Based on baseline disease activity, the likelihood of achieving Clinical Disease Activity Index for Psoriatic Arthritis (cDAPSA) treatment targets (remission [REM], low disease activity [LDA]) was assessed after apremilast monotherapy in disease-modifying antirheumatic drug (DMARD)-naive patients with psoriatic arthritis (PsA).

The post-hoc probability analysis of PALACE 4, a phase III, multicenter, randomized, placebo-controlled research, analyzed shifting across cDAPSA categories from baseline to week 52 and included DMARD-naive patients taking apremilast 30 mg BID with baseline cDAPSA data. Patients with week 52 cDAPSA components had their articular/extraarticular symptoms assessed. The accomplishment of the cDAPSA treatment aim was tested in a subgroup of patients with baseline extraarticular PsA symptoms (skin involvement, enthesitis, dactylitis).

At baseline, 66.3% of the 175 apremilast-treated patients in the probability analysis had high disease activity (HDA), and 31.4% had moderate disease activity (ModDA). Approximately twice as many patients in ModDA at baseline as in HDA attained REM/LDA at week 52 (61.7% vs. 28.2%). Attaining cDAPSA therapy goals were linked to decreased articular (swollen/tender joints) and extraarticular (skin involvement, enthesitis, dactylitis, functional impairment) disease activity. The subgroup with ≥1 extraarticular PsA manifestation had similar treatment target accomplishment rates (n = 126; ModDA: 66.7%, HDA: 32.2%).

Apremilast-treated patients with ModDA at baseline had a better chance of meeting cDAPSA treatment goals than patients with HDA. Patients in REM/LDA obtained remission or near resolution of articular and extraarticular PsA symptoms at week 52.

Reference: jrheum.org/content/49/7/694