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Background Comorbid conditions often accompany rheumatic diseases and can influence the prescription of immunosuppressive therapy. Comorbidity seems to be a factor that is still underestimated in actual practice. Objectives To study the influence of comorbidity on the prescription of biological and targeted therapies in patients with rheumatic diseases (RD) in clinical practice. Methods We perform a retrospective analysis of comorbidity and prescription of biological and targeted immunosuppressors in a group of in-patients with systemic autoimmune RD in rheumatology department. From January 2018 to January 2019, 218 patients with inflammatory RD hospitalized - 146 (67,5%) women, mean age 50.6±14,6 years. Diagnoses: rheumatoid arthritis - 83 patients, spondyloarthritides – 80, systemic lupus erythematosus – 19, systemic scleroderma - 16, ANCA-associated vasculitides – 10, other conditions – 10 patients. Biologics were used in 117 (53,7%) of patients (anti-TNFs – 64 patients, rituximab – 18, tocilizumab – 16, abatacept – 8, secukinumab – 4, ustekinumab – 4, tofacitinib – 3 patients). We examined patients for comorbidities through careful examination of the history, medical records, and general therapeutic laboratory and instrumental screening. The Charlson comorbidity index calculated for every patient. Results 174 (79.8%) patients had at least 1 comorbid condition. The most frequent comorbidities were type2 diabetes (19,5% patients), chronic kidney disease (12,6%), cerebrovascular accidental (11,5%), ischemic heart disease and chronic heart failure (11%), chronic liver disease (7,5%). Mean Charlson index was 2,16±2,05 in total group; it was significantly lower in patients who were treated with biological and targeted therapy (1,64±1,8) than in patients who did not received this therapy (2,76±2,1), p Conclusion Comorbidity has a direct impact on the use of biological and targeted therapy in patients with rheumatic diseases in real clinical practice, limiting the ability to control the activity of the disease. It is necessary to develop a general therapeutic strategy for treating comorbid conditions in patients with rheumatic diseases. References [1] Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Diseases. 1987; 40 (5): 373–83 Disclosure of Interests Dmitry Karateev Speakers bureau: Pfizer, Novartis, Janssen, Abbvie, Biocad, MSD, BMS, Hava Hamhoeva: None declared, Helen Luchihina Speakers bureau: Pfizer, Abbvie, Biocad, Aminat Tangieva: None declared

Background Secukinumab is the first non–tumor necrosis factor inhibitor biologic therapy approved for the treatment of ankylosing spondylitis (AS) in the United States. Patients with AS in clinical trials who receive biologics, including secukinumab, may not be representative of those treated in real-world clinical practice due to differences in patient characteristics, practice patterns, physician experience, and insurance coverage (ie, access). Few real-world studies have characterized patients with AS who initiate secukinumab. The Corrona PsA/SpA Registry collects data on a robust list of outcome measures, many of which overlap with those used in clinical trials. Objectives To describe the characteristics of patients who initiated secukinumab and other biologics for the treatment of AS in the Corrona PsA/SpA Registry. Methods This study included patients aged ≥ 18 years with AS (and without concurrent PsA diagnosis) enrolled in the Corrona PsA/SpA Registry who initiated secukinumab or other biologics (adalimumab, etanercept, certolizumab pegol, infliximab, and golimumab) between April 2017 and December 2018. Patient demographics, clinical characteristics, treatment profiles, disease activity, quality of life, and work productivity were assessed at the time of biologic initiation (baseline) and compared between patients who initiated secukinumab and other biologics using t tests or Wilcoxon rank-sum tests for continuous variables and χ2 or Fisher’s exact tests for categorical variables. Results Of the 106 patients with AS who initiated a biologic 26 (24.5%) initiated secukinumab and 80 (75.5%) initiated other biologics. Secukinumab initiators were similar to patients who initiated other biologics in terms of demographics and clinical characteristics except that a higher proportion of secukinumab initiators had a history of prior biologic use (69.2% vs 45.0%; P = 0.03) and were more likely to have used a higher number of prior biologics compared with other biologic initiators (P Conclusion In this real-world study of US patients with AS, secukinumab initiators had similar demographics, clinical outcomes, disease burden and patient reported outcomes compared with other biologic initiators, with the exception of higher prior biologic use. Acknowledgement This study was sponsored by Corrona, LLC. Corrona is supported through contracted subscriptions with multiple pharmaceutical companies. The abstract was a collaborative effort between Corrona and Novartis, with financial support provided by Novartis. Disclosure of Interests Alexis Ogdie Grant/research support from: (To my university) Novartis, Pfizer, Grant/research support from: Novartis, Pfizer, Grant/research support from: Novartis, Pfizer, Grant/research support from: Novartis, Pfizer, Consultant for: AbbVie, Bristol-Myers Squibb, Celgene, Corrona, Eli Lilly and Company, Novartis, Pfizer, and Takeda, Consultant for: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Corrona, Eli Lilly, Novartis, Pfizer Inc, Takeda, Consultant for: Abbvie, Amgen, BMS, Celgene, Corrona, Lilly, Novartis, Pfizer, Takeda, Consultant for: Abbvie, Amgen, BMS, Celgene, Corrona, Lilly, Novartis, Pfizer, Takeda, Mei Liu Employee of: M. Liu is an employee of Corrona, LLC., Sabrina Rebello Employee of: Corrona, LLC, Meghan Glynn Employee of: M. Glynn is an employee of Corrona, LLC., Robert McLean: None declared, Esther Yi Consultant for: E. Yi is a postdoctoral fellow at the University of Texas at Austin and Baylor Scott and White Health, providing services to Novartis Pharmaceuticals Corporation., Yujin Park Employee of: Y. Park is an employee of Novartis., Philip J. Mease Grant/research support from: AbbVie, Amgen, BMS, Celgene, Janssen, Lilly, Novartis, Pfizer, SUN and UCB, Consultant for: AbbVie, Amgen, BMS, Galapagos, Gilead Sciences, Inc., Janssen, Lilly, Novartis, Pfizer, SUN and UCB, Speakers bureau: AbbVie, Amgen, BMS, Celgene, Genentech, Janssen, Lilly, Novartis, Pfizer and UCB

Background Identifying patient phenotypes using machine-learning (ML) techniques amidst the variability and heterogeneity of the clinical manifestations of psoriatic arthritis (PsA) could be the first critical step towards better understanding of the disease eventually leading to individualized medicine.1 Objectives To identify distinct clusters of patients with PsA based on patients’ tender joint (TJ) and swollen joint (SJ) counts and correlation patterns among TJ and SJ counts at baseline as captured in the secukinumab FUTURE trials program. Methods Pairwise correlations were explored among 76 SJ and 78 TJ measurements of >2,700 patients with PsA across 5 phase III studies with ≈425,000 data entries at baseline and were visualized using heatmaps. Due to high correlations between SJs and corresponding TJs, a composite variable “swollen/tender joint count” was constructed for each joint. Hierarchical clustering was then performed on the composite using “1-correlation” as the dissimilarity metric and Ward’s agglomeration method for pairwise grouping of joints. A dendrogram was used to visualize and assess the resulting joint groupings. Results The hierarchical clustering algorithm grouped the 78 individual joints into distinct and natural clusters (Figure 1A). At higher level of the dendrogram, the algorithm grouped separately all foot, larger (jaws, clavicles, ankles, hips, wrists, knees, shoulders, elbows), and hand joints. Cutting the dendrogram at 15 clusters separated all the joints into distinct groups; hand joints (distal and proximal phalanges, metacarpals and thumbs), and foot joints (distal and proximal phalanges, metatarsals and big toes). Similar clustering algorithms were explored to identify patient clusters at baseline with distinct swelling and tenderness patterns across the identified joint groups. High correlation between swelling/tenderness of the left and swelling/tenderness of the corresponding right joint was observed across all individual joints (Figure 1B); a high correlation was also observed between swelling and tenderness at all individual joints. More localized patterns showed that there is a gradual decrease in correlation (from highest to lowest) among TJs and SJs in adjacent vs non-adjacent fingers, which is evident from grey-scale patterns (Figure 1C). Specifically, a gradual decrease in correlation between the swelling of 2nd distal interphalangeal joint and the tenderness of the 2nd–5th distal phalanges was noted. Conclusion Machine learning methodology confirmed a natural grouping of joints in patients with psoriatic arthritis based on baseline swelling and tenderness and revealed complex correlation patterns. Additional cluster analyses have demonstrated distinct patient clusters across the identified joint groups. Further investigating potential associations of other disease manifestations such as skin and nail involvement to define additional phenotypes may explain differences in disease pathogenesis and treatment outcomes. Reference [1] Grys BT, et al., J Cell Biol. 2017; 216(1): 65-71. Disclosure of Interests Matthias Kormaksson Shareholder of: Novartis, Employee of: Novartis, Effie Pournara Shareholder of: Novartis, Employee of: Novartis, Gregory Ligozio Shareholder of: Novartis, Employee of: Novartis, Luminita Pricop Shareholder of: Novartis, Employee of: Novartis, Ken Abrams Shareholder of: Novartis, Employee of: Novartis, Bruce Kirkham Grant/research support from: Abbvie, Janssen, Lilly, Novartis, Roche, UCB, Consultant for: Abbvie, Janssen, Lilly, Novartis, Roche, UCB, Speakers bureau: Abbvie, Janssen, Lilly, Novartis, Roche, UCB, Kristian Reich Consultant for: Abbvie, Affibody, Amgen, Biogen, Boehringer Ingelheim Pharma, Celgene, Centocor, Covagen, Forward Pharma, Fresenius Medical Care, GlaxoSmithKline, Janssen-Cilag, Kyowa Kirin, Leo, Lilly, Medac, Merck Sharp & Dohme Corp., Novartis, Miltenyi Biotec, Ocean Pharma, Pfizer, Regeneron, Samsung Bioepis, Sanofi, Takeda, UCB Pharma, Valeant, Xenoport; Speakers bureau: Abbvie, Affibody, Amgen, Biogen, Boehringer Ingelheim Pharma, Celgene, Centocor, Covagen, Forward Pharma, Fresenius Medical Care, GlaxoSmithKline, Janssen-Cilag, Kyowa Kirin, Leo, Lilly, Medac, Merck Sharp & Dohme Corp., Novartis, Miltenyi Biotec, Ocean Pharma, Pfizer, Regeneron, Samsung Bioepis, Sanofi, Takeda, UCB Pharma, Valeant, Xenoport, Iain McInnes Grant/research support from: AstraZeneca, Celgene, Compugen, Novartis, Roche, UCB Pharma, Consultant for: AbbVie, Celgene, Galvani, Lilly, Novartis, Pfizer, UCB Pharma

