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5 th World Psoriasis & Psoriatic Arthritis Conference 2018
University, Umeå, 2 Department of Medical and Health Sciences, Linköping University, Linköping, 3 Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
Introduction: Psoriasis is a complex, systemic disease associated with comorbidities extending beyond the skin, often affecting psychological well-being which may manifest as clinical depression. Psoriasis can be viewed narrowly by focusing on the skin, or holistically to include associated comorbidities. To date, the complex interplay between psoriasis, comorbidities, and depression has not been adequately described, and an innovative approach is necessary to understand interrelationship between them. Objectives: Calculate incidence rates of depression in psoriasis patients compared to the general population and subsequently explore the risk factors associated with depression onset. Determine the contributions of comorbidities compared to narrowly defined, psoriasis-only symptoms. Methods: 96,666 psoriasis patients were matched to 15 controls and followed from psoriasis onset until incident depression diagnosis or censoring using population-based routine care data. Incidence of depression was calculated using Poisson regression models. Risk of depression onset using a narrow definition of psoriasis was compared to a holistic definition including all comorbidities using a Cox proportional hazards model, with additional adjustment for sociodemographic factors. Comorbidities were represented by ICD chapters with more than 5 % correlation with psoriasis. Sensitivity analysis examined the role of psoriatic arthropathy, alternative depression definitions, and searched for unobserved confounding. Results: Patients with psoriasis have a higher incidence of clinical depression than those without the disease. Holistically, psoriasis was associated with an increased risk of depression onset of 40 %( HR = 1.404, p < 0.001), compared to 12 % increase( HR = 1.115, p < 0.001) when narrowly defined. The proportional hazards assumption appeared to hold in each survival analysis. A substantial portion, but not all, of psoriasis patients’ risk of depression onset was attributable to comorbidities, and sociodemographic factors did not appear to affect the estimates of association between depression and psoriasis. Major differences were found between antidepressant- and diagnosis-based definitions of depression, while inclusion of psoriatic arthropathy did not affect the results. No unmeasured confounding was identified. Conclusions: Due to the elevated risk of depression in psoriasis patients, treating physicians should ensure patients’ psychological well-being is addressed, especially in those presenting with additional risk factors, to break the cyclical relationship between depression and psoriasis and improve patients’ quality of life. Contemporary, holistic management of psoriasis patients should encourage routine screening for depression.
P016 EFFICACY OF ADALIMUMAB PLUS METHOTREXATE IN PATIENTS WITH MODERATE TO SEVERE PLAQUE
PSORIASIS Ghasem Rahmatpour Rokni, Mohamad Goldust Mazandaran University of Medical Sciences
Background: Adalimumab, a high-affinity monoclonal antibody that selectively targets tumor necrosis factor alpha, is efficacious in treating moderate-to-severe plaque psoriasis. Currently there are some reports regarding drug resistance to adalimumab( 1,2). Objective: This study aimed at evaluating the efficacy of adalimumab plus methotrexate in patients with moderate to severe plaque psoriasis. Methods: In this cross sectional study, 23 patients suffering from moderate to severe psoriasis were recruited. Patients received adalimumab 80 mg week 0, 1 and then 40 mg every 2 weeks and methotrexate up to 25 mg / week. The primary outcome measure was the difference in Psoriasis area and severity index( PASI-
75) response after 12 weeks. The secondary outcomes included PASI 75 at week 6( onset of action) and week 12, Investigator’ s Global Assessment( IGA), Patient Global Assessment, impact on quality of life( Skindex-17 and SF-36), Treatment Satisfaction Questionnaire of Medication, duration of remission, maintenance treatment and safety. Results: In the study group, 86.9 %( 20 out of 23 patients) reached PASI-75 at week 12. The longitudinal analysis showed a PASI reduction of 6.42 % per week. The onset of action was achieved in 65.2 %. At week 12, IGA‘ clear or almost clear’ was observed in 91.3 %( p < 0 · 01). Skindex-17 symptom score was significant with combination therapy( p < 0 · 01). Maintenance treatment achieved PASI 75 for 82.6 %( p < 0 · 01). Mild adverse events were reported in 79.5 %. Conclusion: Combination therapy of adalimumab plus methotrexate is a highly effective, well-tolerated, maintenance therapy in patients with moderate to severe plaque psoriasis. References: 1. Mease P, Hall S, FitzGerald O et al. Tofacitinib or Adalimumab versus Placebo for Psoriatic Arthritis. N Engl J Med 2017 Oct 19. 377; 1537-1550. 2. Papp K, Bachelez H, Costanzo A et al. Clinical similarity of biosimilar ABP 501 to adalimumab in the treatment of patients with moderate to severe plaque psoriasis: A randomized, double-blind, multicenter, phase III study. J Am Acad Dermatol 2017 Jun. 1976; 1093-1102.
