Abstract: Background/Aims  The objective of this analysis was to describe the upadacitinib (UPA) response rates of patients with psoriatic arthritis (PsA) enrolled in the SELECT-PsA-1 and SELECT-PsA-2 randomised controlled trials according to modified Psoriatic Arthritis Response Criteria (PsARC). The UK National Institute for Health and Care Excellence recommends assessing PsA treatment responses using PsARC (advanced therapy-specific time points: after weeks [W] 12, 16 or 24). Methods  PsARC responses were assessed from W2 through W24 post-initiation for patients enrolled in SELECT-PsA-1 (upadacitinib 15 mg once-daily [UPA-15mg], placebo and adalimumab 40 mg every other week [ADA] treatment arms) and SELECT-PsA-2 (UPA-15mg and placebo treatment arms). PsARC responses were derived from tender joint count 68 (TJC), swollen joint count 66 (SJC), patient global self-assessment (PtGA) and physician global assessment (PGA) and analysed using non-responder imputation. Results  UPA-15mg PsARC response rates increased progressively from W2 through to W12 in SELECT-PsA-1 (78.3%) and SELECT-PsA-2 (70.6%; see Table). Despite relatively high placebo response rates, UPA-15mg response rates were statistically significantly higher than placebo at all assessments between W2 and W24 in SELECT-PsA-1 and SELECT-PsA-2 and were statistically significantly higher than ADA from W20 (SELECT-PsA-1; see Table). Baseline characteristics (including sex, PsA duration, body mass index, tobacco use, body surface area ≥3%, enthesitis and dactylitis) were generally balanced between W24 PsARC responders and non-responders in each SELECT-PsA-1 and SELECT-PsA-2 treatment arm. Differences in PsARC response rates at W24 for UPA-15mg versus placebo (pooled SELECT-PsA-1 and SELECT-PsA-2 data) and versus ADA (SELECT-PsA-1) were similar in patients stratified by baseline characteristics and in patients receiving UPA-15mg monotherapy versus combination therapy. By W12, UPA-15mg response rates for individual PsARC components (SJC and TJC: ≥30% improvement; PtGA and PGA: ≥20% improvement) ranged between 77.6%-89.5% in SELECT-PsA-1 and between 70.1%-82.5% in SELECT-PsA-2. Conclusion  PsARC responses greater than placebo were seen as early as W2, with stable response rates from W12 in both SELECT-PsA-1 and SELECT-PsA-2. Statistically significantly higher response rates versus ADA were observed by W20. Differences in W24 PsARC responses versus placebo and versus ADA were generally consistent across baseline characteristics and UPA-15mg mono/combination therapy. P174 Table 1:Modified PsARC response rates at W2 to W24 in SELECT-PsA-1 and SELECT-PsA-2 trialsStudy and week of assessmentTreatment armResponse rate % (95% CI)Response rate difference % (95% CI) UPA-placeboResponse rate difference % (95% CI) UPA-ADASELECT-PsA-1W2Placebo (n = 423)27.2 (22.9-31.4)14.8 (8.5-21.1)*−2.3 (−9.0-4.3)ADA (n = 429)44.3 (39.6-49.0)UPA-15mg (n = 429)42.0 (37.3-46.6)W12Placebo (n = 423)54.6 (49.9-59.4)23.7 (17.6-29.9)*2.8 (−2.8-8.4)ADA (n = 429)75.5 (71.5-79.6)UPA-15mg (n = 429)78.3 (74.4-82.2)W16Placebo (n = 423)55.1 (50.3-59.8)24.4 (18.3-30.5)*1.9 (−3.6-7.4)ADA (n = 429)77.6 (73.7-81.6)UPA-15mg (n = 429)79.5 (75.7-83.3)W20Placebo (n = 423)62.4 (57.8-67.0)21.3 (15.5-27.1)*6.3 (1.0-11.6)*ADA (n = 429)77.4 (73.4-81.3)UPA-15mg (n = 429)83.7 (80.2-87.2)W24Placebo (n = 423)59.3 (54.7-64.0)24.3 (18.5-30.2)*7.0 (1.7-12.3)*ADA (n = 429)76.7 (72.7-80.7)UPA-15mg (n = 429)83.7 (80.2-87.2)SELECT-PsA-2W2Placebo (n = 212)25.5 (19.6-31.3)22.4 (13.5-31.3)*-UPA-15mg (n = 211)47.9 (41.1-54.6)W12Placebo (n = 212)36.3 (29.8-42.8)34.3 (25.4-43.2)*-UPA-15mg (n = 211)70.6 (64.5-76.8)W16Placebo (n = 212)34.4 (28.0-40.8)31.4 (22.4-40.5)*-UPA-15mg (n = 211)65.9 (59.5-72.3)W20Placebo (n = 212)41.5 (34.9-48.1)28.6 (19.6-37.7)*-UPA-15mg (n = 211)70.1 (64.0-76.3)W24Placebo (n = 212)36.3 (29.8-42.8)31.9 (22.9-40.9)*-UPA-15mg (n = 211)68.2 (62.0-74.5)SELECT-PsA-1: randomised controlled trial assessing the safety and efficacy of UPA versus placebo versus ADA in patients with PsA and prior inadequate response or intolerance to ≥ 1 non-biologic disease-modifying antirheumatic drug (DMARD).SELECT-PsA2: randomised controlled trial assessing the safety and efficacy of UPA versus placebo in patients with PsA and prior inadequate response or intolerance to ≥ 1 biologic DMARD.95% confidence intervals (95% CI) for response rates calculated based on normal approximation to the binomial distribution.95% CI for response rate difference based on normal approximation.*Statistically significant at 0.05 level; nominal p values constructed using Cochran-Mantel-Haenszel test adjusting for current disease-modifying antirheumatic drug use (yes/no). Disclosure  L.C. Coates: Consultancies; AbbVie, Amgen, Boehringer-Ingelheim, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Pfizer, Sun Pharma, and UCB. Honoraria; AbbVie, Amgen, Boehringer-Ingelheim, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Pfizer, Sun Pharma, and UCB. Member of speakers’ bureau; AbbVie, Amgen, Boehringer-Ingelheim, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Pfizer, Sun Pharma, and UCB. Grants/research support; AbbVie, Amgen, Boehringer-Ingelheim, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Pfizer, Sun Pharma, and UCB. T. Garrood: Consultancies; AbbVie, Pfizer and Gilead. Honoraria; AbbVie, Pfizer and Gilead. Grants/research support; AbbVie, Pfizer and Gilead. N. Gullick: Consultancies; AbbVie, Celgene, Eli Lilly, Izana, Janssen, Novartis and UCB. Member of speakers’ bureau; AbbVie, Celgene, Eli Lilly, Izana, Janssen, Novartis and UCB. Grants/research support; AbbVie, Celgene, Eli Lilly, Izana, Janssen, Novartis and UCB. P. Helliwell: Consultancies; Eli Lilly. Other; fees for educational services from Pfizer, Novartis and Janssen. T. Kent: Corporate appointments; Employee of AbbVie. Shareholder/stock ownership; may own AbbVie stocks. J. Marks: Honoraria; AbbVie, Gilead, Novartis, Pfizer and UCB for participation in advisory boards and to support educational activities unrelated to the publication. W. Tillett: Consultancies; Lilly, Pfizer, AbbVie, Celgene, UCB, and Novartis. Honoraria; Lilly, Pfizer, AbbVie, Celgene, UCB, and Novartis. Member of speakers’ bureau; AbbVie, Janssen and Celgene. Grants/research support; Lilly, Pfizer, AbbVie, Celgene, UCB, and Novartis. D. Kaur-Papadakis: Corporate appointments; Employee of AbbVie. Shareholder/stock ownership; may own AbbVie stocks. H. Tahir: Consultancies; Fees for consultation or participation in advisory boards from AbbVie, Novartis, Pfizer, UCB, Eli-Lilly and Janssen. Other; Education Grants from Novartis and Pfizer. S. van Haaren: Corporate appointments; Employee of AbbVie. Shareholder/stock ownership; may own AbbVie stocks. I. McInnes: Honoraria; Bristol-Myers Squibb, Celgene, Eli Lilly and Company, AbbVie, Gilead, Janssen, Novartis, Pfizer, and UCB. Grants/research support; Bristol-Myers Squibb, Celgene, Eli Lilly and Company, AbbVie, Gilead, Janssen, Novartis, Pfizer, and UCB.