Background: Medication non-adherence has been associated with treatment failure in chronic inflammatory conditions. A positive relationship between patient activation and adherence to treatment and between activation and improved clinical outcomes has been shown for chronic conditions. Objectives: To measure adherence to biological therapies and targeted synthetic DMARD (tsDMARD), and their relationship with the Patient Activation Measure (PAM) and with patient and therapy related factors, for chronic inflammatory arthropathies. Methods: Cross-sectional observational descriptive study in a general tertiary university hospital. Patients on treatment with the same biological drug (subcutaneous; phase 1) or tsDMARD (oral; phase 2) for ≥6 months were included in order of arrival and those with mental disability, which prevented understanding of the study, were excluded. Demographic variables (sex, age, living environment, educational level), diagnosis and treatment were collected. Adherence was measured using the Simplified Medication Adherence Questionnaire (SMAQ) for biological therapies, the Compliance Questionnaire Rheumatology (CQR-19) for tsDMARD, and the medication possession ratio (MPR). Patients were considered adherent if MPR≥80% and CQR-19≥80% or adherent SMAQ. To measure activation, PAM questionnaire, was used. Patients were classified as activated or not activated. Statistical analysis: relationship between adherence to treatment and PAM was analyzed using chi-square, considering significance level p Results: A total of 58 patients (57% women) were included. Mean age was 54 years (95% CI: 50 to 57), 86% lived in urban areas, 40% had completed elementary education, 31% high-school and 24% university studies. Distribution by diagnosis: rheumatoid arthritis (81%), ankylosing spondylitis (14%) and psoriatic arthritis (5%). Distribution by treatment was: baricitinib (31%), tofacitinib (18%), adalimumab (16%), tocilizumab (14%), etanercept (12%), secukinumab (7%) and golimumab (3%). Median time of disease duration was 9 years (IQR 13) and time on treatment with the drug was 8 months (IQR 20), with significant differences between groups (27 (biological therapy) vs 7 months (tsDMARD)). The proportion of adherent patients was 43%, being higher among tsDMARD (57%) vs biological treated ones (30%), with significant differences. 72% of patients were activated, being more activated biological (80%) than tsDMARD (67%) treated patients. A higher adherent proportion of patients was found among the activated patients (48%) compared to the non-activated ones (27%) in all measures, even though the differences were not statistically significant. Conclusion: Patients treated with biological therapies and tsDMARD have a high degree of activation for the self-management of their disease and its treatment. Adherence to treatment may be influenced by route of administration, type of drug (oral/tsDMARD 57% vs. subcutaneous/biological 30%) and time on treatment (longer time on treatment, lesser adherence). The greater proportion of adherence found among patients with a higher degree of activation could indicate a positive relationship between activation and adherence, so analyzing and promoting patient activation seems important in order to improve adherence to drugs. Disclosure of Interests: None declared

Background Rheumatoid arthritis (RA) and psoriatic arthritis (PsA), although similar in several respects, display clinical as well as therapeutic differences. This includes, for example, the higher effectiveness of the anti-IL17A biologic secukinumab in PsA than in RA patients. Synovial fibroblasts (SF) are one of the key effector cell types in the pathophysiology of RA and PsA. We hypothesized that RASF and PsASF respond differentially to IL-17A and its biologic secukinumab and that this might contribute to the difference seen in the therapeutic response. Objectives To examine the effect of the two cytokines IL-17A and TNF-α on RASF in comparison to PsASF as well as the effect of their corresponding biologics. To analyze the effect of the IL-17A homolog IL-17F. Methods SF were isolated from synovium from PsA or RA patients undergoing surgery. SF from RA and PsA patients were stimulated with recombinant IL-17A, IL-17F and TNF-α alone or with respective combinations. Dose-response curve analysis was performed with IL-17A. The biologics secukinumab and adalimumab were used to block the effects on the SF. As a measure of the proinflammatory response, secretion of the cytokine IL–6 was quantified using an immunoassay. Results IL-6 secretion was induced by IL-17A in RASF as well as PsASF (IL-17A: 13.7-fold ↑ vs 6.9–fold ↑; n=3). Although sharing the same receptor, the IL-17A homolog IL-17F alone caused no induction of IL-6 secretion in SF. However, when combined with TNF-α, both IL-17 isoforms, IL–17A and IL-17F, increased IL-6 secretion due to a strong synergistic effect with TNF-α. RASF (n=3) responded more strongly than PsASF (n=3) to the combined stimulation (IL-17A: 544-fold ↑ vs 127-fold ↑, IL-17F: 54-fold ↑ vs 27-fold ↑). Adalimumab and secukinumab were similarly effective in abolishing the synergistic effect of IL-17A + TNF-α in RASF and PsASF. Conclusion According to our data, the differences in the therapeutic effectiveness of the anti-IL17A biologic secukinumab cannot be attributed to differential SF responses since the response to IL-17A alone and IL-17A together with TNF–α is not stronger for PsASF than for RASF and since secukinumab was similarly effective for both SF types. Furthermore, in a proinflammatory milieu with increased TNF levels, both IL-17A and IL-17F can contribute to promoting inflammation in the pathophysiology of PsA and RA. Acknowledgement Supported by an unrestricted educational grant from Celgene GmbH. Disclosure of Interests Klaus Frommer: None declared, Stefan Rehart: None declared, Ulf Muller-Ladner Grant/research support from: Projekt supported by an unrestricted educational grant from Celgene GmbH., Elena Neumann: None declared

Background Secukinumab, an inhibitor of IL-17, is a new option for the treatment of Psoriatic Arthritis (PsA) which has showed efficacy in clinical trials. However, real-world data of its use is still scarce. Objectives This study aims to analyze the experience of using secukinumab for PsA in four tertiary hospitals. Methods Multicentric observational, longitudinal, retrospective study conducted in 4 tertiary hospitals of the Madrid region. Patients with clinical diagnosis of PsA and having received at least one dose of secukinumab were included. Medical records were reviewed to collect demographic and clinical data (body mass index, BMI, risk factors cardiovascular disease, cancer, HBV/HCV infection), features of PsA (extra-articular involvement, radiological damage), previous therapies, assessment of the disease and response data at 6 months of secukinumab (joint counts, CRP, DAPSA, reasons for discontinuation, adverse events). Descriptive statistic analysis using mean and standard deviation was performed. Results 177 patients, of which 115 female (65%) were included. Mean age was 53 y.o.(SD 15) and average duration of the disease was 9 years (SD 7). 169 patients (95%) had peripheral disease (34% joint erosions), 84 (47%) had axial disease (68 with radiological damage), 148 (84%) had psoriasis, 61 (34%) showed dactilitis and 111 (63%) had enthesitis. Average BMI was 28.4 (SD 6), with an obesity rate of 37% (52 pt). Observed comorbidities were hypertension (22 pt, 12%), diabetes mellitus (22 pt, 12%), dyslipidemia (58 pt, 33%), active smoking (55 pt, 31%) and others: 20 patients had HBV infection, 5 had HCV infection and 12% had malignancy. Regarding previous treatments, 90% had received cDMARDs, particularly methotrexate (77%) and 119 (67%) had been exposed to at least one bDMARD (32% to one, 25% to two, 20% to three and 21% to four or more). 69% were on 150 mg dose and 31% on 300 mg dose. At baseline, average tender joint count was 7 (SD 8), swollen joint count was 4 (SD 4), CRP 7 mg/l and DAPSA 26. At 6 months of secukinumab therapy, tender joint count had decreased to 5 (SD 8), swollen joint count 2 (SD 3), CRP 5 mg/l and DAPSA 17. Thirty-eight (47%) of the patients with the data available (80) had DAPSA ≤14 (low activity) and 9 DAPSA ≤4 (remission). In naive to biologic patients, DAPSA varied from 27 in the baseline visit to 16 at 6 months, and in the other group of patients with biologic experience, DAPSA varied from 24 to 17 at 6 months (if they had been exposed to 3 or more biologics, DAPSA from 18 to 10 at 6 months). Average drug survival time was 20 months (1-34). 79 patients (44.6%) withdrawn therapy, due to primary ineffectiveness (40), secondary ineffectiveness (26), adverse events (9) and other reasons (3). Adverse events do not differ from those reported in clinical trials. Conclusion Secukinumab in real-world setting had been indicated in a population of PsA with a high percentage of axial involvement (47%), with an important previous exposure to biologics, and with higher comorbidity than that reported in clinical trials. Response data were favorable, 47% of patients achieved remission or low activity by DAPSA, and similar profile of adverse events to the one reported in the clinical trials was observed. References [1] Mease PJ, McInnes IB, Kirkham B, Kavanaugh A, Rahman P, van der Heijde D, et al. for the FUTURE 1 Study Group* Secukinumab Inhibition of Interleukin-17A in Patients with Psoriatic Arthritis. N Engl J Med2015;373:1329-39 Disclosure of Interests MARIA MARTIN LOPEZ: None declared, Marta Valero: None declared, Valentina Emperiale: None declared, Carolina Merino Argumanez: None declared, Javier Bachiller-Corral: None declared, Jose Campos Esteban: None declared, Ana Perez Gomez: None declared, Beatriz Joven-Ibanez Speakers bureau: Celgene, Novartis, MSD, Pfizer, AbbVie, and Janssen