P018 ATTAINMENT OF REMISSION AND MINIMAL DISEASE ACTIVITY AFTER STARTING METHOTREXATE
SUBCUTANEOUS THERAPY Elena Loginova, Tatiana Korotaeva, Elena Gubar, Svetlana Glukhova, Eugeny Nasonov Nasonova Research Institute of Rheumatology, Moscow
Introduction: Methotrexate( MTX) is the first-choice therapy in psoriatic arthritis( PsA). There is limited data concerning efficacy of early administration and rapidly dose escalation of MTX subcutaneous( s / c) in early( E) PsA patients( pts). Objective: to study attainment of remission( REM) or minimal disease activity( MDA) after starting MTX s / c therapy in EPsA pts treated according to treat-to-target( T2T) strategy. Methods: 77( M-37 / F-40) pts with active EPsA, according to the CASPAR criteria were included. Mean age 37.4 ± 10.8 years( yrs.), PsA duration 11 ± 10 months( mon.), psoriasis duration 86 ± 96.1 mon., DAPSA 32.45 ± 12.7. At baseline all pts started MTX s / c therapy. The dose of MTX s / c was escalated by 5 mg every 2 weeks from 10 mg / wk to appropriate dose 20 – 25 mg / wk according to the drug intolerance. If the patient did not achieve remission or MDA on MTX mono-therapy, biological( b) DMARDs was added. At baseline and every 3 mon. of study( till 24 mon.) all pts underwent assessment of PsA activity by DAPSA and MDA criteria( tender joint count ≤ 1, swollen joint count ≤ 1, PASI ≤ 1 or BSA ≤ 3, patient pain global assessment VAS ≤ 15, patient ´ s global disease activity VAS ≤ 20, HAQ ≤ 0.5, enthesitis count ≤ 1). The proportion of pts who achieved REM by DAPSA ≤ 4 and MDA( 5 of 7 cutpoints), the timing of REM / MDA, the mean dose of MTX during the study were performed. M ± SD, Me [ Q75; Q50 ],(%), W-test were calculated. All p < 0.05 were considered to indicate statistical significance. Results: 36 out of 77 pts( 46.75 %) did not achieve REM or MDA in MTX therapy within 7 ± 5 mon. and bDMARDs were added. 5 out of 77 pts( 6.5 %) stopped MTX therapy due to intolerance within 6 ± 2 mon. 36 out of 77 pts( 46.75 %) went on taking MTX-monotherapy. In 22 out of 36 pts, who had mean DAPSA 27.7 ± 10.0 at baseline, data was available by the 24 mon. of study. At baseline median dose of MTX s / c was 15 [ 10; 20 ], Min 10 – Max 20 mg / wk. At the third mon. of study median dose of MTX s / c was escalated to 20 [ 20; 20 ], Min 0 – Max 25 mg / wk. After attainment of REM / MDA the dose of MTX was decreased. At the end of the study median dose of MTX s / c was 7.5 [ 0; 15 ], Min 0 – Max 20 www. medicaljournals. se / acta