Journal Article

AB0431 MUSCULOSKELETAL ULTRASOUND ABNORMALITIES IN PATIENTS WITH PSORIASIS AT HIGH RISK OF PROGRESSION TO PSORIATIC ARTHRITIS

Gulliver, W. P., Haberman, R. H., Toprover, M., Thiele, R. G., Piguet, V., Scher, J. U., Hu, J., Tausk, F., Catron, S., Rahman, P., Neimann, A. L., Zhang, Y., Blank, R. B., Moussavi, S., Merola, J. F., Yeung, J., Eder, L., Ritchlin, C. T., Chakravarty, S. D., Gong, C., Samuels, J., Ogdie, A.

2024

Overview

Background:Psoriatic arthritis (PsA) is an immune-mediated disease associated with skin psoriasis that, if untreated, can lead to joint destruction. Up to 30% of patients with psoriasis progress to PsA and, in most cases, psoriasis precedes synovio-entheseal inflammation, providing a unique opportunity for early and potentially preventive intervention in a susceptible and readily identifiable population.Objectives:The ongoing Preventing Arthritis in a Multicenter Psoriasis At Risk cohort (PAMPA) study (NCT05004727) aims to evaluate the efficacy of the fully human interleukin (IL)-23p19-subunit inhibitor guselkumab in preventing PsA and reducing musculoskeletal ultrasound (US) abnormalities in a population of patients with psoriasis at increased risk of PsA progression. Interim findings from screening US evaluations to date are reported.Methods:Patients were screened across 5 sites in the US and Canada. PAMPA inclusion required ≥3% body surface area (BSA) affected by psoriasis, no current systemic immunosuppressant therapy at time of screening or prior exposure to biologic/JAK inhibitor, and evidence of musculoskeletal abnormalities on US. The US scanned a set of 36 joints and 34 periarticular structures (including tendons and entheses), each scored by 2 independent central readers using the Rochester Modified (RM)-PsASon scoring system (range 0-614). Participants required a mean score of ≥3.36 to enroll (the maximized Youden’s index based on previous analysis of scores in healthy controls and patients with psoriasis).Results:Among the 49 participants screened to date, 42 met US criteria. The screened population was mostly male (57.1%), white (83.7%), with an average age of 49.2 (SD 14.3) and a body mass index (BMI) of 30.6 (SD 8.6). Participants had mostly plaque psoriasis (95.1%) at the time of enrollment with a mean BSA of 10.4% (SD 11.9). The mean total US score was 13.55 (SD 10.5, range 1-50), composed of inflammatory and structural subscores (Figure 1A-B). The intraclass correlation coefficient (ICC) assessing reader agreement was 0.89 (95% CI 0.80-0.94) and ICCs on joints, tendons, and entheses were all >0.75, indicating excellent reliability (Figure 1C-F). US scores correlated with increasing age (r=0.55, p≤0.001), but did not correlate with BMI, BSA, Functional Assessment of Chronic Illness Therapy-Fatigue score, patient reported pain intensity, or sex (Figure 2).Conclusion:In a biologic-naïve cohort of patients with psoriasis at increased risk for PsA progression, 85.7% of those with US evaluation exceeded a score of 3.36, a previously identified threshold to distinguish those with psoriasis from healthy controls. The interrater reliability of the US scoring was excellent. US scores were moderately correlated with increasing age, but not with other demographic or disease activity measures, and the biological meaning of this finding is unclear. While the ongoing PAMPA study is actively recruiting for a planned enrollment of 350 participants, these preliminary findings suggest that appropriate patients are being enrolled. These data also underscore the need to better characterize clinical and imaging phenotypes of high-risk patients with psoriasis for subclinical soft tissue/structural changes that may foreshadow transition to PsA.