Background Interleukin 17 (IL17) blockade is a therapeutic alternative for patients who are Tumor Necrosis Factor inhibitor-Inadequate Responders. However, in randomized controlled trials, cases of de novo inflammatory bowel diseases (IBD) have been reported in patients treated by IL17 inhibitors. Objectives To describe patients treated by IL 17 inhibitors developing new onset IBD (Crohn’s disease and ulcerative colitis). Methods A French national registry called MISSIL was started in February 2018 to collect the cases of these patients. This registry is conducted by rheumatologist, dermatologist and gastroenterologist learned societies specialized on immune-mediated inflammatory diseases (IMID). In France, secukinumab has been granted market authorization in June 2016 and ixekizumab in april 2018. Results 12 cases were reported between February and December 2018 : 11 patients with new onset Crohn’s disease and one with ulcerative colitis. Mean age was 51 ± 14.3 years old and 8/12 were female. 6 presented an axial spondyloarthritis, 3 a peripheral spondyloarthritis and 3 both. 9/10 were HLA-B27 positive. 4/10 have a radiographic sacroiliitis and 3/10 a MRI sacroiliitis. Only one was biological Disease-modifying antirheumatic drug (bDMARD)-naive. Crohn’s disease was mainly located at the ileum, colon and rectum. The mean time to onset of symptoms was 4.9 ± 5.6 months. The main symptoms were diarrhoea, nausea and vomiting and loss of weight. Median CRP at the onset of symptoms was 107 mg/L (66.5-200.7). 9 patients underwent biopsies. 5 were in favour of Crohn’s disease. IL17 inhibitors were consistently stopped. Patients were treated by corticosteroids (9/12), mesalazine (3/12), methotrexate (2/12), thiopurines (1/12), infliximab (3/12), adalimumab (1/12), golimumab (1/12), ustekinumab (3/12). The evolution was favourable under treatment with healing (5/12), improvement (4/12) or stabilization (1/12). One patient worsened under treatment and one died (massive myocardial infarction). Conclusion IBD under IL 17 inhibitors are rare and lead to discuss the potential iatrogenic role of IL 17 inhibitor drugs. Further cases and case control studies are needed to better characterize this complication and identify patients at risk to develop IBD under IL 17 inhibitor. Disclosure of interests Jean-Guillaume Letarouilly: None declared, Benjamin Pariente: None declared, Philippe Goupille Grant/research support from: Financial compensation received from MSD on a pro-rota basis for participation in Scientific Committee meetings and functions for this study, Speakers bureau: abbvie, Biogaran, BMS, Hospira, Janssen, MSD, Pfizer, Sanofi-Genzyme, UCB, Pascal Claudepierre Consultant for: Honoraria from Novartis as steering committe of this survey, Stephane Varin: None declared, Sylvain Lanot: None declared, Emmanuelle Dernis: None declared, Loic Le Dantec: None declared, Philippe Gaudin Speakers bureau: Roche, Chugai, BMS, abbvie, Servier, Pfizer, MSD, UCB, ESAOTE, Genevrier, Janssen, Novartis, Lilly, Biogen, amge, Denis Jullien Consultant for: abbott, Celgene, Eli Lilly, Janssen, MSD, Novartis, Pfizer, Serono UCB, Fresenius-Kabi, Biogen, Leo-Pharma and Sandoz, Speakers bureau: abbott, Celgene, Eli Lilly, Janssen, MSD, Novartis, Pfizer, Leo-Pharma, Serono, Thao Pham Speakers bureau: Lilly, Novartis, Rene-Marc Flipo Consultant for: advisory board: Bristol-Myers Squibb

Background Management of enteropathic arthritis may be challenging due to differences in treatment response of inflammatory bowel diseases and arthritis to different therapeutic modalities, which may even cause worsening of some manifestations while improving others. Enteropathic arthritis was not addressed in the management recommendations for spondyloarthritis. Objectives The aim of this project was to develop a set of evidence based recommendations for the management of patients with enteropathic arthritis. Methods A task force was formed that included ten rheumatologists and 8 gastroenterologists. Research questions were determined using a Delphi approach. A systematic literature search, data extraction, and statistical analyses were performed according to a pre-specified protocol. Studies that assessed the efficacy of an intervention on inflammatory bowel disease related outcomes and/or spondyloarthritis relates outcomes in patients with enteropathic arthritis were included. Risk ratios were calculated for binary outcomes and mean difference for continuous outcomes, whenever possible. Results of the systematic literature review were presented to the experts and recommendations were formulated after thorough discussions and voting. Results A total of 4 overarching principles and 10 recommendations were formulated. The recommendations addressed the use of NSAIDs, corticosteroids, sulfasalazine and 5-ASA derivatives, TNF inhibitors, tofacitinib, secukinumab, ustekinumab and vedolizumab among patients with active inflammatory bowel disease, active arthritis, active disease regarding both inflammatory bowel disease and arthritis, and among patients in remission. Final voting showed good agreement among the group on all recommendations. Conclusion These recommendations are intended to help rheumatologists, gastroenterologists and other clinicians dealing with enteropathic arthritis and to point out to the shortcomings of the available data on the management of this challenging condition. Disclosure of Interests Gulen Hatemi Consultant for: Abbvie, Amgen, BMS, Janssen, MSD, Pfizer, UCB, Speakers bureau: Abbvie, Amgen, BMS, Jansen, MSD, Pfizer, UCB, Servet Akar Grant/research support from: MSD, Abbvie, Roche, UCB, Novartis, Pfizer, Amgen, Consultant for: MSD, Abbvie, Roche, UCB, Novartis, Pfizer, Amgen, Speakers bureau: Pfizer, Hale Akpinar: None declared, Pamir Atagunduz: None declared, Goksel Bengi: None declared, Gercek Can: None declared, Aykut Ferhat Celik: None declared, Sinem Nihal Esatoglu: None declared, Onay Gercik: None declared, Hulya Hamzaoglu: None declared, Murat Inanc: None declared, Gokhan Kabacam: None declared, Ismail Hakki Kalkan: None declared, Levent Kilic: None declared, Fatos Onen: None declared, Ahmet Tezel: None declared, Murat Toruner: None declared, Sedat Kiraz: None declared

