Abstract 16 — Are We Treating-to-Target on Spondyloarthritis (SpA)? A One-Year Analysis from the Asia Pacific League of Associations for Rheumatology (APLAR) SpA Registry

Abstract

Background This analysis aimed to evaluate the extent of treat-to-target (T2T) achievement after 1-year intensive treatment in patients enrolled to the APLAR SpA registry. Methods Patients who fulfilled the CASPAR2006 for psoriatic arthritis (PsA), and 2009ASAS criteria for axial spondylitis (AxSpA) were recruited. Current analysis included the first 143 patients reaching the 1-year timepoint across 7 Asia-Pacific regions (Hong Kong, Singapore, Korea, India, Pakistan, Qatar and Thailand). Results 79 patients with PsA(age: 52±13 years, 43(55%) male, disease duration: 8.0±8.3 years) and 64 patients with AxSpA (age:41±16 years, 48(75%) male, disease duration: 4.8±7.2 years) were included. There were significant improvement in Disease Activity in Psoriatic Arthritis (DAPSA) (22.1±14.4 at baseline vs 11.5±10.0 at 1-year, p<0.001) while Ankylosing Spondylitis Disease Activity Score (ASDAS) remained stable. Other characteristics are listed in Table 1. Concerning the medication use, there was an increase in the number of patients receiving biologic/target synthetic disease-modifying drug (b/tsDMARDS, 29% at baseline to 61% at 1-year for PsA, and 52% at baseline to 64% at 1-year for AxSpA) (Fig. 1). Regarding T2T, 62% and 45% of PsA patient achieved DAPSA-low disease activity (DAPSA-LDA) and minimal disease activity (MDA) respectively, while 53% of patients with Axial SpA achieved ASDAS-LDA. The use of b/tsDMARDs was significantly higher in patient who achieved MDA when compared to those who did not (Fig. 1). The MDA/ASDAS-LDA achievement rate were comparable to that of the tight control arm of TICOPA cohort (41%) or TICOSPA study (60%) respectively. Treatment was escalated in 86% of visits when treatment target was not met. The reason for non-escalation of drug included: patients’choice (42%), mild symptoms only and physician decides to keep current regime (27%), adverse events (19%), no viable alternatives (8%) and others (4%). Conclusions Implementing the T2T strategy in patient with SpA was feasible in selected centres from the APLAR region, with similar target achievement rate compared to T2T studies conducted in Europe.