POS1548 ENTHESITIS OUTCOMES IN PATIENTS WITH PSORIATIC ARTHRITIS INITIATING A TUMOUR NECROSIS FACTOR INHIBITOR IN A REAL-WORLD SETTING: DATA FROM THE EuroSpA COLLABORATION NETWORK

Background Enthesitis in patients with psoriatic arthritis (PsA) can be a therapeutic challenge. Objectives To explore the impact of tumor necrosis factor inhibitors (TNFi) on enthesitis in patients with PsA in the EuroSpA collaboration network [1] . Methods Prospectively collected data from biologic-naïve PsA patients ≥18 years at diagnosis, who initiated a TNFi between 2010-2020 and had available baseline data on enthesitis (defined as tenderness at any enthesis included in the Maastricht Ankylosing Spondylitis Enthesitis Score (MASES, mainly axial entheses) and/or Spondyloarthritis Research Consortium of Canada score (SPARCC, peripheral entheses) were pooled from European countries in the EuroSpA collaboration. Changes from baseline to follow-up (6-24 months) in enthesitis scores were calculated both for the first (TNFi-1) and second TNFi (TNFi-2), as were the percentage of sites with complete resolution of enthesitis. Results Demographics and clinical variables of the 723 patients who had a baseline evaluation by MASES (N=549) and/or SPARCC (N=358) are detailed in Table 1. Of these, 192 (35%) and 239 (66.8%) had enthesitis by MASES (3.1±2.4, mean±standard deviation) and SPARCC (3.9±3.4) scores, respectively. The patterns of involvement are shown in Figure 1. MASES/SPARCC baseline and follow-up scores for TNFi-1 were available for 93/85 patients, respectively. Corresponding values were 27/38 patients for TNFi-2. Following TNFi-1, 58 (62.4%) patients (MASES) and 43 (50.9%) patients (SPARCC) achieved complete resolution of enthesitis. These proportions were lower following TNFi-2. SPARCC sites observed an overall lower site-specific enthesitis resolution as compared to MASES sites (61.1% vs 76.2% for TNFi-1). Conclusion Real-life registry data on enthesitis from several European countries are presented. Enthesitis resolution was observed in a substantial proportion of patients with PsA following TNFi-1. Reference [1]Brahe CH, Ørnbjerg LM, Jacobsson L, et al. Retention and response rates in 14261 PsA patients starting TNF-inhibitor treatment – results from 12 countries in EuroSpA. Rheumatology (Oxford) 2020;59:1640-50 Table 1. Demographics, disease activity variables and patient reported outcomes at the initiation of TNFi-1, and effectiveness of TNFi-1 and TNFi-2 regarding change and resolution of enthesitis at follow-up MASES SPARCC Enthesitis Present Absent Present Absent n = 192 n = 357 n = 239 n = 119 Demographics Age* 47.2±12 50.6±13 46.7±11 48.5±11 Sex** (Male) 84 (44) 188 (53) 98 (41) 70 (59) BMI* 27.3±5 27.3±5 27.7±4 26.9±5 Infliximab** Etanercept** Adalimumab** Golimumab** Certolizumab** 7 (3.6) 39 (20.3) 76 (39.6) 55 (28.6) 15 (7.8) 37 (10.4) 87 (24.4) 140 (39.2) 81 (22.7) 12 (3.4) 43 (18) 41 (17) 116 (49.4) 21 (8.8) 16 (6.7) 10 (8.4) 36 (30.3) 45 (37.8) 22 (18.5) 6 (5) Disease activity variables (Baseline ) SJC66*** 3 (0-4.5) 3 (1-6) 3 (1-5) 3 (1-7) TJC68*** 6 (3-13) 4 (2-8) 8 (4-14) 5 (2-9) CRP* 11±18.1 10.6±14.4 8.5±15.1 12.5±15.6 DAPSA-28* 30.8±15.8 29.7±18.3 28.7±13.5 25.4±15.5 Phys Global* 48.9±20 47±22 36.3±18 45.8±23 Patient reported outcomes (Baseline ) Pain* 67.1±21 57.6±25 67.1±21 55.6±26 PGA* 66.8±2 59.2±25 73.5±20 55.7±26 HAQ* 1±1 0.9±1 1.1±1 0.8±1 Effectiveness of TNFi in change and resolution of enthesitis at follow-up Timeline TNFi-1 TNFi-2 TNFi-1 TNFi-2 MASES (N=254 ) MASES (N=70 ) SPARCC (N=167 ) SPARCC (N=59 ) Baseline Follow up Baseline Follow up Baseline Follow up Baseline Follow up Enthesitis + n = 93 n = 93 n=27 n=27 n=85 n=85 n=38 n=38 Score, Mean±SD 3.1±2.2 1.1±2 3.6±2.7 2.3±2.5 4.4±3.5 3±3.5 5.5±4.1 3.8±3.6 Score, Median (IQR) 2 (2-4) 0 (0-1) 2 (2-4.5) 1 (1-3) 3 (2-5) 2 (1-4) 4.5 (2-8) 2 (1.2-5) Change in Score from baseline to Follow up Mean±SD 0.6±1.9 0.2±2.2 0.6±2.8 0.9±3.5 Median (IQR) 0 (0-1) 0 (0-0) 0 (0-1) 0 (0-2) Complete resolution at follow-up Number (%) 58 (62) 7 (26) 43 (51) 5 (13) * Mean±standard deviation; ** Frequency (Percentage); *** Median (Range) Figure 1. Distribution of enthesitis at baseline and follow-up after TNFi-1 Acknowledgements Novartis Pharma AG for supporting the EuroSpA collaboration. Disclosure of Interests Ashish Jacob Mathew Speakers bureau: Novartis, IPCA Laboratories, CIPLA, Grant/research support from: Novartis, IPCA Laboratories, Lykke Midtbøll Ørnbjerg Speakers bureau: Abbvie, Eli-Lilly, Sandoz, Novartis, Egis, UCB, Consultant of: Abbvie, Eli-Lilly, Sandoz, Novartis, Egis, UCB, Grant/research support from: Novartis, Jakub Zavada, Mads Pedersen: None declared, Stylianos Georgiadis: None declared, Bente Glintborg Grant/research support from: Pfizer, Abbvie, BMS, Anne Gitte Loft Speakers bureau: Abbvie, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, UCB, Grant/research support from: Novartis, Michael J. Nissen Speakers bureau: AbbVie, Eli Lilly, Janssens, Novartis, Pfizer, Burkhard Moeller Speakers bureau: Eli-Lilly, Janssen, Novartis, Pfizer, Grant/research support from: Amgen, Ana Maria Rodrigues Speakers bureau: Abbvie and Amgen, Grant/research support from: Novartis, Pfizer and Amgen, Fernando M Pimentel-Santos Speakers bureau: Abbvie, UCB, Janssen, Novartis, MSD, Tecnimed, Eli Lilly, Pfizer, Grant/research support from: Abbvie, Novartis and Janssen, Ziga Rotar Speakers bureau: Abbvie, Novartis, MSD, Medis, Biogen, Eli Lilly, Pfizer, Sanofi, Lek, Janssen, Consultant of: Abbvie, Novartis, MSD, Medis, Biogen, Eli Lilly, Pfizer, Sanofi, Lek, Janssen, Matija Tomšič Speakers bureau: Abbvie, Amgen, Biogen, Eli Lilly, Janssen, Medis, MSD, Novartis, Pfizer, Sanofi, Sandoz, Lek, Heikki Relas Speakers bureau: Abbvie, Celgene, Pfizer, UCB and Viatris, Ritva Peltomaa Speakers bureau: UCB, Lilly, Celtrion, Boehringer Ingelheim, Abbvie, Janssen, Consultant of: Janssen, UCB, Boehringer Ingelheim, Lilly, Sanofi, Björn Gudbjornsson Speakers bureau: Novartis and Nordic Pharma, Thorvardur Jon Löve Speakers bureau: Abbvie, Celgene, Sinem Burcu Kocaer: None declared, Aydan Köken Avşar: None declared, Merete Lund Hetland Speakers bureau: Pfizer, Medac, Sandoz, Grant/research support from: AbbVie, Biogen, BMS, Celltrion, Eli Lilly, Janssen Biologics B.V, Lundbeck Fonden, MSD, Medac, Pfizer, Roche, Samsung Biopies, Sandoz, Novartis, Mikkel Østergaard Speakers bureau: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, UCB, Consultant of: Abbvie, Amgen, Biogen, Eli Lilly, Janssen, Medis, MSD, Novartis, Pfizer, Sanofi, Sandoz, Lek.