Patients with psoriatic arthritis at biologic therapy switch: the corevitas psoriasis registry

Background Up to 40% of patients with psoriasis (PsO) develop psoriatic arthritis (PsA), which can have a significant impact on health-related quality of life (HRQoL) [1] . Among patients with both PsO and PsA (PsO/PsA) who are treated with a biologic agent, individual symptom profiles and response to treatment can vary, with many patients switching biologic agents over their disease course. Whether patient-centred factors, beyond skin clearance, influence biologic switching remains a critical gap in the medical literature. Objectives To evaluate the association of psoriatic disease burden with biologic agent switch among patients with PsO/PsA in a real-world setting. Methods This study included data from the CorEvitas PsO Registry, a prospective, multicentre, non-interventional registry that collects data at ~6-month intervals. Biologic therapy initiations by patients with plaque PsO and dermatologist-diagnosed PsA or history of ≥3 PsO Epidemiology Screening Test (PEST) score who initiated a biologic agent at a registry visit and had ≥1 visit in the subsequent 30 months between April 2015 and August 2021 were included in this study. Disease burden at each follow-up visit after biologic initiation was defined by combinations of Psoriasis Area and Severity Index (PASI) level (≤10 vs >10) with Dermatology Life Quality Index (DLQI) level (≤5 vs >5) or patient-reported joint pain (VAS-100) level (<40 vs ≥40) [2] . The outcome of biologic switch, defined as a start of a different biologic agent within 45 days of discontinuing the initial biologic, was assessed at each follow-up visit. Proportional hazards regression was used to calculate hazard ratios (HR) and 95% confidence intervals (CIs) to evaluate associations between disease burden categories and biologic switch, adjusted for age, sex, race, ethnicity, duration of PsO, baseline disease burden category, body mass index (BMI), employment status, number of comorbidities, and treatment history. Results There were 2,580 patient-initiations included in this study. The mean age at patient-initiation was 52 years (Standard Deviation=13) and 52% occurred in females. Over 56% of patient-initiations were obese (BMI≥30), and 27% had at least one comorbidity. Twenty percent of patient-initiations switched biologic agents over 30 months of follow-up after a median (Interquartile Range) of 6.5 (4.6, 12.4) months of treatment. Patients with combined highest skin involvement and impact on HRQoL (PASI>10 & DLQI>5) were 14 times more likely to switch biologic (HR=14.2; 95% CI: 10.7, 18.9) than those with the lowest combined skin involvement and impact on HRQoL (PASI≤10 & DLQI≤5). Patients with DLQI>5 were over five times more likely to switch biologic vs the DLQI≤5 group among patients with PASI≤10 (HR=5.25; 95% CI: 4.23, 6.51) and nearly twice as likely to switch biologic among those with PASI>10 (HR=1.70; 95% CI: 1.06, 2.71). Similarly, patients with joint pain ≥40 had nearly a four times higher likelihood of switching vs the pain <40 group among those with PASI≤10 (HR=3.78; 95% CI: 2.91, 4.92) and tended to be more likely to switch biologic in patients with PASI>10 (HR=1.35; 95% CI: 0.79, 2.33). Conclusion Patients with PsO/PsA treated in a real-world clinical setting with more significant disease burden due to impaired HRQoL (DLQI and joint pain) after initiation were more likely to switch biologic agents, regardless of PASI level. These findings suggest that patient-centred factors, as well as skin clearance, have an important impact on the occurrence of biologic agent switch and the management of patients with PsO/PsA. References [1]Mease P, et al. Drugs. 2014;74(4):423-441; [ 2 ] Imafuku S, et al. J Dermatol Sci. 2021;101(3):185-193. Acknowledgements: NIL. Disclosure of Interests Philip J Mease Speakers bureau: AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer, UCB Pharma, Consultant of: AbbVie, Acelyrin, Aclaris, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Moonlake Pharma, Novartis, Pfizer, Sun Pharma, UCB, Grant/research support from: AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Gilead, Janssen, Novartis, Pfizer, Sun Pharma, UCB Pharma, Eric Jones: None declared, Adam Sima: None declared, Silky Beaty Employee of: UCB Pharma, Robert Low Employee of: UCB Pharma, Braulio Gomez Employee of: UCB Pharma, Marie Gurrola: None declared, Mark Lebwohl Consultant of: Aditum Bio, Almirall, AltruBio Inc., AnaptysBio, Arcutis, Inc., Arena Pharmaceuticals, Aristea Therapeutics, Arrive Technologies, Avotres Therapeutics, BiomX, Brickell Biotech, Boehringer Ingelheim, Bristol Myers Squibb, Cara Therapeutics, Castle Biosciences, CorEvitas, Dermavant Sciences, Dr. Reddy’s Laboratories, Evelo Biosciences, Evommune, Inc., Facilitation of International Dermatology Education, Forte Biosciences, Foundation for Research and Education in Dermatology, Helsinn Therapeutics, Hexima Ltd., LEO Pharma, Meiji Seika Pharma, Mindera, Pfizer, Seanergy, Verrica, Grant/research support from: Abbvie, Amgen, Arcutis, Avotres Therapeutics, Boehringer Ingelheim, Cara Therapeutics, Dermavant Sciences, Eli Lilly, Incyte, Janssen Research & Development, LLC, Ortho Dermatologics, Regeneron, UCB Pharma.