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  • Gossec, Laure  (9)
  • Lubrano, Ennio  (9)
  • 1
    In: Annals of the Rheumatic Diseases, BMJ, Vol. 78, No. 2 ( 2019-02), p. 201-208
    Abstract: The objective was to compare different definitions of remission and low disease activity (LDA) in patients with psoriatic arthritis (PsA), based on both patients’ and physicians’ perspectives. Methods In ReFlap (Remission/Flare in PsA; NCT03119805 ), adults with physician-confirmed PsA and 〉 2 years of disease duration in 14 countries were included. Remission was defined as very low disease activity (VLDA), Disease Activity index for PSoriatic Arthritis (DAPSA) ≤4, and physician-perceived and patient-perceived remission (specific question yes/no), and LDA as minimal disease activity (MDA), DAPSA 〈 14, and physician-perceived and patient-perceived LDA. Frequencies of these definitions, their agreement (prevalence-adjusted kappa), and sensitivity and specificity versus patient-defined status were assessed cross-sectionally. Results Of 410 patients, the mean age (SD) was 53.9 (12.5) years, 50.7% were male, disease duration was 11.2 (8.2) years, 56.8% were on biologics, and remission/LDA was frequently attained: respectively, for remission from 12.4% (VLDA) to 36.1% (physician-perceived remission), and for LDA from 25.4% (MDA) to 43.9% (patient-perceived LDA). Thus, patient-perceived remission/LDA was frequent (65.4%). Agreement between patient-perceived remission/LDA and composite scores was moderate to good (kappa range, 0.12–0.65). When patient-perceived remission or LDA status is used as reference, DAPSA-defined remission/LDA and VLDA/MDA had a sensitivity of 73.1% and 51.5%, respectively, and a specificity of 76.8% and 88.0%, respectively. Physician-perceived remission/LDA using a single question was frequent (67.6%) but performed poorly against other definitions. Conclusion In this unselected population, remission/LDA was frequently attained. VLDA/MDA was a more stringent definition than DAPSA-based remission/LDA. DAPSA-based remission/LDA performed better than VLDA/MDA to detect patient-defined remission or remission/LDA. Further studies of long-term outcomes are needed.
    Type of Medium: Online Resource
    ISSN: 0003-4967 , 1468-2060
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    Language: English
    Publisher: BMJ
    Publication Date: 2019
    detail.hit.zdb_id: 1481557-6
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  • 2
    In: Rheumatology, Oxford University Press (OUP), Vol. 62, No. Supplement_2 ( 2023-04-24)
    Abstract: A personalised approach is required to optimise management of psoriatic arthritis (PsA). Shared decision-making between physician and patient is key, resulting in greater patient satisfaction and outcomes. We assessed the degree of perceived collaboration following clinic visits in the UK and Europe and whether this was associated with treatment escalation. Methods The ASSIST study was a cross-sectional observational study of PsA patients aged 18 years and older selected from 24 centres across 5 countries (UK, France, Germany, Italy and Spain) between July 2021 and March 2022 (IRAS: 287039). Patients attending a face-to-face appointment with a diagnosis of PsA made by a rheumatologist were selected by systematic sampling at each centre and treated in routine clinical practice. Patients completed the collaboRATE questionnaire (scored 0-9), where high scores indicate greater perceived collaboration. The perceived efficacy in patient-physician interactions (PEPPI) tool (scored 5-25) assessed the patients’ view on their confidence in the consultation. Patient, physician, and disease characteristics were recorded, alongside treatment decisions (medications unchanged, switched, added or reduced). The analysis was descriptive, with no imputation of missing data. Results 503 patients were included, with key characteristics shown (Table 1). Generally, the level of disease severity was low (mean total PsAID score 3.6/10) and PEPPI scores were high, indicating patient confidence in the consultation. A subgroup (n = 10) perceived difficulty in sharing their concerns (PEPPI & lt;12/25). However, collaboRATE scores remained high (mean score 7.96), suggesting satisfaction in the physician’s effort to understand patient concerns. Consultation satisfaction was not associated with treatment decisions: mean collaboRATE and PEPPI scores in those with and without treatment escalation were similar. Mean collaboRATE and PsAID scores were not associated. In patients with low collaboRATE scores ( & lt;5), only patients with higher PsAID scores ( & gt;5) had treatment escalation. However, in patients with high collaboRATE scores, even patients with low PsAID scores had treatment escalation. Conclusion Patients report high levels of shared decision-making in face-to-face PsA consultations, unrelated to treatment escalation. In patients with low PsAID scores, those with higher perceived collaboration are more likely to have treatment escalation than those without, perhaps reflecting the identification of otherwise undetected symptoms/concerns. Disclosure L.L. Watson: None. C. Coyle: None. M. Brooke: None. U. Kiltz: None. E. Lubrano: None. R. Queiro: None. D. Trigos: None. J. Brandt-Juergens: None. S. D'Angelo: None. A. Delle Sedie : None. E. Dernis: None. P. Helliwell: None. P. Ho: None. A. Hueber: None. B. Joven: None. M. Koehm: None. C. Montilla: None. J. Packham: None. J.P. Tasende: None. F.J.R. Garcia: None. A. Ruyssen-Witrand: None. R. Scrivo: None. S. Twigg: None. M. Welcker: None. M. Soubrier: None. T. Wirth: None. L. Gossec: Consultancies; AbbVie, Amgen, BMS, Celltrion, Galapagos, Gilead, GSK, Janssen, Lilly, MSD, Novartis, Pfizer, Sandoz, UCB. Grants/research support; Amgen, Galapagos, Lilly, Pfizer, Sandoz, UCB. L.C. Coates: None.
