AB0909 RETENTION RATE OF APREMILAST AND RISK FACTORS FOR INADEQUATE RESPONSE IN PATIENTS WITH PSORIATIC ARTHRITIS: RESULTS FROM AN ITALIAN MONOCENTRIC COHORT

Background Apremilast (APR) is an oral PDE4 inhibitor approved for the treatment of Psoriatic Arthritis (PsA). Its effectiveness has been assessed in clinical trials 1,2 , but real-life data are still scarce. Objectives To evaluate retention rate (RR) APR PsA patients and risk factors associated to inadequate response. Methods Retrospective monocentric analysis (CASPAR criteria 2006) treated with between 2017 2021. Disease activity was evaluated at baseline (T0) after 6 (T6), 12 (T12) 24 (T24) months therapy using DAPSA score. Data expressed as median [IQR]. Results The cohort included 79 (41% males; age onset: 47 [37-58] years). domains were: oligoarticular involvement (58%), enthesitis (42%), dactylitis (6%), axial (13%), psoriasis (62%). Half presented dysmetabolic traits: 47% overweight/obesity, 34% arterial hypertension, 20% dyslipidemia. prescribed mainly first-line targeted therapy; 42% administered failure ≥1 bDMARD. Contraindications bDMARDs (47%) especially increased infectious (19/37) current/previous malignancy (15/37), mild phenotype (27%) were main reasons choice. discontinued 61% 4 [1-10] because inefficacy (25/48) or adverse events (AEs) (21/48; 81% gastrointestinal complaints). Patients who compared continued (Table 1). Table 1. WITHDRAWAL n=48 CONTINUATION n=31 p value Females 28 (58) 19 (61) 0.79 Age T0, years 51 [44-58] 57 [53-71] 0.03 duration 5 [2-11] [0-12] 0.81 Oligoarticular (50) 20 (65) 0.21 Axial (13) 1.00 Enthesitis / 26 (54) 11 (36) 0.10 T0 22 [16-28] 18 [13-26] 0.27 monotherapy 23 (74) 0.07 naïve (71) [IQR] number (%). Continuous variables Mann-Whitney test; categorical Chi Squared/exact Fisher test. RR 62% T6, 51% T12 38% T24 (Figure 1 a ). Figure a) Overall b) vs previously (exclusion withdrawals intolerance). In continuing therapy, showed good efficacy, significant reduction score observed T6 (13 [9-19]), (11 [4-18]) (8 [3-10]) (21 [14-28]) (p<0.01). An overall trend BMI (kg/m 2 ) (T0: 25 [22-28], T6: [21-27], T12: [21-26]); overweight decreased significantly (28 [26-31] 27 [26-29] last evaluation; p<0.01). Because high discontinuations due intolerance first we conducted sub analysis: (n=31) it (n=25). A higher frequency withdrawal registered younger (51 [47-57] years; p:0.01) (71% 40%; p:0.02). Multivariate confirmed these associations (OR [95% CI]: 0.1 [0.89-0.99], p:0.03 2.3 [1.70-59.17], p:0.01; respectively). (T6: 75% 67%, 71% 63%, T24: 67% 34%; log-rank test= p:0.05) b Conclusion This study confirms safety scenario. We experienced AEs (44%) registration studies which suspended (8%). However, when tolerated, maintained efficacy over time, demonstrated by progressive reduction. suggests early use APR. Moreover, could favor patients. These need be larger studies. References [1]Edwards CJ et al. Ann Rheum Dis. 2016. Kavanaugh Res Ther. 2019. Disclosure Interests None declared