Reaching RAPID3 and cDAPSA Treatment Targets Linked with Active PsA Control in DMARD-naïve Patients Treated with Apremilast
Disease-modifying anti-rheumatic drug (DMARD)-naïve patients achieving Routine Assessment of Patient Index Data 3 (RAPID3) and the Clinical Disease Activity for Psoriatic Arthritis (cDAPSA) targets with apremilast showed early and sustained improvements in 52 weeks with continued treatments, according to Dr. Philip J. Mease.
Achievement of treatment targets was associated with improvements in other areas not captured directly by RAPID3 or cDAPSA (eg, dactylitis, enthesitis). As illustrated in a prior analysis, RAPID3 low disease activity (LDA) was associated with higher residual tender joints count (TJC) than would be expected from this categorization.
Phase III PALACE 4
In the clinical trial Phase III PALACE 4, Dr. Mease and colleagues assessed the efficacy of apremilast in DMARD-naïve patients with psoriatic arthritis (PsA). Among patients receiving apremilast in the PALACE 4 trial, researchers examined trajectories for improving RAPID3 scores for those achieving cDAPSA remission or low disease activity, and PsA manifestations not measured by either outcome by week 52.
DMARD-naive patients in PALACE 4 who were randomized to receive apremilast 30 mg twice daily at baseline with available scores on RAPID3 and/or cDAPSA components at week 52 were included and grouped according to RAPID3 categories at week 52 using RA cutoffs (near REM: ≤3; low severity: >3-≤6; moderate severity: >6-≤12; and high severity: >12-30) and cDAPSA categories at week 52 (REM: ≤4; LDA: >4-≤13; moderate disease activity: >13-≤27; high disease activity: >27). Mean RAPID3 and cDAPSA scores were assessed from baseline through week 52. Other measures of PsA disease activity were reported longitudinally by RAPID3 and cDAPSA categories at week 52. RAPID3 and cDAPSA Analyses
The RAPID3 analysis included 139 apremilast patients; the cDAPSA analysis included 138 apremilast patients. Achievement of near REM or low severity (RAPID3) or REM or LDA (cDAPSA) by week 52 with apremilast were associated with improvements over time in mean RAPID3 and cDAPSA trajectories, with observable improvement at week 16. Patients achieving RAPID3 or cDAPSA treatment targets at week 52 had mild or resolved articular involvement at week 52. Achievement of treatment targets was also associated with improvements in extra-articular disease activity at week 52, although not all manifestations were as well controlled in patients achieving RAPID3 treatment targets.
In the RAPID3 and cDAPSA analyses, improvements in swollen joints count and TJC were observed for patients with REM or low severity (RAPID3) or REM or LDA (cDAPSA) at week 52. In the RAPID3 analysis, mean TJC was higher than expected at week 52 in patients achieving low severity. The Psoriasis Area and Severity Index (PASI) score was the only measure for which a pattern of greater improvement for the near RAPID3 REM/cDAPSA REM group versus the RAPID3 low severity/cDAPSA LDA group was not observed; it was numerically lower in cDAPSA REM versus LDA and numerically higher in RAPID3 REM versus low severity.
Resource: Mease P, Kavanaugh A, Ogdie A, et al. Achievement of RAPID3 and cDAPSA Treatment Targets Is Associated with Control of Articular and Extra-Articular Manifestations of Active Psoriatic Arthritis in DMARD-Naive Patients Treated with Apremilast [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/achievement-of-rapid3-and-cdapsa-treatment-targets-is-associated-with-control-of-articular-and-extra-articular-manifestations-of-active-psoriatic-arthritis-in-dmard-naive-patients-treated-with-apremil/. Accessed November 4, 2020.