    Type of Medium: Online Resource
    ISSN: 1462-0324 , 1462-0332
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 1474143-X
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  • 3
    In: Rheumatology, Oxford University Press (OUP), Vol. 62, No. Supplement_2 ( 2023-04-24)
    Abstract: Psoriatic arthritis (PsA) is a heterogeneous, multi-dimensional disease. Treatment pathways are not well defined and have to be tailored to the individual; however, little is known about the factors underpinning a decision to intensify treatment. By comparing treatment data between countries, we can understand more about factors influencing patient outcomes and establish international benchmarks in practice. Methods ASSIST was a cross sectional study of patients (18 years and older) diagnosed with PsA. Participants were selected from 24 centres across 5 countries (UK, France, Germany, Italy and Spain). Patients were selected from face to face (F2F) appointments using systematic sampling with random starting numbers generated for each site. Participants were treated as usual in their routine clinical practice. The Health Assessment Questionnaire (HAQ) and the EQ-5D-5L QoL survey were provided to all participants as patient-reported outcome tools. The perceived confidence on patient-physician interaction score (PEPPI) and the CollaboRATE measure were used to assess patient satisfaction with a consultation. Results 503 patients from 24 centres across five countries in Europe (49.1% F, 50.9% M) (mean age 53) participated in the survey between 12/07/2021-22/03/2022. Despite similar rates of treatment escalation and similar satisfaction with consultations, QoL was poorer in the UK. Comparing EQ-5D-5L scores, participants in the UK (107) reported worse outcomes across all domains except pain/discomfort versus participants in mainland Europe (396). 52.3% in the UK reported some problems with self-care versus 33.9% in mainland Europe. 72.9% of patients in the UK reported issues with mobility (mainland Europe: 61.6%). The UK had the highest percentage of participants reporting issues with anxiety (66.4%). The UK had the most severe HAQ scores, (mean= 0.936) compared to means of 0.62 or below in other countries. Physician-reported severity of disease was higher in the UK; however, patients in the UK reported the second highest PEPPI scores, the second highest collaboRATE scores and comparable methods of treatment escalation (dose adjustment or addition of another medication) to mainland Europe. Moreover, data on co-morbidities (including FCI categorical breakdown) does not demonstrate obvious variation between the UK and Europe. Conclusion Overall, patients with PsA in the UK reported lower quality of life (QoL) compared to patients in mainland Europe. It is not clear from our data why the UK performs less well on the majority of EQ-5D-5L domains and HAQ scoring compared to Europe. This may relate to variation in disease activity; however, there is potential selection bias in the higher disease activity reported by physicians in the UK as patients with more severe disease could have been selected for F2F appointments compared to mainland Europe. There may also be additional factors outside of the consultation impacting these scores, which could be identified with future research. Disclosure C. Coyle: None. L. Watson: None. M. Brooke: None. U. Kiltz: None. E. Lubrano: None. R. Queiro: None. D. Trigos: None. J. Brandt-Jürgens: None. S. D'Angelo: None. A. Delle Sedie: None. E. Dernis: None. P. Helliwell: None. P. Ho: None. A. Hueber: None. B. Joven Ibáñez: None. M. Köhm: None. C. Montilla Morales: None. J. Packham: None. J. Antonio Pinto Tasende: None. F. Ramíez García: None. A. Ruyssen-witrand: None. R. Scrivo: None. S. Twigg: None. M. Welcker: None. M. Soubrier: None. T. Wirth: None. L. Gossec: None. L. Coates: None.
