1028: How Does PsAID Implementation Affect Treatment Intensification and Patient Satisfaction in PsA?

Conor Coyle¹, Caroline Whately-Smith², Melanie Brooke³, Uta Kiltz⁴, Ennio Lubrano⁵, Ruben Queiro⁶, David Trigos⁷, Jan Brandt-Juergens⁸, Salvatore D'Angelo⁹, Andrea Delle Sedie¹⁰, Emmanuelle Dernis¹¹, Philip Helliwell¹², Pauline Ho¹³, Axel Hueber¹⁴, BEATRIZ E. JOVEN¹⁵, Michaela Koehm¹⁶, Carlos Montilla¹⁷, Jon Packham¹⁸, JOSE PINTO TASENDE¹⁹, Felipe Julio Ramirez Garcia²⁰, Adeline Ruyssen-Witrand²¹, Rossana Scrivo²², sarah twigg²³, Martin Welcker²⁴, Theo Wirth²⁵, Laure Gossec²⁶ and Laura Coates²⁷, ¹Oxford University Hospitals NHS Trust, Oxford, United Kingdom, ²Whately-Smith Ltd, Kings Langley, United Kingdom, ³Bath Institute for Rheumatic Disease, Bath, United Kingdom, ⁴Rheumazentrum Ruhrgebiet, Herne, Germany, ⁵Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute ‘‘Vincenzo Tiberio’’, Università degli Studi del Molise, Campobasso, Italy, ⁶Faculty of Medicine, Rheumatology Service & the Principality of Asturias Institute for Health Research (ISPA), Universidad de Oviedo, Oveido, Spain, ⁷Patient partner, Oveido, Spain, ⁸Rheumatologische Schwerpunktpraxis, Berlin, Germany, ⁹Rheumatology Department of Lucania - San Carlo Hospital of Potenza, Potenza, Italy, ¹⁰University of Pisa, Pisa, Pisa, Italy, ¹¹LE MANS general hospital, LE MANS, France, ¹²Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom, ¹³The Kellgren Centre for Rheumatology, Manchester, United Kingdom, ¹⁴Paracelsus University Nürnberg, Erlangen, Germany, ¹⁵Hospital Universitario 12 de Octubre, Madrid, Spain, ¹⁶Rheumatology Goethe-University Frankfurt, Frankfurt Am Main, Germany, ¹⁷Complejo asistencial Universitario de Salamanca, Salamanca, Spain, ¹⁸University of Nottingham, Stafford, United Kingdom, ¹⁹SERGAS, A Coruña, Spain, ²⁰Hospital Clínic, Barcelona, Spain, ²¹CHU de Toulouse, Toulouse, France, ²²Rheumatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy, Roma, Rome, Italy, ²³Bradford Teaching hospitals NHS foundation trust, Bradford, United Kingdom, ²⁴GBR, Planegg, Germany, ²⁵Aix Marseille University, Marseille, France, ²⁶Sorbonne Université, Paris, France, ²⁷Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK, Oxford, England, United Kingdom

Background/Purpose: Psoriatic arthritis (PsA) is a heterogenous, multi-dimensional disease. Little is known about factors underpinning treatment intensification in routine practice. Treatment pathways are not well defined and need individual tailoring. The purpose of the ASSIST study was to investigate the prescribing practice for PsA in routine care and whether the use of the patient reported outcome (PRO), PsA Impact of Disease questionnaire (PsAID-12), impacted treatment decisions.

Methods: ASSIST was a cross sectional study of patients diagnosed with PsA (by a rheumatologist using CASPAR criteria). Patients were selected using systematic sampling with random starting numbers generated for each site. Participants were treated in their usual routine clinical practice, decisions on whether treatment was escalated, unchanged or reduced (and why) were recorded. The PsAID-12 questionnaire and additional PROs were provided to patients in one single study visit, during a routine clinic appointment. Univariable and multivariable analyses were performed to explain treatment escalation. There was no imputation of missing data.

