ABS0436 APREMILAST VS ADALIMUMAB EFFECTIVENESS IN BIOLOGIC-NAIVE PsA

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Background: Both Apremilast (APR) and Adalimumab (ADA) are well known therapeutical strategies for the management of psoriatic arthritis (PsA) [1]. There are no direct effectiveness (i.e. survival rates) comparison between such therapies in biologic-naïve PsA patients. Objectives: To compare APR and ADA survival rates in a cohort of biologic-naïve PsA patients with low to medium disease activity. Methods: In this retrospective study, patients with low to moderate PsA (classified according to standard criteria) [2] were enrolled in several Italian centers between 2018 and 2023. The following variables were collected at baseline: age, disease duration, gender, concomitant use of csDMARDs, disease subset (axial and/or peripheral), disease activity (i.e. as DAPSA). Continuous variables are presented as medians (interquartile range - IQR) and categorical variables are presented as numbers (percentages). Survival distribution curves were computed by the Kaplan–Meier method. Cox proportional hazard multivariate models were formulated to highlight potential predictors of drug survival. Results are presented as hazard ratios (HRs) with 95% confidence intervals (95% CI). A p-value ≤ 0.05 was considered statistically significant. Results: 268 patients treated with ADA (median age 53 IQR 44-62 years, F:M 154:114, disease duration 24.5 IQR 8.0-69.3 months, DAPSA at baseline 18.0 IQR 14.0-23.0 concomitant use of csDMARDs 37.7%) and 183 with APR (median age 59 IQR 51-68 years, F:M 99:84, disease duration 30 IQR 10.8-84.3 months, DAPSA at baseline 19.4 IQR 15.9-23.4, concomitant use of csDMARDs 6.9%). No significant differences (p=0.066) in drug survival were found between the patients treated with ADA vs APR (Figure 1). The 1, 2 and 3-year retention rate of Adalimumab (75.7%, 54.2% and 38.7%, respectivel) were lower than those one of Apremilast group (84.7%, 60.4% and 52.1%, respectively) (p=0.066). As for the multivariate regression models, the concomitant use of csDMARDs (HR 1.49, 95% CI: 1.02-2.16, p=0.038), year of prescription (HR1.11 95%CI 1.00-1.23) and DAPSA at baseline (HR 1.03, 95% CI: 1.01-1.06, p=0.019) were the only predictors associated with drug discontinuation (Figure 2). Conclusion: No statistical differences were found between the survival rates of ADA and APR in a multi-centric cohort of biologic-naïve low to moderate PsA patients. Disease activity, year of prescription and concomitant use of csDMARDs were predictors associated with drug interruption. REFERENCES: [1] Gossec L, et al. Ann Rheum Dis. 2024. [2] Taylor W, et al. Arthritis Rheum. 2006. Figure 1Kaplan-Meier curve representing the survival rates of Adalimumab VS Apremilast Figure 2Forest plots showing predictive variables of drug survivalData presented as hazard ratio (HR) and 95% confidence intervals (CI). Acknowledgements: NIL . Disclosure of Interests: None declared . © The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.

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