    Type of Medium: Online Resource
    ISSN: 1462-0324 , 1462-0332
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
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  • 4
    In: Arthritis Care & Research, Wiley, Vol. 72, No. 12 ( 2020-12), p. 1772-1779
    Abstract: Sex differences may modify symptoms, disease expression, and treatment effects. The objective of this study was to evaluate the link between life impact and sex in psoriatic arthritis (PsA). Methods Remission and Flare in Psoriatic Arthritis (ReFlaP; ClinicalTrials.gov identifier: NCT03119805) was a study in 14 countries of consecutive adult patients with definite PsA. Participants underwent comprehensive PsA assessment using the following measures: Disease Activity in Psoriatic Arthritis (DAPSA), Minimal Disease Activity (MDA), and Psoriatic Arthritis Impact of Disease (PsAID). Disease activity was compared by sex using t ‐tests or Wilcoxon tests. The association of PsAID with sex was analyzed using hierarchical generalized linear models. Results Of 458 participants, 50.2% were male and the mean ± SD age was 53.1 ± 12.6 years. The mean ± SD PsA duration was 11 ± 8.2 years, and 51.5% of participants were being treated with biologic disease‐modifying antirheumatic drugs. Women, compared to men, had worse mean ± SD Leeds Enthesitis Index scores (0.8 ± 1.7 versus 0.3 ± 0.9), pain on a numerical rating scale (NRS; range 0–10) (4.7 ± 2.7 versus 3.5 ± 2.7), HAQ DI scores (0.9 ± 0.7 versus 0.5 ± 0.6), fatigue on an NRS (5.2 ± 3 versus 3.3 ± 2.8), and PsAID scores (4.1 ± 2.4 versus 2.8 ± 2.3) ( P 〈 0.001 for all). Women were also less frequently at treatment target compared to men according to DAPSA (cutoffs of ≤4 for remission and 〉 4 and ≤14 for low disease activity; mean ± SD score 16.9 ± 14.9 in women versus 12.6 ± 16.6 in men) and MDA (25.7% versus 50.0%; P 〈 0.001 for all) scores. High life impact (PsAID score ≥4) was associated with female sex (odds ratio [OR] 2.3), enthesitis (OR 1.34), tender joints (OR 1.10)( P 〈 0.001 for all), and comorbidities (OR 1.22, P = 0.002). Conclusion High life impact was independently associated with female sex, enthesitis, comorbidities, and tender joints. At treatment target, women had higher life impact compared to men. It is necessary for life impact to become a part of PsA treat‐to‐target strategies.
    Type of Medium: Online Resource
    ISSN: 2151-464X , 2151-4658
    URL: Issue
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    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2016713-1
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  • 5
    In: Joint Bone Spine, Elsevier BV, Vol. 90, No. 3 ( 2023-05), p. 105511-
    Type of Medium: Online Resource
    ISSN: 1297-319X
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2023
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  • 6
    In: RMD Open, BMJ, Vol. 8, No. 1 ( 2022-05), p. e002031-
    Abstract: Patient care can vary substantially by country. The objective was to explore differences in psoriatic arthritis (PsA) across countries for disease activity, impact and treatments. Methods A cross-sectional analysis of 13 countries from the Remission/Flare in PsA study ( NCT03119805 ) of consecutive adult patients with definite PsA was performed. Countries were classified into tertiles by gross domestic product (GDP)/capita. Disease activity (Disease Activity in PsA, DAPSA and Minimal Disease Activity, MDA) and their components, disease impact (patient-reported outcomes) and biological disease-modifying antirheumatic drugs (bDMARDs) were analysed per country and compared between the three tertiles of GDP/capita by parametric and non-parametric tests. We also explored the percentage of patients with significant disease activity (DAPSA 〉 14) and no ongoing bDMARD prescription. Results In 439 patients (50.6% male, mean age 52.3 years, mean disease duration 10.1 years), disease activity and disease impact were higher in the lowest GDP/capita countries. DAPSA remission and MDA were attained in the lowest tertile in 7.0% and 18.4% patients, vs 29.1% and 49.5% in the middle tertile and 16.8% and 41.3% in the high tertile, respectively (all p 〈 0.001). bDMARDs use was similar in the tertiles (overall mean 61%). The overall rate of patients with DAPSA 〉 14 and no bDMARDs was 18.5%, and was higher in lower GDP/capita countries (p=0.004). Conclusion PsA patients from countries with the lowest GDP/capita, despite similar use of bDMARDs, were more likely to have high disease activity and worse disease impact. There is a need for more equity in healthcare.