Abstract: This study evaluated the scale-up of a remote monitoring (RM) service, capturing monthly Rheumatoid Arthritis Impact of Disease scores and patient-generated text messages, for patients with rheumatoid arthritis (RA; in remission or with low disease activity) attending routine outpatient clinics across six hospitals. We explored patients and staff experiences and implementation outcomes. Methods A pragmatic, mixed methods approach was used, with active patient involvement throughout. We undertook a rapid review, analysed service-level data, and conducted a patient survey and patient and staff interviews, informed by the Capability, Opportunity, Motivation, Behaviour (COM-B) and Exploration, Preparation, Implementation, Sustainment (EPIS) theoretical frameworks. Results The review included 37 articles, covering themes of patient and clinician acceptability, engagement, feasibility and clinical impact. Service-level data (n = 202) showed high levels of patient engagement with the service. The patient survey (n = 155) showed patients felt the service was easy to use, had confidence in it and felt it improved access to care. Patient interview (n = 22) findings mirrored those of the survey. Motivating factors included increased responsiveness and ease of contact with clinical teams. Views from staff interviews (n = 16) were more mixed. Some implementation barriers were specific to roll-out sites. Prioritisation of staff needs was emphasised. Conclusion Patients were positive about the service and engagement was high. Staff views and engagement were more mixed. Results suggest that equal levels of patient and staff engagement are required for sustainability. These findings further our understanding of the implementation challenges to scaling RM interventions for patients with RA in routine care settings.

Abstract: The inflammatory arthritides (IAs) make up a significant proportion of conditions followed up in rheumatology clinics. These patients require regular monitoring, but this is increasingly difficult with rising patient numbers and demand on clinics. Our objective is to evaluate the clinical impact of electronic patient‐reported outcome measures (ePROMs) as a digital remote‐monitoring intervention on disease activity, treatment decisions, and health care resource use in patients with IA. Methods Five databases (MEDLINE, Embase, PubMed, Cochrane Library, and Web of Science) were searched, with randomized controlled trials and (nonrandomized) controlled clinical trials included, and meta‐analysis and forest plots conducted for each outcome. Risk of bias was assessed using the Risk of Bias‐2 tool and Risk of Bias in Nonrandomized Studies of Interventions. Results Eight studies were included with a total of 4,473 patients, with seven studies assessing patients with rheumatoid arthritis. Compared with control, the disease activity in the ePROM group was lower (standardized mean difference [SMD] −0.15; 95% confidence interval [CI] −0.27 to −0.03) and rates of remission/low disease activity were higher (odds ratio1.65; 95% CI 1.02–2.68), but five of eight studies provided additional combined interventions (e.g., disease education). Fewer face to face visits were needed in the remote ePROM group (SMD −0.93; 95% CI −2.14–0.28). Conclusion Most studies were at high risk of bias with significant heterogeneity in design, but our results suggest there is an advantage in using ePROM monitoring in patients with IAs, with the potential for reduction in health care resource use without detrimental impact in disease outcomes.

Abstract: The COVID-19 pandemic has put health systems across the world under significant pressure. In March 2020, a national directive was issued by the National Health Service (NHS) England instructing trusts to scale back face-to-face outpatient appointments, and rapidly implement virtual clinics. Methods A multidisciplinary team of change managers, analysts and clinicians were assembled to evaluate initial implementation of virtual clinics at Guy’s and St Thomas’ NHS Foundation Trust. In-depth interviews were conducted with clinicians who have delivered virtual clinics during the pandemic. An inductive thematic approach was used to analyse clinicians’ early experiences and identify enablers for longer term sustainability. Results Ninety-five clinicians from specialist services across the trust were interviewed between April and May 2020 to reflect on their experiences of delivering virtual clinics during Wave I COVID-19. Key reflections include the perceived benefits of virtual consultations to patients and clinicians; the limitations of virtual consultations compared with face-to-face consultations; and the key enablers that would optimise and sustain the delivery of virtual pathways longer term. Conclusions In response to the pandemic, outpatient services across the trust were rapidly redesigned and virtual clinics implemented. As a result, services have been able to sustain some level of service delivery. However, clinicians have identified challenges in delivering this model of care and highlighted enablers needed to sustaining the delivery of virtual clinics longer term, such as patient access to diagnostic tests and investigations closer to home.