Background Psoriatic arthritis (PsA) is a chronic, progressive, inflammatory disorder of skin and joints, it impacts both physical and emotional well-being, and increases the risk of comorbidities. Thus, improvement of disease activity as well as emotional well-being is of utmost importance in treatment of PsA patients (pts). In clinical trials, secukinumab, an anti-interleukin (IL)-17A monoclonal antibody, has shown to significantly improve signs and symptoms of PsA1. Objectives To evaluate real-world interim data on the effectiveness of secukinumab on treatment outcomes and quality of life (QoL) in pts with active PsA. Methods AQUILA is an ongoing, 52-week (wk) non-interventional study enrolling 2000 pts with active PsA and ankylosing spondylitis. Here, we report interim results of effectiveness in a subgroup of PsA pts treated with secukinumab. Validated questionnaires were used to measure effectiveness of secukinumab on: disease activity Physician’s Global Assessment (PhGA, 0=no disease activity, 10=most intense disease activity), Psoriasis Area and Severity Index (PASI), American College of Rheumatology (ACR) joint count and C–reactive protein (CRP); and QoL Psoriatic Arthritis Impact of Disease 12–item score (PsAID–12), Medical Outcomes Study (MOS) Sleep scale and Beck’s Depression Inventory II (BDI–II). Pts who were already under secukinumab treatment or just about initiating secukinumab therapy, based on medical therapeutic need, were included; in both scenarios, disease activity at start of secukinumab treatment was used as starting point for analysis. Treatment decision was made independently of participating in this study. Pts were observed from BL up to wk 52 according to clinical routine. Real-world effectiveness of secukinumab was assessed prospectively and analyzed as observed. Results At BL, 641 PsA pts were included of whom 385 (60.1%) completed 52 wks so far (i.e. at the time of data cut-off for this interim analysis). 58.5% (n=375) of the pts were female and 41.5% (n=266) were male, mean age was 52.6 years. About 66% (n=424) were pre-treated with biologics. Mean PhGA improved from 5.3 at BL (n=571, 89.1%) to 2.5 at wk 52 (n=341, 53.2%). Mean absolute PASI improved from 8.1 at BL (n=211, 32.9%) to 1.2 at wk 52 (n=147, 22.9%). More than half of the documented pts (51 out of 94) achieved a 100% reduction (PASI 100) in skin symptoms at wk 52. The mean number of tender/swollen joints (ACR) was reduced from 7.6 (n=436, 68.0%)/3.9 (n=437, 68.2%) to 3.0 (n=241, 37.6%)/0.7 (n=242, 37.8%) at wk 52. The percentage of pts with CRP >5mg/L dropped from 43.0% at BL (n=230) to 36.6% at wk 52 (n=112). Mean PsAID-12 improved from 5.0 at BL (n=602, 93.9%) to 3.3 at wk 52 (n=343, 53.5%). The percentage of PsA pts with high disease activity (score ≥ 5) assessed by PsAID-12 dropped from 61.0% at BL (n=367) to 26.2% at wk 52 (n=90). MOS sleep scales did not change relevantly over time. With respect to pts with a BDI-II reduction of at least 3 score points, the mean value improved from 16.4 (mild depression) at BL to 8.0 (no depression) at wk 52 (n=123, 19.2%). Conclusion Secukinumab reduced disease activity and improved QoL already within this subgroup of PsA pts. Thus, real-world data from the AQUILA study show that, in clinical routine, secukinumab treatment up to one year provides a clear benefit for PsA pts in clinical and QoL parameters. References [1] Mease PJ, et al. N Engl J Med. 2015;373:1329–39 Disclosure of Interests Uta Kiltz Grant/research support from: AbbVie, Chugai, Eli Lilly, Grunenthal, Janssen, MSD, Novartis, Pfizer, Roche, and UCB., Consultant for: AbbVie, Chugai, Eli Lilly, Grunenthal, Janssen, MSD, Novartis, Pfizer, Roche, and UCB., Daniel Peterlik Employee of: Novartis Pharma GmbH, Veronika Winkelmann Employee of: Novartis Pharma GmbH, Hans-Peter Tony Consultant for: Eli Lilly and Company, Speakers bureau: Eli Lilly and Company

Background Recently, systemic inflammation has been shown to be a key determinant of prognosis. Neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), and platelet-lymphocyte ratio (PLR) has been related to inflammation status and suggested as additional markers of response to bDMARDs in patients with rheumatoid arthritis. However, few studies were yet developed about this subject in psoriatic arthritis (PsA). Objectives The aim of this study was to investigate the time-course change of NLR, MLR and PLR levels in PsA patients after 6 and 12 months of bDMARD therapy and to evaluate their clinical significance and utility in monitoring response to biologic agents. Methods An observational retrospective study was performed in patients with PsA under bDMARD, followed at our Rheumatology department until December 2018. Demographic and clinical data were collected from the national database. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and total blood count were consulted before and after 6 and 12 months of biologic treatment and NLR, MLR and PLR were calculated by dividing neutrophil, monocyte and platelet count by lymphocyte count, respectively. Disease activity was evaluated with DAS28 and ASDAS. The variation of each parameter was calculated as the difference between the levels registered at 6 and 12 months and the baseline and presented as Δ. Correlation between ΔNLR, ΔMLR and ΔPLR with ΔCRP and ΔESR levels, ΔDAS28 and ΔASDAS was calculated using the Spearman’s test. Results A total of 83 patients were included. Forty-three were females (51.8%). The mean age at diagnosis was 41 years (±11.3) and the median disease duration at start of biological therapy was 6.9 years (min:1.4; max:32.4). In total, 67.5% of the patients had axial involvement (n=56), 91.6% articular involvement (n=76) and 43.4% enthesopathic involvement (n=36). Almost all patients fulfilled the CASPAR criteria for PsA (n=78; 94%). At the baseline, 25 patients (30.1%) had high disease activity and 45 patients (54.2%) very high disease activity according to ASDAS criteria. The most used bDMARD was etanercept (n=29; 35%), followed by golimumab (n=26; 31%), adalimumab (n=16; 19%) and infliximab (n=8; 10%). Certolizumab was administered to 2 patients and secukinumab to others 2 patients. Fifty-nine patients were concomitantly treated with csDMARDs. The median value of CPR was 1.5mg/dL [0.03-30], 0.26 [0.03-11] and 0.37 [0.02-19] at baseline, 6 and 12 months, respectively. The median value of ESR was 33mm/hr [4-98], 11 [2-75] and 10 [1-68] at baseline, 6 and 12 months, respectively. We realize that NLR, MLR and PLR decreased after 6 months of treatment and remained relatively stable at 12 months (NLR median: 2.6 [0.1-8.8], 1.6 [0.5-5.3], 1.6 [0.5-8]; MLR median: 0.32 [0.11-250], 0.23 [0-7.4], 0.25 [0.05-1]; PLR median: 132 [69.6-342.5], 97.6 [33.4-415.1], 98.6 [ 38.3- 528.6] at baseline, 6 and 12 months, respectively). A significant positive correlation was found between ΔNLR and ΔCPR at 6 months (r=0.272; p=0.016) and also between ΔMLR and ΔCPR at 6 and 12 months (r=0.309, p=0.006; r=0.364, p=0.002). ΔPLR showed a statistically significant correlation only with ΔESR at 6 months (r=0.312; p=0.006). No correlation were found between ΔNLR, ΔMLR and ΔPLR with ΔDAS28 or between ΔNLR, ΔMLR and ΔPLR with ΔASDAS at evaluation of 6 and 12 months. Conclusion Our data showed that NLR, MLR decreased promptly in parallel with decrease of CRP and PLR with ESR for up 6 months of therapy with biologics. This results, in agreement with the literature, suggests that NLR, MLR and PLR may be seen as a useful marker for demonstrating systemic inflammation in PsA patients. Further studies are needed to better emphasize the importance of these parameters and to evaluate their utility to monitor the effectiveness of biologic therapy. Disclosure of Interests None declared

Background Evaluation of long-term efficacy and safety for treatments for ankylosing spondylitis (AS) is important. Secukinumab, a fully human monoclonal antibody that directly inhibits interleukin-17A, has shown significant and sustained improvement in the signs and symptoms of AS through 3 years in the MEASURE 2 study (NCT01649375).1 Objectives We report the 5-year end-of-study results of subcutaneous (s.c.) secukinumab 150 mg in the MEASURE 2 study. Methods AS patients (pts; N = 219) were randomised to receive s.c. secukinumab 150 mg, 75 mg or placebo at baseline, Weeks (Wks) 1, 2 and 3 and every 4 wks from Wk 4. At Wk 16, placebo-treated pts were re–randomised to receive secukinumab 150/75 mg. Efficacy results are reported for pts initially randomised to secukinumab 150 mg and those who switched from placebo to secukinumab 150 mg at Wk 16 (N = 106). An optional dose escalation from secukinumab 75 mg to 150 mg was initiated beginning Wk 140. Outcome measures at Wk 260 included ASAS20/40, BASDAI50, BASMI, BASFI, SF-36 PCS and ASAS partial remission. Analyses stratified by anti-TNF status (anti–TNF-naive and anti-TNF inadequate response [IR]) were performed. Safety analysis included all pts who received ≥1 dose of secukinumab. Results are reported as observed. Results The retention rate to Wk 260 was 77% (82/106) for secukinumab 150 mg. Sustained efficacy was observed with secukinumab 150 mg across all endpoints through 5 years (Table). Improvements were maintained regardless of prior exposure to anti–TNF therapy with greater responses in anti–TNF-naive pts. A total of 49 pts on secukinumab 75 mg (46.7%) escalated dose to 150 mg after Wk 140; efficacy responses improved in pts whose dose was escalated. Over the entire study period, the mean exposure (±SD) to secukinumab was 1459.1 ± 597.8 days. Exposure-adjusted incidence rates (per 100 pt-years) with any secukinumab dose for selected adverse events were: Candida infections (1.0), Crohn’s disease (0.5), major adverse cardiovascular events (0.7), uveitis (0.5), and malignant/unspecified tumours (0.5). Conclusion Secukinumab 150 mg provided sustained improvement in the signs, symptoms, and physical function in pts with AS through 5 years of treatment. The safety profile of secukinumab remained consistent with previous reports.1–3 References [1] Marzo-Ortega, et al. RMD Open. 2017;3:e000592; 2. Marzo-Ortega, et al. Ann Rheum Dis. 2016;75:812–3; 3. Baraliakos X,et al. Clin Exp Rheumatol2017. Disclosure of Interests Helena Marzo-Ortega Grant/research support from: Janssen, Novartis and Pfizer, Consultant for: AbbVie, Celgene, Janssen, Eli-Lilly, Novartis and UCB, Speakers bureau: AbbVie, Celgene, Janssen, Eli-Lilly, Novartis and UCB, Joachim Sieper Consultant for: Abbvie, Bohringer Ingelheim, Janssen, Lilly, Merck, Mylan, Novartis, Pfizer, UCB., Speakers bureau: Abbvie, Bohringer Ingelheim, Janssen, Lilly, Merck, Mylan, Novartis, Pfizer, UCB., Alan Kivitz Shareholder of: Novartis, Consultant for: Abbvie, Janssen, Pfizer, UCB, Genzyme, Sanofi, Regeneron, Boehringer Ingelheim, Sun Pharma Advanced Research, Flexion., Paid instructor for: Celgene, Horizon, Merck, Novartis, Pfizer, Genzyme, Sanofi, Regeneron, Speakers bureau: Celgene, Horizon, Merck and Genetech, Flexion, Ricardo Blanco Grant/research support from: Abbvie, MSD and Roche, Consultant for: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Martin Cohen Consultant for: AbbVie, Amgen, Celgene, Lilly, Novartis, Pfizer, Sandoz, Sanofi and UCB, Speakers bureau: AbbVie, Amgen, Celgene, Janssen, Merck, Novartis and Pfizer, Karel Pavelka: None declared, Eumorphia Maria Delicha Employee of: Novartis, Anna Stefanska Shareholder of: Novartis, Employee of: Novartis, Hanno Richards Shareholder of: Novartis Pharma AG, Employee of: Novartis Pharma AG, Susanne Rohrer Shareholder of: Novartis, Employee of: Novartis