    Type of Medium: Online Resource
    ISSN: 2056-5933
    Language: English
    Publisher: BMJ
    Publication Date: 2022
    detail.hit.zdb_id: 2812592-7
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  • 7
    In: Joint Bone Spine, Elsevier BV, Vol. 89, No. 5 ( 2022-10), p. 105372-
    Type of Medium: Online Resource
    ISSN: 1297-319X
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
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  • 8
    In: Rheumatology, Oxford University Press (OUP), Vol. 62, No. Supplement_2 ( 2023-04-24)
    Abstract: Psoriatic arthritis (PsA) is a multi-system disease with a range of management options. Treatment may vary by geographic location. We compared disease characteristics and prescribing practices in the UK and Europe in the post-Covid era. Methods The ASSIST study was a cross-sectional observational study of PsA patients aged 18 years and older selected from 24 centres across 5 countries (UK, France, Germany, Italy and Spain) between July 2021 and March 2022 (IRAS: 287039). Patients attending a face-to-face appointment with a diagnosis of PsA made by a rheumatologist were selected by systematic sampling at each centre and treated in routine clinical practice. Patient and disease characteristics, current treatment and treatment decisions (medications unchanged, switched, added or reduced) were recorded. The analysis was descriptive, with no imputation of missing data. Results 503 patients were included, with arthritis subtype, patient age, disease activity and duration shown (Table 1). Physician- and patient-reported disease severity was highest in the UK, where median patient age was lowest. Conventional synthetic (cs) DMARDS constituted a higher percentage of current PsA treatment in UK than continental Europe (66.4% vs 44.9%), whereas biologic use was more frequent in Europe (68.1% vs 36.4%). Adalimumab was the most commonly used biologic in the UK and Spain. Adalimumab and secukinumab were equally used in Germany, and ixekizumab and adalimumab were joint-first in Italy. Implementing change to the current PsA treatment was most common in the UK, predominantly being a treatment increase. This may reflect the higher level of disease activity or younger patient age in the UK than other countries, as treatment escalation is more likely earlier in the disease course. In the UK, treatment escalation was more commonly achieved by medication addition (26.2%) than medication switch (14%) or dose increase (7.5%). In Europe, medication addition and switch were of more similar frequency (10.9% vs 9.85%). Conclusion Disease characteristics and treatment strategies varied between countries, but particularly between UK and the rest of Europe. In contrast to mainland Europe, csDMARDs predominated in the UK, perhaps reflecting current NICE guidelines. Treatment escalation was most common in the UK, in keeping with higher disease activity. Disclosure L. Watson: None. C. Coyle: None. M. Brooke: None. U. Kiltz: None. E. Lubrano: None. R. Queiro: None. D. Trigos: None. J. Brandt-Juergens: None. S. D'Angelo: None. A. Delle Sedie : None. E. Dernis: None. P. Helliwell: None. P. Ho: None. A. Hueber: None. B. Joven: None. M. Koehm: None. C. Montilla: None. J. Packham: None. J.P. Tasende: None. F.J.R. Garcia: None. A. Ruyssen-Witrand: None. R. Scrivo: None. S. Twigg: None. M. Welcker: None. M. Soubrier: None. T. Wirth: None. L. Gossec: Consultancies; AbbVie, Amgen, BMS, Celltrion, Galapagos, Gilead, GSK, Janssen, Lilly, MSD, Novartis, Pfizer, Sandoz, UCB. Grants/research support; Amgen, Galapagos, Lilly, Pfizer, Sandoz, UCB. L.C. Coates: None.
    Type of Medium: Online Resource
    ISSN: 1462-0324 , 1462-0332
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 1474143-X
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  • 9
    In: Rheumatology, Oxford University Press (OUP), Vol. 60, No. 11 ( 2021-11-03), p. 5292-5299
    Abstract: In PsA, the treatment objective is remission or low disease activity (LDA), but patients’ perception of remission is poorly studied. This analysis aimed to identify factors associated with patient-defined remission. Methods This analysis uses ReFlaP data, an international PsA study, with remission defined as ‘At this time, is your psoriatic arthritis in remission, if this means: you feel your disease is as good as gone?’. Variables associated with, first, patient-defined remission and, second, LDA were identified using multivariable logistic regression and principal component analysis (PCA) to explore correlated variables. Results Of 424 patients (50.2% male, mean age 52 years) with established disease, 94 (22.2%) reported themselves as being in remission and 191 (45.0%) as LDA alone. In multivariable analysis pain, psoriasis, impact of disease, physician opinion of symptoms from joint damage and Groll comorbidity index were independent predictors of remission. For LDA, results were similar. Using PCA, variance explained was 74% by five components for men and 80% by six components for women. The key component from PCA for remission was, for both sex, disease impact (Psoriatic Arthritis Impact of Disease, pain and HAQ) explaining 22.2–27.5% of variance. Other factors included musculoskeletal disease activity, chronicity/joint damage, psoriasis, enthesitis and CRP. For LDA, similar factors were identified but the variance explained was lower (64–68%). Conclusion Many factors impact on patients’ opinion of remission, dominated by disease impact. Disease activity in multiple domains, chronicity/age, comorbidities and symptoms due to other conditions contribute to a robust model highlighting that patient-defined remission is multifaceted. Trials registration Clinicaltrials.gov, http://clinicaltrials.gov, NCT 03119805.
    Type of Medium: Online Resource
    ISSN: 1462-0324 , 1462-0332
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
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