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5 th World Psoriasis & Psoriatic Arthritis Conference 2018
tologists and rheumatologists an important aspect to understanding the management of these diseases. Dermatologists represent an important referral-base for rheumatologists, accounting for over one-quarter of all new PsA patients. However, there are discrepancies between the specialists regarding the timing in which these referrals take place. Objectives: One objective of the study was to gain further insight into rheumatologist and dermatologist co-management of patients with PsA. Methods: An independent market analytics firm collaborated with US rheumatologists( n = 101) and US dermatologists( n = 101) to conduct analysis of both the PsA and PSO markets. Data were collected via an online survey fielded in November / December 2017 and included patient demographics, as well as physician demographics, and attitudinal survey responses. Results: Rheumatologists indicate that 51 percent of referrals result from primary care physicians, 28 percent result from a dermatologist, and 13 percent are self-referred. The majority( 73 %) of PsA patients under the care of collaborating rheumatologists had previously been diagnosed with PSO prior to PsA. Dermatologists state that one-quarter of their patients with severe PSO also have PsA, with more than one-third of severe PSO patients also being co-managed with a rheumatologist. The majority of rheumatologists believe that dermatologists refer patients at the first sign of joint involvement and do not attempt to treat joint pain; however, 31 percent of dermatologists report they do not refer PSO patients to rheumatologists until patients have failed biologics or are not improving on their current systemic regimen, while an additional 35 percent report they refer only severe arthritis / patients with worsening disease. Furthermore, only 35 percent of dermatologists agree that they refer their PSO patients to a rheumatologists at the first sign of joint involvement. At the time of dermatologist referral, rheumatologists state that two-thirds of referred patients are biologic / apremilast naïve, with only 6 percent having controlled PSO and joint pain. However, dermatologists state that 40 percent the patients that they referred to rheumatologists were treated with biologics and 15 percent of said referred patients were treated with apremilast. Indeed, 76 percent of dermatologists agree with the statement,“ I believe that starting my PSO patients earlier on biologic therapy will slow the development and progression of the arthritic component of the disease( PsA),” while 57 percent of dermatologists agree“ I prefer to use biologics that are indicated in both PSO and PsA.” Conclusion: With many patients diagnosed with both PSO and PsA, co-management between dermatologists and rheumatologists is common. While rheumatologists appear to be under the impression that they are receiving the majority of dermatologisttreated patients with PsA at the first sign of joint involvement, dermatologists largely report that they are managing and treating PsA patients. Furthermore, most dermatologists believe early aggressive use of biologic treatments will mitigate the development and / or progression of joint involvement, implying their willingness to manage their patients with PsA, particularly at early stages.
P123 THE USE OF TUMOR NECROSIS FACTOR INHIBITORS( TNF) IN THE SECOND-LINE BIOLOGIC / SMALL MOLECULE SETTING: A CROSS-SPECIALTY
COMPARISON Lynn Price, Jennifer Robinson, Gianna Melendez Spherix Global Insights
TNF therapy has been the standard of care for adult patients diagnosed with autoimmune conditions, resulting in familiarity, comfort, and satisfaction among physicians. TNFs are typically used as a first-line biologic / small molecule in the treatment of psoriasis( PSO) and psoriatic arthritis( PsA). However, the adoption of agents with alternate mechanisms of action( AMOA) has increased in recent years across indications and the practice of sequential TNF prescribing after an initial TNF is less common. Though TNFs are still the preferred first-line agent, there are discrepancies between specialists on the use of AMOA agents in the second-line setting. This research sought to understand the extent to which AMOA agents are prescribed after an initial TNF, and how this varies across PSO and PsA. An independent market analytics firm collaborated with US dermatologists( n = 201) and US rheumatologists( n = 200) to conduct a retrospective chart review of patients diagnosed with PSO( n = 950) and PsA( n = 1,008) who had switched from one biologic / apremilast to another agent in the prior 12 weeks. Physicians were able to submit up to 7 patient charts. PSO data was collected in September 2017 and PsA data was collected in April 2017. Analysis of patients recently switched from one biologic / apremilast to a different brand revealed the majority of patients were treated with a TNF in the first-line biologic / small molecule setting, though this varies by indication. Rheumatologists prescribe first-line TNFs significantly more than dermatologists. 83 % of PsA patients are prescribed TNFs first-line compared to just 69 % of PSO patients. Furthermore, rheumatologists are significantly more likely to practice TNF-sequencing than dermatologists. Indeed, 44 % of PsA patients treated with a first-line TNF were prescribed a second TNF, compared to 6 % of PSO patients. Additionally, certain TNF brands have experienced recent declines in first line use, though this varies by indication as well. For rheumatologists, use of first-line etanercept has declined, 38 % of PsA patients were initiated on etanercept at least 24 months prior to the study, compared to just 28 % initiated on etanercept within 12 months of the study. For dermatologists, there were significantly more PSO patients initiated on etanercept in the first-line setting 24 months or more prior to the study compared to those initiated within 12 months of the study,( 45 % vs 31 %.) This pattern also held true for adalimumab, where 42 % of first-line PSO patients initiated more than 24 months prior to the study were prescribed adalimumab, a figure that drops to just 27 % for patients initiated within 12 months. Though the position of TNFs as first-line agents remains dominant, the treating specialist and indication influence how widespread and continuous TNF use is. Specifically, dermatologists are less likely to prescribe TNFs as first-line agents and are also significantly less likely to partake in the sequencing of TNFs in the first- and second-line setting than rheumatologists. The introduction of several agents in PSO reporting substantially higher rates of skin clearance compared to TNFs could potentially be the source of increased switching to AMOAs compared to other specialties; whereas superior efficacy of AMOA agents over TNFs in PsA may be less apparent.
P124 IMPACT OF GUSELKUMAB VERSUS PLACEBO AND ADALIMUMAB ON PATIENT REPORTED OUTCOMES IN PATIENTS WITH AND WITHOUT PSORIATIC
ARTHRITIS IN VOYAGE 2 Luis Puig 1, Chenglong Han 2, Ron Vender 3, Michael Song 2, Yin You 2, Yaung-Kaung Shen 2, Peter Foley 4
1
Hospital de la Santa Creu i Sant Pau and Universitat Autònoma de Barcelona Medical School, Barcelona, Spain, 2 Janssen Research & Development, LLC, Spring House, PA, USA, 3 McMaster University, Hamilton, ON, Canada, 4 University of Melbourne, St. Vincent’ s Hospital, Melbourne and Skin & Cancer Foundation Inc., Carlton, Victoria, Australia
Introduction / Objective: VOYAGE 2 is a phase 3 double-blind, placebo / active comparator-controlled trial comparing guselkumab( GUS) with placebo( PBO) and adalimumab( ADA) in patients( pts) with moderate-to-severe PsO. The impact of treatment on patient-reported outcomes( PROs) was evaluated. Methods: Pts were randomized to GUS 100mg( wks 0 & 4, then www. medicaljournals. se / acta