Ab0894 Treat-to-Target Strategy Implementation in Spondyloarthritis Patients With High Disease Activity in Real-World Clinical Practice: A Cross-Sectional Single-Center Study

Background: Data regarding the adoption of the treat-to-target (T2T) approach aiming at inactive disease (ID), or low disease activity (LDA) in axial (axSpA) and peripheral Spondyloarthritis (perSpA) in real-world clinical practice is scarce. Objectives: Our aims were to assess the level of disease activity of SpA patients in real-world practice, the extent of T2T strategy implementation and the reasons of possible non-implementation. Methods: Cross-sectional study of all consecutive patients with SpA who visited the outpatient department or the one-day infusions' clinic of our hospital during a 7-month period. Detailed patient, disease and treatment characteristics were collected, as well as disease activity of axial (using ASDAS-CRP), peripheral (DAPSA) and extraarticular manifestations. Additionally, physicians filled in questionnaires regarding treatment intensification or not (and reasons) of patients not in target at the specific visit. Multivariable logistic regression analysis was employed to identify predictors of therapy intensifications in patients not in target. Results: We analyzed 243 patients (54% males; AxSpA:187, perSpA:56) with median (IQR) age of 52 (42-61) and disease duration 4.1 (2.1-12.3) years. The main therapy in the majority of the patients (83%) was a biologic (b-)DMARD. In patients with AxSpA, median (IQR) ASDAS-CRP was 2.4 (1.7-3.1), while in perSpA patients, median (IQR) DAPSA score was 26 (12.4-36.2). Low disease activity or inactive disease (LDA/ID), taking into account axial and/or peripheral as well as extraarticular manifestations was found in 26% and 25% of the patients in AxSpA and perSpA respectively. Of the patients not having at least LDA (N=181), 82 (45%) had their treatment intensified. Physician-documented reasons of non-intensification are shown in Figure 1. In multivariable logistic regression analysis, the type of patients' main therapy OR (95%CI) for non-bDMARD vs bDMARD:12.2 (4.8-41.4), physician's VAS score OR:1.22 (1.10-1.27) and patients' VAS global score OR:1.08 (1.02-1.12) were predicting therapy intensifications in patients not in target. Conclusion: In this real-world study, the majority of SpA patients had high disease activity levels. T2T strategy was implemented in approximately half of those patients, especially those on non-biologic main therapy and high physician VAS score. The most common reason of non-implementation of T2T was a satisfactory clinical status according to physician in patients with long-standing disease and irreversible damage. REFERENCES: NIL. Acknowledgements: This research is co-financed by Greece and the European Union (European Social Fund- ESF) through the Operational Programme «Human Resources Development, Education and Lifelong Learning» in the context of the project "Reinforcement of Postdoctoral Researchers - 2nd Cycle" (MIS-5033021), implemented by the State Scholarships Foundation (ΙΚΥ). Disclosure of Interests: Irini Flouri: None declared, Nestor Avgoustidis Abbvie, Pfizer, Argyro Repa Abbvie, Katerina Pateromichelaki: None declared, Sofia Pitsigavdaki: None declared, Eleni Marolachaki: None declared, Evgenia Emmanouilidou: None declared, Olga Dobysh: None declared, Eleni Kalogiannaki: None declared, Myrto Nikoloudaki: None declared, George K. Bertsias Novartis, Pfizer, Abbvie, Prodromos Sidiropoulos Lilly, Novartis, Pfizer, Abbvie.