis Area Severity Index (DAPSA LDA) of one or less or a body surface area of 3% or less; patient’s assessment of pain of 15 or less out of 100; patient’s global assessment of disease activity 0f 20 or less out of 100; a HAQ-DI score of 0.5 or less; or one or less tender entheseal points. Also included in measures of disease control were low disease activity based on the Disease Activity Index in PsA score of 14 or less and an ACR50 response, according to the poster.
The patient-reported outcomes included the assessment of pain by visual analog scale, HAQ-DI scores, FACIT-Fatigue scores, SF-36 Physical and Mental Component Summary scores, and the Work Productivity and Activity Impairment questionnaire.
Among patients enrolled in KEEPSAKE 1, 18% achieved MDA, 34% achieved DAPSA LDA, and 22% achieved ACR50 by week 24, while 21% achieved MDA, 31% achieved DAPSA LDA, and 20% achieved ACR50 in KEEPSAKE2. The researchers reported “significantly” greater improvements in pain, HAQ-DI, FACIT-Fatigue, SF-36 PCS and MCS, and productivity loss scores among patients in KEEPSAKE1 who achieved clinical disease control compared with patients who did not. The same was seen among patients in KEEPSAKE 2, except for SF-36 PCS scores.
“Our conclusion is that among patients who achieve disease control, as measured by one of those three common metrics, those patients are likely to improve across the board in other patient-reported outcomes as well, at least compared to non-responders,” Ogdie said. “We should be continuing to use these metrics, these treat-to-target metrics, such as MDA and DAPSA in clinical practice, and can think that that is a reasonable way of measuring overall disease control as well.”
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Ogdie A, et al. Abstract 1019. Presented at: ACR Convergence 2022; November 11-14, 2022; Philadelphia (hybrid meeting).
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