Short composite measures identify disease activity in psoriatic arthritis
Presenter: William Tillett, PhD, MBChB, Royal National Hospital for Rheumatic Diseases, Bath, United Kingdom
Strong correlation between short- vs long-form composite measures of psoriatic arthritis disease activity in a TNFi-IR population treated with guselkumab: Data from the phase 3b COSMOS trial. Abstract 2142.
Abbreviated visual analogue scales can accurately assess disease activity in psoriatic arthritis.
Several composite measures are available to assess various domains of psoriatic arthritis (PsA) treatment response, which help clinicians provide the right drug to the right patient. Capturing data on multiple domains of disease can avoid underestimating the total burden of disease, a trap clinicians may fall into if they just assess joints, according to William Tillett, PhD, MBChB, Royal National Hospital for Rheumatic Diseases Bath, United Kingdom.
“Some composite measures are time consuming to perform,” he said. “One way to address this is to develop shortened versions of these existing composite measures. The abbreviated instruments — 3 visual analogue scale (3VAS) and 4VAS scale — have shown promising performance characteristics in terms of response, treatment, and relationship to decisions about treatment escalation.”
Currently available composite tools used in PsA include the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis Composite Exercise (GRACE) and the PsA Disease Activity Score (PASDAS). The 3VAS includes 3 domains (physician global, patient global, and patient skin) and 4VAS includes 4 domains (physician global, patient pain, patient joint, and patient skin).
This new analysis by Tillett and colleagues explored the correlation between 3VAS or 4VAS and GRACE, PASDAS, and measures of quality of life using data from the phase 3b COSMOS study. The COSMOS study assessed guselkumab 100 mg every 8 weeks versus placebo in patients with active PsA and inadequate response to a tumor necrosis factor inhibitor. Patients who received placebo crossed over to guselkumab at either week 16 or week 24. Calculated mean scores were plotted over time in a patient-continuer population (ie, those with week 0 and week 48 data).
Researchers examined data from 285 patients (189 received guselkumab, 96 placebo) from the COSMOS study. Substantial improvements of at least 45% were seen in scores on GRACE, PASDAS, 3VAS, and 4VAS through week 48 in guselkumab-treated patients, with separation from placebo as early as week 8.
“A simple, short measure was able to distinguish between active treatment with guselkumab and placebo,” said Tillett.
Strong correlations were observed between 3VAS/4VAS and both GRACE (r = 0.83-0.92) and PASDAS (r = 0.72-0.85) in guselkumab-randomized patients at each visit. The 3VAS/4VAS scores showed moderate correlation with the Health Assessment Questionnaire-Disability Index (r = 0.45-0.63), a physical function scale, and SF-36 PCS (r = -0.40 to -0.65), a health survey. Consistent results were observed in placebo recipients who crossed over to guselkumab, he said.
In conclusion, Tillet said: “We found substantial improvements in PsA disease activity through year 1 using several composite indexes in patients treated with guselkumab. The strong correlation between 3VAS/4VAS and GRACE/PASDAS in this patient population is promising and highlights that abbreviated composite indexes can provide an accurate assessment of disease activity. Owing to their better feasibility, they may potentially be options to use in routine clinical practice.”
References
Tillett W, McHugh N, Orbai AM, et al. Outcomes of the 2019 GRAPPA workshop on continuous composite indices for the assessment of psoriatic arthritis and membership-recommended next steps. J Rheumatol Suppl 2020; 96:11-18. doi:10.3899/jrheum.200121
Tillett W, FitzGerald O, Coates LC, et al. Composite measures for routine clinical practice in psoriatic arthritis: testing of shortened versions in a UK multicenter study. J Rheumatol Suppl 2021; 97:45–9. doi:10.3899/jrheum.201675
Coates LC, Gossec L, Theander E, et al. Efficacy and safety of guselkumab in patients with active psoriatic arthritis who are inadequate responders to tumour necrosis factor inhibitors: results through one year of a phase IIIb, randomised, controlled study (COSMOS). Ann Rheum Dis 2021; 81(3):35-369. doi:10.1136/annrheumdis-2021-220991
Tillett W, Coates L, Sharaf M, et al. Strong correlation between short- vs long-form composite measures of psoriatic arthritis disease activity in a TNFi-IR population treated with guselkumab: Data from the phase 3b COSMOS trial [abstract 2142]. Arthritis Rheumatol 2022; 74(suppl 9). https://acrabstracts.org/abstract/strong-correlation-between-short-vs-long-form-composite-measures-of-psoriatic-arthritis-disease-activity-in-a-tnfi-ir-population-treated-with-guselkumab-data-from-the-phase-3b-cosmos-trial/
Disclosures
William Tillett: No relevant disclosure