Results: 503 patients from 24 centres across five countries in Europe (49.1% F, 50.9% M) aged 18 years or above (mean age 53) participated in the survey between 12/07/2021-22/03/2022. Overall, treatment was changed for 182 patients (36.2%) with an increase in treatment being the most common type of change (160 patients, 31.8%). Treatment escalation was most common in the UK (51 patients, 47.7%) compared to other countries (31.5% of patients or fewer). In 22/24 sites, the mean PsAID score for patients with treatment escalation was higher than that for those with no escalation. (figure 1) The PsAID score was found to have statistically significant association with the odds of treatment escalation (OR: 1.58; p< 0.0001) - the estimated odds of treatment escalation increased by 58% with every 1-point increase in the score. A statistically significant relationship between treatment escalation and patient characteristics, physician characteristics, disease activity, disease impact was identified (Figure 2). Only age, tender joint count and comorbidity index were not significantly associated with treatment escalation. A high level of correlation was seen between a number of these variables, including physician's global assessment of disease and the patient reported PsAID score. In most cases, the clinicians reported that the PsAID score did not significantly influence the decision on treatment escalation.

Conclusion: The PsAID score had a significant association with odds of treatment escalation. The greater the PsAID score, the more likely escalation in treatment. Several factors influenced treatment change indicating the complex decision making in routine clinics. Clinicians reported PsAID score did not impact treatment escalation in most cases, but a significant correlation between PsAID and physician global scores was seen. Our work highlights the influence of multiple factors on decision making when reviewing treatments for individuals with PsA providing insight into the management of patients with this complex condition.
Figure 1: Mean PsAID score by treatment escalation, by site

Figure 2: Effect of each variable on the odds of treatment escalation
Disclosures: C. Coyle, None; C. Whately-Smith, None; M. Brooke, None; U. Kiltz, AbbVie, Amgen, Biogen, Fresenius, GSK, Hexal, Novartis, Pfizer, Biocad, Lilly, Grünenthal, Janssen, MSD, Roche, UCB; E. Lubrano, None; R. Queiro, None; D. Trigos, None; J. Brandt-Juergens, AbbVie/Abbott, Bristol-Myers Squibb(BMS), Janssen, Eli Lilly, Merck/MSD, Novartis, Pfizer, Roche, UCB, Sanofi-Aventis, Medac, Gilead, Gilead, Affibody; S. D'Angelo, Merck/MSD, AbbVie/Abbott, Amgen, Bristol-Myers Squibb(BMS), Janssen, Eli Lilly, Novartis, Pfizer, UCB; A. Delle Sedie, None; E. Dernis, AbbVie/Abbott, Amgen, Bristol-Myers Squibb(BMS), Janssen, Nordic Pharma France, Novartis, UCB; P. Helliwell, Eli Lilly, AbbVie, Amgen, Janssen, Novartis; P. Ho, None; A. Hueber, None; B. JOVEN, Novartis, UCB, Janssen, Amgen, AbbVie/Abbott, Eli Lilly; M. Koehm, Janssen; C. Montilla, None; J. Packham, None; J. PINTO TASENDE, None; F. Ramirez Garcia, Amgen; A. Ruyssen-Witrand, Pfizer, AbbVie/Abbott, Novartis, Eli Lilly, Janssen, Bristol-Myers Squibb(BMS), galapagos, fresenius kabi, Merck/MSD, UCB, Pfizer, Roche, Sanofi; R. Scrivo, None; s. twigg, None; M. Welcker, None; T. Wirth, None; L. Gossec, Amgen, Lilly, Pfizer, Sandoz, UCB Pharma, AbbVie, Bristol Myers Squibb, Gilead, Janssen, Novartis, Samsung Bioepis, Sanofi-Aventis, Galapagos, GlaxoSmithKlein (GSK), Celltrion, MSD; L. Coates, AbbVie, Amgen, Boehringer-Ingelheim, Bristol-Myers Squibb (BMS), Eli Lilly, Gilead, Galapagos, Janssen, Medac, Novartis, Pfizer, UCB, Celgene, Biogen, Moonlake, GlaxoSmithKlein (GSK).