POS1250 Association between metabolic comorbidities and retention rates of first-line b/tsDMARD treatment in patients with psoriatic arthritis: European real-world results

Background:
Psoriatic arthritis (PsA) is associated with metabolic comorbidities, including obesity, diabetes, dyslipidemia, and hypertension. Metabolic comorbidities induce chronic inflammation, increase cardiovascular disease risk, and may be associated with increased PsA disease activity. However, only a few studies have explored the impact of these comorbidities on treatment outcomes in PsA.
Objectives:
We investigated the association between metabolic comorbidities and the 12-month retention rate of a first-line biologic/targeted synthetic Disease-Modifying Anti-Rheumatic Drug (b/tsDMARD) in patients with PsA treated in routine care.
Methods:
Patients with PsA who initiated their first b/tsDMARD after 2014 were identified in 10 registries participating in the European Spondyloarthritis Research Collaboration Network (EuroSpA) that were able to register the following four metabolic comorbidities: obesity, diabetes, dyslipidemia, and hypertension at b/tsDMARD treatment start (baseline). The comorbidity status in each patient was calculated (0 (reference) versus ≥1). Co-existence between comorbidities was displayed in a Venn diagram. Kaplan-Meier estimation with log-rank tests and Cox regression with hazard ratios (HR), adjusting for baseline age, sex, purchasing power-adjusted Gross Domestic Product (GDP) per capita per €1,000 [1], and calendar year, were applied to assess and compare 12-month drug retention rates between patients with 0 vs ≥1 comorbidities.
Results:
Of the 8,162 included patients, 36% (n=2,912) had at least one metabolic comorbidity. Compared with patients with no metabolic comorbidity, patients with comorbidity were older, more often treated with an interleukin 17 inhibitor as first b/tsDMARD and had higher scores for disease activity and patient-reported outcomes, Table 1. Among the 2,912 patients, a considerable overlap between the metabolic comorbidities was observed, and 40% (n=1,147) had two or more comorbidities, Figure 1. The 12-month crude retention rate for patients with no metabolic comorbidity was 78% versus 77% for patients with ≥1 metabolic comorbidity. The risk of treatment withdrawal was higher in patients with ≥1 metabolic comorbidity (HR 1.12 [95% confidence interval 1.03-1.22] compared to no metabolic comorbidity in the adjusted analyses.
Conclusion:
In patients with PsA, metabolic comorbidities were prevalent and often overlapping. Patients with one or more metabolic comorbidity had higher disease activity at treatment start, and a slightly higher risk of treatment withdrawal within the first 12 months compared to patients without any metabolic comorbidity. The clinical implications of our findings need to be further investigated.