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of Interests:Cinty Gong Employee of Janssen Research & Development, LLC, a wholly owned subsidiary of Johnson & Johnson, and own stocks in Johnson & Johnson, Rebecca H. Haberman Consultant for Janssen, UCB, Sarah Moussavi: None declared, Yan Zhang: None declared, Sydney Catron: None declared, Jonathan Samuels: None declared, Rebecca B. Blank: None declared, Michael Toprover Consultant for ANI Pharmaceuticals, Horizon Therapeutics, Jiyuan Hu: None declared, Vincent Piguet Speaker and/or advisory board member of AbbVie, Almirall, Celgene, Janssen, Kyowa Kirin Co. Ltd, LEO Pharma, Novartis, Pfizer, Sanofi, UCB, and Union Therapeutics; Department Division Director of Dermatology at the University of Toronto, Educational grants from AbbVie, Bausch Health, Celgene, Eli Lilly, Janssen, LEO Pharma, L’Oréal, NAOS, Novartis, Pfizer, Pierre-Fabre, Sandoz and Sanofi, Francisco Tausk: None declared, Jensen Yeung Speaker/consultant/honoraria/trialist for AbbVie, Amgen, Anacor, Arcutis, Astella, Bausch, Baxalta, Boehringer Ingelheim, BMS, Celgene, Centocor, Coherus, Dermira, Eli Lilly, Forward, Galderma, Janssen, Leo, Medimmune, Novartis, Pfizer, Regeneron, Roche, Sanofi Genzyme, Sun Pharma, Takeda, UCB, and Xenon, Andrea L. Neimann Consultant for AbbVie, BMS, Janssen, and UCB, Wayne P. Gulliver Consultant/advisory board member/speaker for AbbVie, Actelion, Amgen, Arylide, Bausch Health, Boehringer Ingelheim, Celgene, Cipher, Eli Lilly, Galderma, Janssen, LEO Pharma, Merck, Novartis, PeerVoice, Pfizer, Sanofi-Genzyme, Tribute, UCB, and Valeant, Research grants from AbbVie, Amgen, Eli Lilly, Novartis, and Pfizer; Clinical trial study fees from AbbVie, Asana Biosciences, Astellas, Boerhinger Ingleheim, Celgene, Corrona/National Psoriasis Foundation, Devonian, Eli Lilly, Galapagos, Galderma, Janssen, LEO Pharma, Novartis, Pfizer, Regeneron, and UCB, Joseph F. Merola Pharma Consultant and/or investigator for AbbVie, Amgen, Biogen, BMS, Dermavant, Eli Lilly, Incyte, Janssen, Leo Pharma, Novartis, Pfizer, Regeneron, Sanofi, Sun Pharma, and UCB, Alexis Ogdie Consultant for AbbVie, Amgen, BMS, Celgene, CorEvitas, Eli Lilly, Gilead, Happify Health, Janssen, Novartis, Pfizer, and UCB, Research grants to the University of Pennsylvania from AbbVie, Janssen, Pfizer and Novartis and to Forward from Amgen, Proton Rahman Consultant for AbbVie, Amgen, BMS, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, and UCB, Research grants from Janssen and Novartis, Soumya D. Chakravarty Employee of Janssen Research & Development, LLC, a wholly owned subsidiary of Johnson & Johnson, and own stocks in Johnson & Johnson, Ralf G. Thiele Consultant for Bioclinica and Novartis, Research grants from AbbVie, Eli Lilly, Janssen, Novartis, Pfizer, Sandoz, and UCB, Lihi Eder Consultant for AbbVie, Eli Lilly, Janssen, Novartis, Pfizer, and UCB, Research grants from AbbVie, Eli Lilly, Janssen, Novartis, Pfizer, Sandoz, and UCB, Christopher T. Ritchlin Consultant for AbbVie, Amgen, Eli Lilly, Gilead, Janssen, Novartis, Pfizer, and UCB, Research grants from AbbVie, Amgen, and UCB, Jose U. Scher Consultant for AbbVie, Janssen, Kaleido, Novartis, Pfizer, Sanofi, and UCB, Research grants from Janssen, Novartis, and Pfizer.

• Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism,Elsevier B.V,Elsevier Limited
• Subject: Age / Body mass index / Clinical Trial / Devonian / Disease-modifying Drugs (DMARDs) / Inflammation / Joint diseases / Monoclonal antibodies / Phenotypes / Psoriasis / Psoriatic arthritis / R&D / Randomized controlled trial / Research & development / Risk groups / Scientific Abstracts / Skin diseases / Tendons / Ultrasonic imaging / Ultrasound / Xenon