P164 Do real-world treatment patterns reflect PsA recommendations? Results from the PRO-SPIRIT study
Bibliographic record
Abstract
Abstract Background/Aims The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) and the European Alliance of Associations for Rheumatology (EULAR) developed recommendation sets for psoriatic arthritis (PsA) treatment based on current evidence. All biologic disease-modifying anti-rheumatic drugs (bDMARDs) are equally recommended for peripheral arthritis. Different treatments exist for relevant skin and axial involvement. Interleukin 17 (IL-17) inhibitors (i) and IL-12/23i are recommended over tumour necrosis factor inhibitors (TNFi) for PsA with significant skin involvement. IL-12/23i are not recommended with axial manifestations. PRO-SPIRIT is the first large sample prospective multi-national observational PsA study. The objective of this study was to report the real-world treatment patterns reflecting PsA recommendations using results from the PRO-SPIRIT study. Methods PRO-SPIRIT enrolled adults with PsA from 2019 to 2022 who initiated or switched to approved biologic or targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARD). Treatment groups included TNFi, IL-17Ai, IL-12/23i, IL-23i, Janus kinase (JAKi), and phosphodiesterase-4 (PDE4i). Mode of action (MoA) was at the discretion of the treating physician. Patient demographic, disease activity, treatment characteristics, and clinical and patient-reported outcomes were collected at baseline (BL). Descriptive results are presented. Missing BL values were imputed. Results Analysis includes 1,192 patients with PsA treated by different MoA. Patients with arthritis (defined by swollen joint count (SJC) and tender joint count (TJC) ≥5) were equally distributed across treatment classes except for a lower percentage in PDE4i. Patients receiving IL-17Ai commonly presented with joint, skin, and nail involvement. Patients with higher skin (body surface area (BSA) ≥3%) and nail involvement were more commonly treated by IL-17Ai and IL-23i, less so with JAKi. Patients receiving JAKi presented with more joint and axial, and less skin involvement. After IL-23i, PDE4i had the second highest proportion of patients with nail involvement. PDE4i patients were low and reported less active domain affectation in general. Line of therapy results showed more patients treated with IL-12/23i, JAKi, and IL-17Ai after prior b/tsDMARDs treatment. Conclusion In general, patients had polyarticular disease at BL. Pts with skin and nail involvement were more commonly treated with IL-17Ai and IL-23i over TNFi and JAKi. Patients with axial manifestations were more commonly treated with IL-17Ai and JAKi over IL-12/23i and IL-23i. Findings add to the evidence on real-world PsA treatment patterns and recommendations sets for guiding individualised PsA treatment. Disclosure W. Tillett: Honoraria; AbbVie, Amgen, Celgene, Eli Lilly and Company, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, and UCB Pharma. M. Nisar: Honoraria; AbbVie, Bristol Myers Squibb, Celgene, Chugai, Eli Lilly and Company, Merck Sharp and Dohme, Novartis, Pfizer, Roche, and UCB Pharma. V. Chandran: Grants/research support; AbbVie, and is a consultant for: AbbVie, Amgen, Bristol Myers Squibb, Celgene, Eli Lilly and Company, Janssen, Novartis, Pfizer, and UCB Pharma. K. Ng: Shareholder/stock ownership; Employee and shareholder of Eli Lilly and Company. M. Ngantcha: Shareholder/stock ownership; Employee and shareholder of Eli Lilly and Company. C. Laedermann: Shareholder/stock ownership; Employee and shareholder of Eli Lilly and Company. S. Moyano: Shareholder/stock ownership; Employee and shareholder of Eli Lilly and Company. R. Alten: Grants/research support; AbbVie, Bristol Myers Squibb, Eli Lilly and Company, Galapagos NV, Gilead Sciences, Janssen, Novartis, Pfizer, and UCB Pharma. L. Kristensen: Consultancies; AbbVie, Amgen, Biogen, Bristol Myers Squibb, Eli Lilly and Company, Gilead Sciences, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, and UCB Pharma. Grants/research support; AbbVie, Biogen, Eli Lilly and Company, Gilead Sciences, Janssen, Novartis, Pfizer, and UCB Pharma.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.046 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".