Very Low Disease Activity Validated as Remission Target for Psoriatic Arthritis
Very low disease activity may be an appropriate target for remission in patients with psoriatic arthritis treated with golimumab. Photo Credit: Chris Priest/Science Source
Study data published in Rheumatology suggest that very low disease activity may be an appropriate target for remission in patients with psoriatic arthritis (PsA) treated with golimumab.
Investigators abstracted data from the Biologic Treatment Registry Across Canada (BioTRAC), an ongoing, prospective registry of patients with inflammatory arthritis. BioTRAC maintains clinical and safety data on patients receiving infliximab, golimumab, or ustekinumab as part of their routine arthritis care. For the present study, researchers included patients with PsA treated with golimumab between 2010 and 2017 (n=201). Investigators captured the following clinical values from baseline and 6- and 12-month follow-up visits: morning stiffness, stiff joint count, tender joint count, patient's global assessment and physician's global assessment of disease activity, Health Assessment Questionnaire score, and patient's assessment of pain, among other metrics. Disease Activity Index for PsA (DAPSA) and Minimal Disease Activity scores were also calculated and compared to identify an appropriate remission target.
The mean age of study participants was 52 years, and 53% were women. At baseline, mean disease duration was 5.5 years, and mild or moderate disease activity was most commonly observed. Across all clinical metrics, between 15.6% and 38.3% of patients achieved remission, and 37.4% to 77.7% achieved low disease activity at follow-up. Patients who achieved low disease activity per MDA or DAPSA criteria had significantly lower swollen joint count, tender joint count, psoriasis area and severity index, and dactylitis and enthesitis scores compared with nonachievers (P <.05). Patients achieving remission with remaining dactylitis or active skin disease had higher HAQ scores (P <.03). The proportion of patients achieving any MDA low disease activity outcomes at 6 and 12 months was substantially lower than those achieving low disease activity using DAPSA. As such, researchers concluded that DAPSA low disease activity may be a more discerning metric of remission.
Very low disease activity per DAPSA may be a "stringent...potential target" for remission in patients with PsA. Patients achieving DAPSA remission end points did not, however, show significant reduction in skin disease, suggesting that the efficacy of DAPSA may be restricted to joint symptoms.
Coates LC, Rahman P, Psaradellis E, et al. Validation of new potential targets for remission and low disease activity in psoriatic arthritis in patients treated with golimumab [published online December 4, 2018]. Rheumatology. doi:10.1093/rheumatology/key359