Background The data regarding the efficacy and safety of Secukinumab (SEC) in patients with psoriatic arthritis (PsA) in daily clinical practice are scarce. Objectives To assess the safety and efficacy of SEC in patients with PsA in real life settings. Methods All PsA patients treated with SEC in the Rheumatology Units of 2 referral University Hospitals were prospectively included (from 3/2016-12/2018). Patients’ characteristics, treatments and indices of disease activity (DAPSA, DAS28-CRP, BASDAI) and function (HAQ, BASFI) as well as the extent of skin disease (BSA) were recorded at baseline and during therapy. Results 79 patients treated with SEC were included; 75% were females (n=59) with a mean age of 54±13.4 years, a median disease duration of 7.8 years and a median SEC treatment duration of 10 months (IQR 13). At baseline, 42% had axial involvement, 25% enthesitis and 13% dactylitis. The majority of patients had previously failed anti-TNFs (91%, n=72; n=1: 32%, n=2: 43% or n≥3: 25%), anti-IL12/23 (37%), both biologic agents (34%) or apremilast (5%). SEC was administered in combination with csDMARDs in 55% and corticosteroids in 40% of patients, respectively. At the end of the follow-up period (median: 15 months), patients’ disease activity (median DAPSA: 29 → 18.5, p Conclusion In a large, real life, cohort of patients with PsA, resistant to different biologics (anti-TNFs and/or anti-IL12/23), SEC displayed a high retention rate (63% after a median follow-up of 15 months) without significant side effects. These data emphasize the role of SEC as a viable therapeutic option even in patients with difficult to treat, multi-resistant PsA in daily clinical practice. Acknowledgement This work was supported by research grants from the Special Account for Research Grants (S.A.R.G.), National and Kapodistrian University of Athens, Athens, Greece Disclosure of Interests None declared

Background Secukinumab was the IL-17 inhibitor licensed for use in Psoriatic Arthritis (PsA) and Ankylosing Spondylitis (AS). The aim of this study was to evaluate the effectiveness and safety of Secukinumab in our cohort of patients. Objectives In order to assess the effectiveness and safety of Secukinumab, a retrospective analysis of patients treated with this drug in the Northern Health and Social Care Trust was undertaken. Methods Retrospective data was collected from the Local Biologic database. All patients who were on Secukinumab were selected. They were divided into two arms, Psoriatic Arthritis and Ankylosing Spondylitis. From this baseline disease severity was sought, baseline inflammatory markers and patient cohort data was collected. Patients were seen routinely at three monthly intervals and outcomes were collected up to a 12 month period. From patient notes drug response and adverse effects were recorded. Results A total of 41 patients with psoriatic arthritis were treated with Secukinumab over the 12-month period studied. Twenty-six patients were female and fifteen were male, with ages ranging from 26 to 70. Only 12 of the patients were on concomitant methotrexate, all met the NICE start criteria with required DAS 76 scores. Seven of the patients were biologic naive (17%) at commencement of drug. Of all the patients who responded, most had some response by 3 months, and all had further response by six months. Sixteen patients (39%) discontinued treatment due to no response, one due to increasing shortness of breath, wheeze and rash, and one patient developed colitis. Other side effects were noted, which did not cause the drug to be discontinued. Five patients had rash and urticaria, three reported headaches. Infections were fairly common, five patients had chest infections, four had sinusitis and three had urinary tract infections. Four patients reported thrush, one oral thrush and three vaginal. A total of 18 patients with Ankylosing Spondylitis were commenced on Secukinumab. 11 males and 7 females. A third (6/18) were biologic naive. Ages ranged from 27 to 65. In the first three months of commencement there was a reduction in BADSAI scores of all patients. This remained at six months. Inflammatory markers CRP and ESR were also reduced. Seven patients discontinued Secukinumab after six months due to side effects or lack or perceived response by the patient (seen in 1 patient). Two patients had a loss of efficacy. The remaining four patients noted cutaneous skin infections, sinus symptoms or headaches as noted in the PsA arm of the audit. Conclusion Patients in the Northern Trust starting Secukinumab generally have severe disease and most have had prior treatment with biologics. There was a high incidence of non responders in this group, however in those patients who responded there was a good response rate at 3 months, and these patients were still on treatment at 12 months. Side effects were as expected, with infections being the most commonly reported side effect. References [1] Robertson J, Tindell A, Crosbie D, Siebert S. Real-world experience of secukinumab for psoriatic arthritis and axial spondyloarthritis. Rheumatology. Volume 57. Issue suppl_3, April 2018. Acknowledgement Department of Rheumatology Antrim Area Hospital Disclosure of Interests None declared

Background There is a lack of real-life data on secukinumab exposure, treatment outcomes and retention rates in axial spondyloarthritis (axSpA) patients. Objectives Primary objective: To assess the proportion of axSpA patients in BASDAI low disease activity ( Methods Data from axSpA patients treated with secukinumab in routine care from 12 countries in the European Spondyloarthritis Research Collaboration (EuroSpA) were pooled. Time from treatment initiation to data cut was >= 6 months. Group comparisons were performed with independent t-test, Mann-Whitney U-test, ANOVA, Kruskal-Wallis and Chi-square test, as appropriate. Kaplan-Meier analyses with log rank test were performed for comparison of secukinumab drug survival. Results A total of 1556 axSpA patients were included. Overall 6-month BASDAI Drug retention was higher for bDMARD naive compared with non-naive patients (figure 1a). Baseline characteristics and disease activity (data not shown) as well as drug retention differed in-between the European registries (figure 1b). Conclusion This study of >1500 patients in 12 European countries provides real-world data on the effectiveness of secukinumab in patients with axSpA, adding evidence to existing RCTs. A majority of the patients was previous bDMARD users and had long disease duration. BASDAI Acknowledgement Novartis Pharma AG and IQVIA for supporting the EuroSpA collaboration Disclosure of Interests Brigitte Michelsen Grant/research support from: Unrestricted grant: Novartis, Consultant for: Novartis, UCB, Cecilie Heegaard Brahe Grant/research support from: Unrestricted grant: Novartis, Johan Askling Grant/research support from: Karolinska Institutet (JA) has or has had research agreements with the following pharmaceutical companies, mainly in the context of the ATRIS national safety monitoring programme for rheumatology biologicals: Abbvie, BMS, MSD, Eli Lilly, Pfizer, Roche, Samsung Bioepis, and UCB., Consultant for: Karolinska Institutet has received remuneration for JA participating in ad boards arranged by Lilly, Novartis, and Pfizer., Catalin Codreanu: None declared, Adrian Ciurea Consultant for: AbbVie, Celgene, Janssen-Cilag, MSD, Eli Lilly, Novartis, Pfizer, UCB, Speakers bureau: Abbvie, Celgene, Janssen-Cilag, MSD, Eli Lilly, Novartis, Pfizer, UCB, Anne Gitte Loft: None declared, Heřman Mann Consultant for: Pfizer, Eli Lilly, Sanofi, Speakers bureau: AbbVie, Roche, Pfizer, MSD, Eli Lilly, Sanofi, Manuel Pombo-Suarez: None declared, Fatos Onen: None declared, Joe Sexton: None declared, Ziga Rotar: None declared, Maria Jose Santos: None declared, Kari Eklund: None declared, Bjorn Gudbjornsson: None declared, Florenzo Iannone Consultant for: F Iannone has received consultancy fees and/or speaker honoraria from Pfizer, AbbVie, MSD, BMS, Novartis, Lilly, UCB outside this work, Speakers bureau: F Iannone has received consultancy fees and/or speaker honoraria from Pfizer, AbbVie, MSD, BMS, Novartis, Lilly, UCB outside this work, Daniela Di Giuseppe: None declared, Ruxandra Ionescu: None declared, Michael Nissen Consultant for: AbbVie, Lilly, Novartis, and Pfizer, Karel Pavelka: None declared, Carlos Sanchez-Piedra: None declared, Servet Akar Grant/research support from: MSD, Abbvie, Roche, UCB, Novartis, Pfizer, Amgen, Consultant for: MSD, Abbvie, Roche, UCB, Novartis, Pfizer, Amgen, Speakers bureau: Pfizer, Eirik kristianslund: None declared, Matija Tomsic: None declared, Helena Santos: None declared, Nina Trokovic: None declared, Arni Jon Geirsson: None declared, Ennio Giulio Favalli: None declared, Irene van der Horst-Bruinsma Grant/research support from: MSD, Pfizer, AbbVie, Consultant for: Abbvie, UCB, MSD, Novartis, Speakers bureau: BMS, AbbVie, Pfizer, MSD, Gary Macfarlane Grant/research support from: Have received research grants (not current) from Abbvie and Pfizer. Have received research grants (not current) from the British Society for Rheumatology, who received the funds from Abbive, Pfizer and UCB. Have received research grant (current) from the British Society for Rheumatology, who received the funds from Celgene., Lise Hyldstrup: None declared, Niels Steen Krogh: None declared, Mikkel Ǿstergaard Grant/research support from: Abbvie, Celgene, Centocor, Merck, Novartis, Consultant for: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, and UCB, Speakers bureau: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, and UCB, Merete L. Hetland Grant/research support from: BMS, MSD, AbbVie, Roche, Novartis, Biogen, Pfizer, Consultant for: Eli Lilly, Speakers bureau: Orion Pharma, Biogen, Pfizer, CellTrion, Merck, Samsung Bioepis

