(041) Predictors of effectiveness of biologic Disease-Modifying Antirheumatic Drugs (bDMARD) in the treatment of psoriatic arthritis

Publication Number: 378

Background: Psoriatic arthritis (PA) is an inflammatory, chronic, autoimmune disease. The study evaluates the profile of the population that uses biologic Disease-Modifying Antirheumatic Drugs (bDMARD) for the treatment of PA in the Brazilian public health system, as well as evaluating the use of these medicines and the influence with sociodemographic and clinical variables. Such knowledge can help in optimizing the use of public resources and in the elaboration of public policies to improve access to bDMARD.

Objectives: To identify evolution predictors through data collected in a cohort of patients with PA, treated with biologic Disease-Modifying Antirheumatic Drugs (bDMARD) in the Brazilian public health system (SUS).

Methods: A prospective cohort was carried out, from January/2012 to December/2020, in Belo Horizonte city, Brazil. Patients included were using adalimumab, infliximab, etanercept, golimumab or secukinumab. Sociodemographic and clinical characteristics were collected, such as gender, race, marital status, education, use of drugs, disease activity, functional capacity and quality of life. Disease activity was assessed by the Ankylosing Disease Activity Index (BASDAI) and Clinical Disease Activity Index (CDAI) instruments, functional capacity by the Health Assessment Questionnaire-Disability Index (HAQ-DI) and quality of life by the EuroQol-5 dimensions (EQ-5D). BASDAI and CDAI were used to identify predictors of good clinical response at 6 months, which were correlated with the remaining variables collected. Paired t test and linear regression (bivariate analysis) were used.

Results: A total of 242 patients were included, 57.4% female, 52.9% white, mean age 51.7 years. 198 patients completed follow-up. After 6 months, there was a reduction in BASDAI mean from 5.29 to 3.64, CDAI from 23.81 to 14.06, HAQ-DI from 1.22 to 0.86 and increase in EQ-5D from 0 .64 to 0.73, with a statistically significant difference (p < 0.001). According to the BASDAI and CDAI index, patients with a low HAQ-DI score (good functional capacity) at the beginning of treatment were more likely to be effective (BASDAI: 95% CI=1.58-2.43; p< 0.001 and CDAI: 95% CI=6.84-11.74; p< 0.001). The worse quality of life at the beginning of treatment was identified as a predictor of non-effectiveness (BASDAI: CI 95%=-9.62 to -6.36; p< 0.001 and CDAI: CI 95%=-46, 04 to -27.28; p< 0.001). And being female was also a predictor of better effectiveness considering the CDAI index (95% CI=3.17 to 10.79; p< 0.001).

Conclusions: bDMARD are effective for the treatment of PA. Characteristics such as gender, functional capacity and quality at the beginning of treatment with bDMARDs can influence the effectiveness of the drug.