Treatment‐to‐Target With Apremilast in Psoriatic Arthritis: The Probability of Achieving Targets and Comprehensive Control of Disease Manifestations

Abstract

Objective The present study was undertaken to evaluate the probability of achieving the Clinical Disease Activity Index for Psoriatic Arthritis (cDAPSA) treatment targets of remission or low disease activity (LDA) with apremilast based on disease activity categories and corresponding responses in arthritis and other domains of psoriatic arthritis (PsA) not included in the cDAPSA. Methods Pooled analyses from the Psoriatic Arthritis Long‐term Assessment of Clinical Efficacy studies 1, 2, and 3 were performed. Probability analyses assessing the likelihood of achieving cDAPSA treatment targets by week 52 were performed using multiple imputation for discontinuations and missing values. Longitudinal analyses were performed in patients grouped by cDAPSA category at week 52. Results Among 494 patients in the probability analyses, 46.9% with moderate disease activity and 24.9% with high disease activity at baseline achieved treatment targets (remission or LDA) by week 52. For patients with moderate disease activity at baseline, small improvements (cDAPSA reductions ≥30%) by week 16 were associated with achieving targets. Patients achieving remission or LDA by week 16 had high probabilities of remaining at treatment targets at week 52. Of 375 patients with cDAPSA components available at week 52, achieving targets with apremilast was associated with continuous disease activity improvements and no or mild arthritis and other PsA manifestations. Conclusion The probability of achieving treatment targets (remission or LDA) at week 52 was greater for patients with moderate versus high disease activity at baseline. At a mean level, partial improvements by week 16 were associated with achieving treatment targets. Patients receiving apremilast who achieved cDAPSA targets by week 52 also had no or mild arthritis or other PsA manifestations.

Baseline Disease Activity Predicts Achievement of cDAPSA Treatment Targets With Apremilast: Phase III Results in DMARD-naïve Patients With Psoriatic Arthritis

“…Apremilast-treated, DMARD-naïve patients with PsA in PALACE 4 had substantial baseline disease activity, particularly for disease activity domains such as SJC, TJC, enthesitis, and dactylitis. 7 The disease activity reported here (ModDA: 31.4%; HDA: 66.3%) was similar to that observed in DMARD-experienced patients in the PALACE 1-3 studies (ModDA: 24.5%; HDA: 74.3%), 12 suggesting disease burden that is potentially higher than expected in this DMARD-naïve population.…”

“…These findings were similar to those observed in the PALACE 1-3 DMARD-experienced patient population, in which achievement of treatment targets was twice as likely in the group with ModDA vs HDA at baseline (46.9% vs 24.9%). 12 This pattern also held true for patients in the subgroup with skin involvement, enthesitis, and/or dactylitis at baseline, with greater proportions of those in ModDA at baseline attaining cDAPSA REM or LDA at week 52 of apremilast treatment than patients in HDA. This observation was consistent regardless of whether patients had only 1 PsA manifestation or multiple PsA manifestations.…”

“…11 Apremilast was associated with achievement and maintenance of the commonly used Clinical Disease Activity Index for Psoriatic Arthritis (cDAPSA) treatment targets in DMARD-experienced patients with moderate disease activity (ModDA) in the PALACE 1-3 studies. 12 Whether DMARD-naïve patients treated with apremilast have greater chances of achieving cDAPSA treatment targets than DMARD-experienced patients is unknown. It is often assumed that patients with less treatment experience tend to have less disease burden, but the DMARD-naïve patients in PALACE 4 had substantial active disease and burden.…”

Psoriatic arthritis: one year in review 2022

“…APR 30 mg x 2/day was significantly more effective in PsA patients with lower levels of disease activity. Mease and colleagues also noted that clinical DAPSA improvements were associated with better PROs outcomes (64). The efficacy of the drug was confirmed in both musculoskeletal and psychological domains also in Belgian patients; the AEs observed were mainly mild headache or diarrhoea, as already shown in previous studies (65).…”

Clinical and Economic Benefit of Achieving Disease Control in Psoriatic Arthritis and Ankylosing Spondylitis: A Retrospective Analysis from the OM1 Registry

“…Most patients who do achieve remission relapse within a year. Moreover, in patients who relapse and restart therapy, nearly half do not again achieve remission and some do not respond to therapy at all [ 6 – 9 ]. Patients with poor disease control report significantly reduced health-related quality of life (HRQoL) [ 10 , 11 ].…”