Background Secukinumab (SEC), a fully human monoclonal antibody to IL-17A, has demonstrated significant and sustained efficacy in patients (pts) with ankylosing spondylitis (AS) across several phase 3 studies.1-3 MEASURE 5 (NCT02896127) is a placebo (PBO)-controlled phase 3 China centric 1-year study in pts with active AS. Objectives To present the primary efficacy and safety results of the MEASURE 5 study. Methods Pts were randomised (2:1) to receive subcutaneous (s.c.) SEC 150 mg or PBO at baseline (BL), Weeks (Wks) 1, 2, 3, and 4, and then every 4 wks (q4w) thereafter through Wk 52. All PBO pts were switched to s.c. SEC 150 mg q4w starting at Wk 16. Primary endpoint was ASAS20 at Wk 16. Key secondary endpoints were ASAS40, hsCRP, ASAS5/6, BASDAI, SF-36 PCS, ASQoL and ASAS partial remission (PR). Randomisation was stratified by geographic location (China vs. non-China). Statistical analyses used non-responder imputation (NRI) for binary and mixed-effect model repeated measures (MMRM) for continuous variables. A pre-defined hierarchical testing strategy was used for overall population to adjust multiplicity. Safety analysis included all pts who received ≥1 dose of SEC. Results A total of 458 pts were randomised; 327 (71.4%) from China and 131 (28.6%) from Czech Republic, South Korea and UK. Overall, 97.7% (298/305) and 97.4% (149/153) pts in the SEC and PBO groups, respectively, completed 16 wks. BL characteristics were comparable between groups. Approximately 24% of pts were anti-TNF-inadequate responders/intolerant. The primary endpoint was met; SEC (58.4%) significantly improved ASAS20 response at Wk 16 vs. PBO (36.6%; P Conclusion SEC demonstrated rapid and significant improvement in the signs and symptoms of AS in both the overall and Chinese populations. Secukinumab was well tolerated with no new safety signals identified. References [1] Baeten D, et al. N Engl J Med. 2015;373:2534-48. [2] Pavelka K, et al. Arthritis Res Ther. 2017;19:285. [3] Kivitz AJ, et al. Rheumatol Ther. 2018;5:447-62. Disclosure of Interests Feng Huang: None declared, Fei Sun: None declared, Weiguo Wan: None declared, Lijun Wu: None declared, Lingli Dong: None declared, Xiao Zhang: None declared, Tae-hwan Kim: None declared, Raj Sengupta Grant/research support from: AbbVie, Celgene Corporation, Merck Sharp & Dohme, Novartis, Pfizer, and UCB, Speakers bureau: AbbVie, Celgene Corporation, Merck Sharp & Dohme, Novartis, Pfizer, and UCB, Ladislav Senolt Grant/research support from: AbbVie, Consultant for: AbbVie, Bristol-Myers Squibb, Celgene Corporation, Merck Sharp and Dohme, Novartis, Pfizer, Roche, UCB, Amgen, Takeda, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene Corporation, Eli Lilly, Merck Sharp and Dohme, Novartis, Pfizer, Roche, UCB, Yi Wang Shareholder of: Novartis, Employee of: Novartis, Haomin Qiu Shareholder of: Novartis, Employee of: Novartis, Brian Porter Shareholder of: Novartis, Employee of: Novartis, Sibylle Haemmerle Shareholder of: Novartis, Employee of: Novartis

Background The evolution of the disease is heterogeneous among patients with psoriatic arthritis (PsA). Specifically, the influence of gender on the disease outcomes (and the need of a more intensive treatment) has been pointed. However, data regarding this are scarce. Objectives: to analyse the disease profile in male and female patients with PsA starting biological treatment. Methods Data from an observational prospective cohort including all patients with PsA initiating biological therapy from 2002-2018 in a university hospital was conducted. Demographic information, laboratory tests, disease presentation (axial presentation, including oligoarticular affection, and poliarticular presentation), disease activity indexes (ASDAS and DAPSA for axial and peripheral-only presentations, respectively) and concomitant treatment were collected before starting biological drug. Patients were stratified by gender to compare the characteristics of the populations. Chi-squared for categorical and tstudent tests for continuous variables were used to analyse the differences between groups. Results Out of 109 included patients, 55 (51%) were males and 54 (49%) females. Baseline gender-stratified characteristics are shown in Table 1. Including the whole population of the study, mean age at diagnosis was 57 ± 14.6 years, mean PsA duration was 17.7 ± 9.2 years, and mean Body Mass Index (BMI) was 27.2 ± 4.9. Axial or oligoarticular presentation was shown in 57 patients (52%), whereas 52 patients (48%) had poliarticular manifestations. Mean baseline ASDAS was 3.2 ± 1.0 and mean baseline DAPSA was 25.4 ± 13.6. Biological therapies initiated included etanercept in 42% of the cases, infliximab in 25%, adalimumab in 19%, golimumab in 7% and secukinumab in 6%. No significant differences were observed between genders for most of the characteristics including: age at starting biologic, disease duration, BMI, smoking habit, positive HLA B27 and rheumatoid factor, baseline activity, baseline ESR, baseline CRP, baseline sulfasalazine (SSZ), baseline prednisone (PRD), baseline patient global assessment and biological drug use. However, there were substantial differences between gender in some other characteristics. While males had more frequently a predominant axial disease (p=0.01), females more frequently presented a poliarticular disease (p=0.02) and received methotrexate more frequently (p=0.02). These differences in methotrexate use might be explained by the predominance of peripheral presentation in female patients. Conclusion In clinical practice, biological therapy (TNFi and IL-17i) is prescribed in a similar frequency in male and female patients with PsA. Nevertheless, the predominant articular manifestation behind the prescription of the biological therapy is different among genders: while men have predominant axial disease, women have predominant peripheral manifestations. These differences in clinical presentation in both genders may contribute to differences in therapeutic management, such as increased use of methotrexate in women with PsA who initiate biological therapy. Disclosure of Interests Diego Benavent: None declared, Chamaida Plasencia Speakers bureau: Pfizer, MSD, Victoria Navarro-Compan: None declared, Laura Nuno: None declared, Irene Monjo: None declared, Carolina Tornero: None declared, Patricia Bogas Grant/research support from: non restricted grant from Sanofi, Juan Molina Collada: None declared, Alejandro Balsa Grant/research support from: Abbvie, Pfizer, Novartis, BMS, Nordic, Sanofi, Consultant for: Abbvie, Pfizer, Novartis, BMS, Nordic, Sanofi, Sandoz, Lilly, Paid instructor for: Pfizer, Speakers bureau: Pfizer, Novartis, UCB, Nordic, Sanofi, Sandoz, Lilly

