ARE WE TREATING-TO-TARGET IN SPONDYLOARTHRITIS (SPA)? A ONE-YEAR ANALYSIS FROM THE ASIA PACIFIC LEAGUE OF ASSOCIATIONS FOR RHEUMATOLOGY (APLAR) SPA REGISTRY

I. T. Cheng, C. C. Y. Yip, H. So, Y. Y. Leung, K. Shin, M. A. Saeed, N. Subramanian, P. Chiowchanwisawakit, H. Y. Chung, M. Kishimoto, J. C. C. Wei, L. S. TamThe Chinese University of Hong Kong, Department of Medicine and Therapeutics, Hong Kong, Hong Kong (SAR) Singapore General Hospital, Department of Rheumatology and Immunology, Singapore, Singapore SMG-SNU Boramae Medical Center, Department of Internal Medicine, Seoul, Korea, Rep. of (South Korea) Central Park Medical College, Department of Rheumatology, Lahore, Pakistan Velammal Medical College Hospital, Department of Rheumatology and Medicine, Madurai, India Siriraj Hospital, Mahidol University, Department of Medicine, Bangkok, Thailand Chiron Medical, Department of Rheumatology, Hong Kong, Hong Kong (SAR) Kyorin University School of Medicine, Department of Nephrology and Rheumatology, Mitaka, Japan Chung Shan Medical University, Department of Allergy, Immunology & Rheumatology, Taichung, Taiwan, Republic of China  Background Data on the extent to which internationally agreed treat-to-target (T2T) recommendations were applied in clinical practice in patients with spondyloarthritis (SpA) across the Asia-Pacific region is lacking. The APLAR SpA Registry is a multi-centre study aiming to assess the utility of early diagnosis and intensive protocolized treatment to patients with SpA on the long-term outcome. Objectives This analysis aimed to evaluate the extent of T2T achievement after 1-year intensive treatment in patients with SpA. Methods Patients who fulfilled the CASPAR 2006 classification criteria for psoriatic arthritis (PsA), and 2009 ASAS classification for axial spondylitis (AxSpA) were recruited. The current analysis included the first 99 patients reaching the 1-year timepoint across 6 Asia-Pacific regions. Results 49 patients with PsA (age: 52±11 years, 27(55%) male, disease duration: 6.0±7.9 years) and 50 patients with AxSpA (age: 40±14 years, 36(72%) male, disease duration: 5.9±7.6 years) were included. All of them were Asian. After 1-year treatment, there were significant improvements in disease activity (Disease Activity in Psoriatic Arthritis (DAPSA): 15.3±11.6 at baseline vs 10.1±11.2 at 1-year, p=0.002; Ankylosing Spondylitis Disease Activity Score (ASDAS): 2.4±1.0 at baseline vs 1.9±0.9 at 1-year, p=0.003). Other characteristics are shown in Table 1. Concerning medication use, there was an increase in the number of PsA patients receiving conventional synthetic disease-modifying drugs (csDMARDS, 65% at baseline to 72% at 1-year) and biologic DMARDS (bDMARDS, 24% at baseline to 43% at 1-year). For AxSpA, the prevalence of csDMARDs use decreased (30% at baseline to 18% at 1-year) while the prevalence of bDMARDs use increased (32% at baseline and 54% at 1-year). Patients in both groups required less NSAIDs (Figure 1). Regarding T2T, 63% and 51% of PsA patient achieved DAPSA-low disease activity (DAPSA-LDA) and minimal disease activity (MDA) respectively, while 66% of patients