Abstract: Power Doppler ultrasound (PDUS) is superior to clinical examination in detecting synovitis in patients with rheumatoid arthritis (RA). Although dynamic and cheap it is impractical to scan large numbers of joints in routine clinical settings. MRI, whilst sensitive for synovitis, is expensive and routine use is limited to targeted joints. Bone scintigraphy produces whole body images but due to lower specificity is not routinely used. 99mTc-maraciclatide (Serac Healthcare) is a radio-labelled tracer which binds with high affinity to integrin αvβ3 (αvβ3), a cell-adhesion molecule up-regulated on neoangiogenic blood vessels. It therefore has the potential to image synovial inflammation at the whole-body level. We previously showed in a pilot study that uptake was seen in the inflamed joints of 5 RA patients and that this correlated with PDUS. This study explores correlation with PDUS in a larger group of patients with varied disease activities. Methods 50 patients with RA, fulfilling ACR 2010 classification criteria, were recruited. Patients underwent an ultrasound scan of 40 joints with grey scale (GS) and PD quantification. Each joint was scored on a scale of 0-3 for GS and PD with a total score calculated for each patient. Within 3 hours of the ultrasound, patients were injected with 740 MBq of 99mTc-maraciclatide. Using a gamma camera, whole body planar views and dedicated hand and foot views were taken 2 hours after injection. Acquisition time was 20 minutes for whole body, and 20 minutes for hand and foot views. 99mTc-maraciclatide images were scored as positive or negative uptake for each joint (binary score). A quantitative score was also calculated for each joint where there was uptake with this corrected for background muscle uptake. Total binary and quantitative scores per patient were calculated. Ultrasound and 99mTc-maraciclatide scores were tested for correlation with Pearson’s correlation coefficient (r) and the coefficient of determination (r2). Results Strong correlation was seen when total PDUS was compared to binary scores (r = 0.92, r2=0.85) and quantitative scores (r = 0.85, r2=0.72). p was & lt;0.0005 for all results. 99mTc-maraciclatide uptake was also seen in inflamed tendons/tendon sheaths. The imaging procedure was well-tolerated. Conclusion 99mTc-maraciclatide uptake was highly correlated with PDUS highlighting its potential as an alternative imaging modality. 99mTc-based planar imaging has the unique capacity to image the whole body and hence the total synovial inflammatory load in a quick acquisition. The imaging equipment to perform these scans is already widely available in radiology departments. Interpretation of scans is also much simpler compared to US/MRI. It could therefore have a role in key decision-making points in pathways for diagnosis, treatment failure, and remission prior to dose tapering. Disclosures L. Attipoe None. T. Garrood Grants/research support; Serac Healthcare. M. Opena None. C. Blanco-Gil None. S. Subesinghe None. S. Norton None. M. Rosser Other; Serac Healthcare Ltd. G. Cook None. A. Cope Grants/research support; AP received funding for research from BMS.

Abstract: Patients with rheumatoid arthritis are generally seen at arbitrary intervals in secondary care. Patients with active disease may not always be seen at the most appropriate time and those with low disease activity may be seen more frequently than necessary. The NHS Long Term Plan expects outpatient appointments to be reduced by up to a third, with digital transformation a key enabler. The remote capture of patient-reported outcome measures (PROMs) has the potential to facilitate more flexible and responsive outpatient services. Methods This project aimed to design a digital remote monitoring platform to test the hypothesis that PROMs can be used to proactively monitor and trigger consultations when patients need them most. The Rheumatoid Arthritis Impact of Disease (RAID) questionnaire, a validated multidimensional PROM, was used. Waiting room testing with patients informed the design of an acceptable mobile device format of the RAID. Recruitment criteria and acceptable cut-offs for defining flare were agreed by the rheumatology multidisciplinary team. Patients in low disease activity or remission (DAS & lt;3.2) were invited to the service via SMS. All patients were informed regarding the governance of handling patient data and an opt-out option was offered. Patients were sent an automated monthly SMS with a PROM link and weekly reminder SMS if required. They also had the option to send in SMS messages at other times or add free text comments. Patients submitting a RAID score of ≥ 4 received a SMS with a link to the rheumatology advice service advising a remote consultation. The SMS-based service went live in January 2019 and all incoming communication was monitored on a daily basis. Results 104 RA patients are currently using the remote monitoring service with 10.3% (13/117) opting-out. 847 monthly PROMs have been sent via SMS. The PROM completion rate has been 68.9% (range 59.0-85.1%). 120 RAID (21.8%) scored 2-≤4 indicating low disease activity and 136 RAID (24.7%) ≤ 2 indicating disease remission. 480 SMS have been sent manually to patients who have engaged in two-way communication or returned a RAID score ≥4. 44 telephone advice appointments were triggered through the remote monitoring service by patients in disease flare. 80% (35/44) of remote consultation were considered to have to have averted a face to face consultation with the remaining 20% providing advice alone. Interviews have been conducted with PROM ‘non-completers’ to learn and inform further service design. Conclusion This project has demonstrated how a user-centred design approach to utilising technology can support access to rheumatology care when patients need it most, such as disease flare. The identification of patients self-reporting low disease activity using multidimensional PROMs may enable more efficient utilisation of clinical capacity through patient-initiated appointment deferment and lead to improved patient-centred care. Disclosures M.J. Martin: Honoraria; Novartis, Abbvie. Grants/research support; National Ankylosing Spondylitis Society. N. Ng None. L. Blackler None. T. Garrood None.