Background Enthesitis and dactylitis are hallmarks for patients with psoriatic arthritis and mechanical injury are common risk factor for enthesitis and dactylitis [1-4]. Biologic disease modifying anti-rheumatic drugs (bDMARDs), including tumor necrosis factor alpha (TNF-α), interleukin (IL), phosphodiesterase type 4(PDE-4), Janus kinase (JAK) blockers and abatacept have shown efficacy on enthesitis and dactylitis in patients with PsA. Objectives The aims of this study are to summarize the efficacy of the bDMARDs on enthesitis and dactylitis in patients with PsA. Methods Systematically review of articles published up to Jan 2019 in Medline and Web of Science, and abstracts from the two last EUropean League Against Rheumatism (EULAR) and American College of Rheumatology (ACR) meetings. Primary endpoint was the proportion of patients with resolution of enthesitis or dactylitis from week 12 to 24. Secondary endpoint was the mean change in different enthesitis score (Leeds Enthesitis Index [LEI, 0-6], Maastricht Ankylosing Spondylitis Enthesitis Score [MASES, 0-13], PsA modified MASES [0-15]) and dactylitis score (Leeds Dactylitis Index [LDI, 0-60], dactylitis severity score [DSS, 0-60], [DSS, 0-20]) from week 12 to 24. Odds ratio (OR) and standardized mean difference (SMD) with 95% CIs across studies were synthesized. Results Nineteen studies (8,208 patients), 10 drugs (adalimumab, infliximab, certolizumab pegol, golimumab, secukinumab, ustekinumab, ixekizumab, abatacept, tofacitinib and apremilast) and 22 treatments were evaluated. Patients treated with bDMARDs were more likely to achieve resolution of enthesitis compared with placebo (OR for pooled: 1.99, 95%CI:1.74, 2.27; OR for IL blocker: 2.06, 95%CI:1.78, 2.38; OR for abatacept:1.82, 95%CI:1.05,3.14; OR for PDE4 blocker:1.67, 95%CI:1.14, 2.45) (Figure 1) and have significant improvement in terms of LEI (SMD for pooled: -2.17, 95%CI: -2.87, -1.46; SMD for tofacitinib: -3.83, 95%CI: -5.24, -2.43; SMD for TNF blocker: -1.43, 95%CI: -2.38, -0.48; SMD for ixekizumab: -1.47, 95%CI: -2.42, -0.52; Figure 2A), MASES (SMD for apremilast: -1.50, 95%CI: -2.80, -0.21; Figure 2B), PsA modified MASES (SMD for golimumab: -0.32, 95%CI: -0.52, -0.12; Figure 2C) compared with placebo. Patients treated with bDMARDs were more likely to achieve resolution of dactylitis compared with placebo (OR for pooled: 3.26, 95%CI:2.45, 4.33; OR for IL blocker: 3.88, 95%CI:2.97, 5.06; OR for abatacept:1.54, 95%CI:0.71, 3.34; OR for PDE4 blocker:1.50, 95%CI:0.97, 2.33) (Figure 3) and have significant improvement in terms of LDI (SMD for pool: -1.73, 95%CI: -3.07, -0.40; SMD for TNF blocker: -1.67, 95%CI: -3.72, 0.38; SMD for ixekizumab: -1.67, 95%CI: -3.69, 0.12; Figure 4A), DSS [0-60] (SMD for pool: -2.10, 95%CI: -3.11, -1.10; SMD for tofacitinib: -3.39, 95%CI: -4.95, -1.83; SMD for TNF blocker: -0.84, 95%CI: -1.48, -0.20; Figure 4B), DSS [0-20] (SMD for apremilast: -1.20, 95%CI: -2.07, -0.34; Figure 4C) compared with placebo. Conclusion Biologic DMARDs was effective for PsA patients with enthesiitis and dactylitis. IL blocker is probably the optimal option to consider when patients present with predominant enthesitis and dactylitis References [1] Kaeley GSet al, Semin Arthritis Rheum. 2018Aug;48(1):35-43 [2] Kaeley GSet al, Semin Arthritis Rheum. 2018Oct;48(2):263-273 [3] Schett Get al, Nat Rev Rheumatol. 2017Nov21;13(12):731-741 [4] McGonagle Det al, Nat Rev Rheumatol. 2019Feb;15(2):113-122 Disclosure of Interests None declared

Background The burden of ankylosing spondylitis (AS) is reported to be higher in female patients (pts). In addition, females show less improvement in AS outcome measures as compared to males when treated with tumour necrosis factor (TNF) inhibitors.1,2 Currently, there are no data available on the efficacy of secukinumab (SEC) in males versus females. Objectives To compare the efficacy of SEC in pts with active AS by gender (male vs female) from data pooled from four phase 3 studies (MEASURE 1-4). Methods This post hoc analysis pooled data from the MEASURE 1-4 trials. Baseline (BL) demographics and disease characteristics were summarized across genders. Efficacy outcomes assessed at Week (Wk) 16 and 52 were ASAS20, ASAS40, ASDAS-ID, BASDAI, BASMI, BASFI, SF-36 PCS and FACIT-F. BL predictor analysis used multivariable logistic regression (binary variables) or generalized linear model (continuous variables) to assess the impact of gender as an independent variable on ASAS40, ASDAS-ID, and BASDAI at Wk 52, after adjusting for treatment group and other baseline factors in a pooled analysis across studies and treatment groups. Results Overall, 647 males and 322 females who received SEC 300mg IV load (LD) (n=76), 150mg IV LD (n=199), 150mg s.c. LD (n=188), 150mg no LD (n=117), and placebo (n=389), respectively, were included in the analysis. At BL, significant differences in TNFi, HLA-B27, and smoking status were observed between genders. MASES scores were significantly higher in females; hs-CRP, BASMI-occiput to wall, and BASMI tragus to wall distance scores were significantly higher in males. Efficacy outcomes were generally similar in males and females (Figure 1). There was no significant impact of gender as an independent predictor of SEC efficacy at Wk 52 as measured by ASAS40 (Odds ratio [OR] 1.1; P=0.50), ASDAS-ID (OR 1.32; P=0.16) or change in BASDAI (treatment effect, -0.17; P=0.82). Conclusion Similar efficacy outcomes were observed in male and female patients with active ankylosing spondylitis treated with secukinumab over 52 weeks. References [1] Rusman Tet al, Int J Rheum Dis. 2018; 21: 836–42. [2] van der Horst-Bruinsma IEet al, Ann Rheum Dis. 2013;72:1221–4. Disclosure of Interests Irene van der Horst-Bruinsma Grant/research support from: MSD, Pfizer, AbbVie, Consultant for: Abbvie, UCB, MSD, Novartis, Speakers bureau: BMS, AbbVie, Pfizer, MSD, Corinne Miceli Richard Grant/research support from: MSD, Pfizer, AbbVie, Biogen, UCB, Novartis, Consultant for: Abbvie, Novartis, BMS, Juergen Braun Shareholder of: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB, Grant/research support from: Abbott, Bristol Myers Squibb, Celgene, Celltrion, Chugai, Johnson & Johnson, MSD, Novartis, Pfizer, Roche, UCB Pharma, Grant/research support from: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB, Grant/research support from: Abbvie (Abbott), Amgen, Baxter, Biogen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, Hexal, Janssen, Lilly, Medac, MSD (Schering-Plough), Mylan, Mundipharma, Novartis, Pfizer (Wyeth, Hospira), Roche, Sanofi-Aventis and UCB, Consultant for: Abbvie (Abbott), Amgen, Baxter, Biogen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, Hexal, Janssen, Lilly, Medac, MSD (Schering-Plough), Mylan, Mundipharma, Novartis, Pfizer (Wyeth, Hospira), Roche, Sanofi-Aventis and UCB, Consultant for: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB, Consultant for: Abbott, Bristol Myers Squibb, Celgene, Celltrion, Chugai, Johnson & Johnson, MSD, Novartis, Pfizer, Roche, UCB Pharma, Speakers bureau: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB, Speakers bureau: Abbvie (Abbott), Amgen, Baxter, Biogen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, Hexal, Janssen, Lilly, Medac, MSD (Schering-Plough), Mylan, Mundipharma, Novartis, Pfizer (Wyeth, Hospira), Roche, Sanofi-Aventis and UCB, Speakers bureau: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB, Weibin Bao Employee of: Novartis, Brian Porter Shareholder of: Novartis, Employee of: Novartis, Effie Pournara Shareholder of: Novartis, Employee of: Novartis

