Ab0755 regional and Temporal Variation in the Baseline Profile of Psoriatic Arthritis Patients Initiating Adalimumab Following Failure of Non-Biologic Treatment in Canadian Routine Care

Abstract

BackgroundTreatment selection in routine clinical care is driven by treatment guidelines, physician judgment, patient preferences, and regional reimbursement policies, which may vary over time and among geographic regions.ObjectivesThe objective of this analysis is to investigate the regional and temporal variability of the profile of anti-TNF naïve psoriatic arthritis (PsA) patients at initiation of adalimumab (ADA) treatment following failure of initial non-biologic treatment.MethodsCOMPLETE-PsA is an ongoing Canadian observational study of anti-TNFα naïve adults with active PsA who require change in their current treatment as per the judgement of their treating physician. Patients are followed for up to 2 years. Regional variation was assessed for the following regions: British Columbia/Manitoba (BC/MB), Newfoundland/Nova Scotia (NL/NS), ontario (ON), and Quebec (QC). Temporal variation was assessed for the following periods: 2012-2014 and 2015-2017. Multivariate linear regression was used to evaluate the independent impact of region and time period on disease activity (DAS28) and patient function (HAQ).ResultsA total of 278 patients were included, of whom 68 (24.5%) were from BC/MB, 25 (9%) from NL/NS, 104 (37.4%) from on, and 81 (29.1%) from QC. One hundred fifty-three patients (55%) were enrolled in 2012-2014 and 125 (45%) in 2015-2017.Using univariate analysis, significant regional variation at aDA initiation was observed for the following disease parameters: BSA<3% (from 42.3% in on to 76% in NL/NS; p=0.003), morning stiffness (from 60.9 min in QC to 119.7 in BC/MB; p=0.049), WLQ productivity loss score (from 8.4% in BC/MB to 12.9% in NL/NS; p=0.028), and DLQI (from 3.5 in NL/NS to 7.9 in on; p=0.007); and for the initiation of aDA monotherapy vs. ADA combination therapy (range from 9.9% in QC to 27.9% in on; p=0.022). No differences were observed in demographics (other than race: Caucasian range from 85% to 100%; p=0.006), or other disease parameters (DAS28, HAQ, SJC, TJC, DAPSA, PtGA, BDI). A statistical trend towards lower DAS28 (2012-14 vs. 2015-17: 4.9 vs. 4.6; p=0.070), SJC (8.3 vs. 6.4; p=0.001), TJC (9.5 vs. 8.1; p=0.074), and DAPSA (30.8 vs. 27.8; p=0.083) at aDA initiation was observed for the more recent time period. Using multivariate analysis to adjust for age, gender, BSA levels, and corticosteroid use, there was no regional or temporal variation in DAS28 and HAQ.ConclusionThe results of this analysis demonstrate that there is significant regional and temporal variation in the profile of PsA patients initiated on aDA treatment in Canadian routine care. The impact of this profile variation on treatment outcomes requires further investigation.AcknowledgementThe authors wish to acknowledge JSS Medical Research, Montreal (QC) Canada for statistical analysis, medical writing and editorial assistance during the preparation of this abstract, and Nathalie Ross, PhD, for editorial assistance. AbbVie provided funding to JSS Medical Research and Nathalie Ross for this work.Disclosure of interestsMajed K...