Ab0946 Are We Treating-to-Target in Spondyloarthritis? A Two-Year Update From the Asia Pacific League of Associations for Rheumatology (Aplar) Spa Registry

Background: Data on the extent to which internationally agreed treat-to-target (T2T) recommendations were implemented in clinical practice in patients with spondyloarthritis (SpA) is lacking. The APLAR SpA Registry is a multi-centre study aiming to evaluate the effectiveness of early diagnosis and intensive protocolised treatment to SpA patients on long-term outcomes. Objectives: This analysis aimed to evaluate the proportion of patients who achieved treatment targets after a two-year follow-up period. Methods: Patients who fulfilled the CASPAR classification criteria for PsA and 2009 ASAS criteria for axSpA were recruited. Data from the first 98 patients who reached the 2-year follow-up timepoint from 4 Asia-Pacific regions (Hong Kong, Korea, Singapore and Pakistan) were analysed. Results: 62 patients with PsA (age: 54±13 years, 33(53%) male, disease duration: 7.5±7.2 years) and 36 patients with AxSpA (age: 44±15 years, 26(72%) male, disease duration: 4.3±4.4 years) were included in this analysis. All of them were Asians. Compared to results at one year of T2T intervention, further significant improvement in disease activity was observed in PsA (DAPSA: 11.2±10.6 at 1-year vs 9.2±8.8 at 2-year, p=0.043). In axSpA, disease activity remained low (ASDAS: 1.7±0.8 at 1-year vs 1.9±0.7 at 2-year, p=0.076). Regarding medication use, there was a continued decline in the prevalence of NSAIDs and csDMARDs in PsA, while the use of b/tsDMARDs remained high in both groups (PsA: 62% at 1-year vs 61% at 2-year; axSpA: 65% at 1-year vs 68% at 2-year). (Figure 1a) Majority of patients received TNF inhibitor or interleukin inhibitor. Only 3 patients received tsDMARD. The retention rates for TNF inhibitors and interleukin inhibitors were similar (68% and 66% respectively). In PsA patients, 81% and 60% of achieved DAPSA-LDA and MDA, respectively. In patients with axSpA, the ASDAS-LDA achievement rate decreased from 79% at 1-year to 50% at 2-year. (Figure 1b) The MDA achievement rate at 2-year was higher than the tight control arm of the TICOPA (41%)1 study at 1-year. The longer follow-up duration and higher bDMARD usage in our registry (61% vs 39%) might account for the higher MDA rate achieved. The ASDAS-LDA rate at 2-year was slightly lower than the TICOSPA study (60%)2 at 1-year. Overall, in patients who achieved the treatment target at the 2-year mark, a higher proportion were receiving bDMARDs (Prevalence of bDMARD use: 84% in the DAPSA-LDA group vs 62.5% in the non-DAPSA LDA group, p=0.182; 88% in the MDA group vs 67% in non-MDA group, p=0.090; 69% in the ASDAS-LDA group vs 56% in the non-ASDAS-LDA group, p=0.465). PsA patients who achieved DAPSA-LDA were younger, had a shorter disease duration, lower patient pain score and disease activity, less severe enthesitis and fewer tender joint counts at baseline. (Table 1) By multivariate logistic regression, younger age (OR = 0.912, p=0.028) and lower disease activity (OR = 0.949, p=0.039) at baseline were found to be independent factors for achieving DAPSA-LDA. A lower BMI predicted the achievement of MDA (OR = 0.886, p=0.046). Considering axSpA, a lower patient's global assessment score at baseline independently predicted ASDAS-LDA achievement (OR = 0.540, p=0.019). Table 1. Baseline characteristics of PsA (left) and axSpA (right) patients, stratified by low disease activity attainment at 2-year follow-up Conclusion: The study observed satisfactory target achievement rates, and these positive outcomes were sustained up to the two-year follow-up period. This suggests that the T2T approach can be effectively applied in the management of SpA and can lead to favorable and sustained treatment outcomes. REFERENCES: 1 Coates LC et al. Lancet. 2015;386(10012):2489-98. 2 Molto A et al. Ann Rheum Dis. 2021;80(11):1436-44 Acknowledgements: NIL. Disclosure of Interests: None declared.