with Axial SpA achieved ASDAS-LDA. The MDA and ASDAS-LDA achievement rate was slightly higher than that of the tight control arm of TICOPA (41%) and TICOSPA cohort (60%) respectively. The bDMARDs use in TICOPA cohort was 37% and that in TICOSPA was 57%, both comparable to our APLAR SpA cohort (Figure 1). There was no significant difference in baseline demographics and clinical features between patients who could or could not achieve treatment target, except a lower patients’ pain and global assessment, and lower functional disability in patients who achieved DAPSA-LDA at 1-year. Table 1. Clinical features and disease activity in patients with SpA in the APLAR region at baseline and 1-year PsA (n=49) AxSpA (n=50) Baseline Year 1 Baseline Year 1 p Age, years 52 ± 11 40 ± 14 NRS Patients’ pain assessment, 0-10 4 ± 2 3 ± 2 * 4 ± 2 3 ± 2 * NRS Patients’ global assessment, 0-10 4 ± 2 3 ± 2 * 4 ± 2 3 ± 2 * NRS Physicians’ global assessment, 0-10 3 ± 2 2 ± 2 * 4 ± 2 3 ± 2 * PASS, acceptable 33 73% 41 89% 31 67% 44 92% * TJ count, 0-68 4 ± 5 3 ± 6 * 1 ± 2 1 ± 2 SJ count, 0-66 2 ± 4 1 ± 3 * 0 ± 0 0 ± 1 Dactylitis digit 1 ± 2 0 ± 1 * 0 ± 0 0 ± 0 PASI 3.81 ± 5.38 2.17 ± 3.27 * SPRACC, 0-15 0 ± 1 0 ± 1 * 0 ± 1 0 ± 1 ESR, mm/h 20 ± 18 17 ± 12 25 ± 21 19 ± 13 CRP, mg/L 7.3 ± 8.9 4.3 ± 4.9 * 20.9 ± 62.3 8.4 ± 19.4 DAPSA 15.27 ± 11.60 10.06 ± 11.21 * ASDAS CRP 2.43 ± 1.00 1.93 ± 0.87 * BASDAI 3.6 ± 2.2 2.6 ± 2.1 * BASFI 2.8 ± 2.3 1.9 ± 2.2 * BASMI 3 ± 2 3 ± 2 * HAQ-DI 0.503 ± 0.614 0.372 ± 0.469 0.470 ± 0.471 0.318 ± 0.428 * Image/graph:Figure 1. Medication use at baseline and 1-yr in patients with PsA (Upper panel)/ Axial SpA (middle panel) and T2T achievement in PsA and Axial SpA patients in APLAR SpA registry and other studies (lower panel) Conclusion Implementing the T2T strategy in a patient with SpA is feasible in the selected sites of the APLAR SpA registry. We expect more long-term outcome data in the following years regarding other outcomes. References Coates LC et al. Lancet. 2015;386(10012):2489-98. Molto A et al. Ann Rheum Dis. 2021;80(11):1436-44. Acknowledgements: NIL. Disclosure of Interests Isaac T. Cheng: None declared, Carson C.Y. Yip: None declared, Ho So: None declared, Ying Ying Leung: None declared, Kichul Shin: None declared, Muhammad Ahmed Saeed: None declared, Nallasivan Subramanian: None declared, Praveena Chiowchanwisawakit: None declared, Ho Yin Chung: None declared, Mitsumasa Kishimoto Consultant of: AbbVie, Amgen, Asahi-Kasei Pharma, Astellas, Ayumi Pharma, BMS, Celgene, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, Gilead, Janssen, Kyowa Kirin, Novartis, Ono Pharma, Pfizer, Tanabe-Mitsubishi, and UCB Pharma, James Cheng-Chung Wei Consultant of: Tsh biopharm, Abbvie, BMS, Celgene, Chugai, Eisai, Janssen, Novartis, Pfizer, Sanofi-Aventis and UCB pharma, Grant/research support from: Abbvie, Amgen, Astellas, BMS, Celgene, Eli Lilly, Gilead, Janssen, Novartis, Pfizer Sun and UCB, Lai-Shan Tam: None declared. Keywords: Spondyloarthritis DOI: 10.1136/annrheumdis-2023-eular.2471Citation: , volume 82, supplement 1, year 2023, page 885Session: Spondyloarthritis - treatment (Poster View)