Background Reports on the prevalence of osteoporosis, osteoporotic fractures and risk factors for osteoporosis in patients with psoriasis (PSO) or psoriatic arthritis (PSOA) are scarce, and the published results on this are, at least in part, contradictory. [1] Despite the fact that IL-17 is involved in bone homeostasis under both physiologic and pathologic conditions, there is no detailed knowledge of the direct and indirect impact an IL-17 antagonist like secukinumab (SEC) has on bone mineral density (BMD). Objectives Rh-GIOP (ClinicalTrials.gov Identifier NCT02719314) is an ongoing prospective study monitoring glucocorticoid (GC)-induced osteoporosis of rheumatic patients, established in 2015 at the Charite University Hospital. For this analysis, clinical data and bone mineral density data measured by dual x-ray absorptiometry (DXA) of 936 patients with inflammatory rheumatic diseases provided the basis. The main objective of this cross-sectional analysis was to evaluate the prevalence of osteoporosis and the frequency of fractures in patients with PSO or PSOA. Additionally, patients treated with secukinumab were compared to those with methotrexate (MTX) with regard to BMD, fracture incidence, physical activity, and back pain Methods We analyzed the initial visit of 103 patients with PSO (n= 31, 74% female) or PSOA (n=72, 64% female). Descriptive analyses were performed, and values are displayed as means and standard deviations. For subgroup analyses non-parametric tests were used. Results The prevalence of osteoporosis in our patient group (mean age: 62±10 years; 67% female; mean disease duration: 17±13 years) was 19%. The prevalence of osteopenia was 26%, 34% (n=35) reported peripheral fragility fractures, and 11% (n=11) had vertebral fractures in history. Regular physical activity was reported by 41% (n=42), while 53% (n=55) suffered from movement restrictions. Back pain was present in 68% (n=70) of patients with a mean numeric rating scale of 5 (NRS; 0-10). SEC was used by 18% (n=19), and MTX by 42% (n=43, 25% sc, 13% oral, 4% unknown), respectively. Eight percent had a combination therapy of MTX and SEC. Twenty-seven percent used GC and/or other biologics/conventional disease modifying antirheumatic drugs (DMARDs). Mean glucocorticoid cumulative dose (GCCD) was 12.8±22.0g. Patients with SEC showed a significantly longer disease duration (median: 24 years vs. 13 years) compared to MTX, but showed no other differences in baseline-characteristics or risk factors. T-Scores of both femora were significantly higher in the MTX versus the SEC group. We could not find significant differences between these groups with regard to physical activity, back pain, movement restriction, fracture rates or GCCD. Twenty-five percent of the MTX users and 27% of the patients in the SEC group additionally had GC while; in contrast to no patient in the combination group. Conclusion The prevalence of osteoporosis in patients with PSO or PSOA was found to be as high as in the normal population. However, there was a high frequency of peripheral fragility, but not vertebral fractures. Patients with PSO or PSOA patients treated with SEC had a longer disease duration and lower hip BMD, but showed no differences in back pain, physical activity or movement restrictions compared to MTX users. Funding: Rh-GIOP is supported by a joint funding of Amgen, BMS, Celgene, Generic Assays, GSK, Hexal, Horizon, Lilly, medac, Mundipharma, Novartis, Pfizer, Roche, and Sanofi. References [1] Frediani, B., et al., Bone mineral density in patients with psoriatic arthritis. J Rheumatol, 2001. 28(1): p.138-43. Disclosure of Interests Desiree Freier: None declared, Edgar Wiebe Grant/research support from: Rh-GIOP is supported by a joint funding of Amgen, BMS, Celgene, Generic Assays, Chugai, Hexal AG, Horizon, Lilly, medac, Mundipharma, Novartis, Pfizer, Roche, and Sanofi., Kim Zeiner: None declared, Robert Biesen: None declared, Thomas Buttgereit: None declared, Sandra Hermann: None declared, Frank Buttgereit: None declared

Background Secukinumab (SEC), an interleukin-17A inhibitor, is approved for the treatment of ankylosing spondylitis (AS) and has been integrated into the current treatment recommendations of patients with axial spondyloarthritis (axSpA) as an alternative to tumor necrosis factor inhibitors (TNFi). The optimal use of one mode of action over the other remains unclear and longitudinal real-life data are lacking to date. Objectives To compare drug survival of SEC versus TNFi in axSpA patients having previously stopped at least one TNFi in a large prospective cohort. Methods Patients with a clinical diagnosis of axSpA in the Swiss Clinical Quality Management cohort were included if they had previously stopped treatment with at least one TNFi, initiated therapy with either SEC or a next TNFi after approval of SEC and had a baseline clinical visit. Drug survival was evaluated by Cox proportional hazards models adjusted for sex, age, Bath ankylosing spondylitis disease activity index (BASDAI), Maastricht ankylosing spondylitis enthesitis score (MASES), proportion of patients with elevated CRP, number of previous TNFi and interaction between mode of action and number of previous TNFi. Results Baseline characteristics of 382 axSpA patients included (N=107 for SEC and N=275 for next TNFi) are shown in Table 1. The proportion of patients with ≥2 TNFi administered previously was significantly higher in the SEC group. Patients starting SEC had higher baseline disease activity, more enthesitis and greater impairment of spinal mobility, function and quality of life. A history of uveitis was more prevalent in the TNFi group. No differences between the groups could be detected with regards to the reason for discontinuation of the previous TNFi. Unadjusted median (interquartile range) drug maintenance was 1.1 (0.9; 1.3) years for SEC and 2.0 (1.7; 2.2) years for TNFi (p=0.03). The adjusted hazard ratio to stop SEC vs. TNFi in patients without missing data (N=233, 61%) was 1.05 (95% CI 0.42; 2.61; p=0.91) (Table 2). Conclusion SEC was predominantly initiated in axSpA after use of at least 2 TNFi. Patients starting SEC had a higher mean disease activity than patients starting a next TNFi. Adjusted drug survival after previous withdrawal of TNFi was comparable for SEC or a next TNFi. Acknowledgement Supported by a grant from Novartis. Disclosure of Interests Christoph Tellenbach: None declared, Raphael Micheroli: None declared, Kristina Buerki: None declared, Almut Scherer Grant/research support from: Almut Scherer is an employee of SCQM, which receives funding from AbbVie, Celgene, iQONE, Lilly, MSD, Novartis, Pfizer, Roche, Sandoz, Sanofi Genzyme, and UCB., Consultant for: Consultant for Pfizer, MSD, and AbbVie, Michael Nissen Consultant for: AbbVie, Lilly, Novartis, and Pfizer, Pascal Zufferey: None declared, Pascale Exer: None declared, Burkhard Moeller Consultant for: Swissmedic Human Medicines Expert Committee Member (regulatory agency), Diego Kyburz: None declared, Adrian Ciurea Consultant for: AbbVie, Celgene, Janssen-Cilag, MSD, Eli Lilly, Novartis, Pfizer, UCB, Speakers bureau: Abbvie, Celgene, Janssen-Cilag, MSD, Eli Lilly, Novartis, Pfizer, UCB

Background Many experiments to study inflammation, hyperplasia, and fibrosis in the synovium have been performed in animal models of RA and OA. However, the predictive value of these models for the screening of potential drugs in RA is variable and for OA, none were sufficiently effective in clinical trials. Translational arthritis research with human cells is often performed in monolayer culture where the absence of extracellular matrix and other cell types results in alterations of cell functions and loss of phenotype. Objectives To improve the predictive value of preclinical arthritis research by developing and optimizing innovative translational models to study human synovial pathology in vitro and in vivo. Methods Synovial biopsies from RA patients were obtained during joint replacement surgery and processed for either (1) explant cultures, (2) 3D-synovial micromasses, (3) RA-SCID transplantation studies, and/or (4) a biobank for corresponding mRNA and IHC profiling. For explant culture, 3mm biopsies were cultured for 24hr w/o various inhibitors, and cytokine production was analyzed by Luminex. 3D-micromasses were generated from primary RA FLS and CD14+ PBMCs, stimulated for 3 weeks with 10 ng/ml TNFα or TGFβ and analyzed by histology, IHC and QPCR. For target validation and preclinical imaging, 6mm biopsies were engrafted SC into SCID mice. Radionuclide- and fluorescently-labelled anti-CD64 antibodies were injected IV, and targeting was determined by biodistribution, µSPECT/CT and IVIS imaging analysis. Results Our first assay with RA synovium explants demonstrated to be highly suitable to test the therapeutic efficacy of inhibitors for TNFα, TLR4, p38 and the JAK-pathway, resulting in significantly reduced production of proinflammatory mediators after 24hr of culture. In contrast to the explant cultures, our 3D synovial micromasses could be followed for weeks. In this second translational model, lining formation was observed at day 7 and the micromasses could be stimulated to mimic RA- or OA-like features of synovial hyperplasia or fibrosis respectively. Long-term exposure to the RA-related cytokine TNFα lead to hyperplasia of the lining and an altered macrophage phenotype characterized by reduced CD163 expression. Conversely, the repair-related growth factor TGFβ induced fibrosis-like changes in the micromass lining, a hallmark of OA. This was accompanied by an increased expression of PLOD2, COL1A1 and αSMA. Our third preclinical model, the RA synovium SCID mouse, was previously validated using adalimumab, secukinumab, and rituximab, and was now used to study CD64 as a potential marker to image synovitis. Gene expression of FCGRI (CD64) in synovial explants from RA patients was shown to correlate positively to gene expression of pro-inflammatory factors IL1B, TNFA, IL8, S100A8, MCP1, and with damage-associated genes MMP2 and MMP13. Interestingly, dual-labelled 111In-DTPA-IrDye800CW-anti-CD64 antibody showed high uptake in the synovial transplants of the SCID mice, and specifically visualized the subcutaneous synovial grafts by both µSPECT/CT and IVIS imaging. Conclusion The development of these translational models allows us to bridge the gap between preclinical and clinical drug development research. Whereas our synovial explant assay is ideal for short-term interventions, and the RA-SCID mouse a great translational model for in vivo preclinical studies, donor variability and access to sufficient tissue may be challenging. In such cases, the 3D synovial micromass model may be an excellent alternative. Especially in combined setting, these 3 translational approaches will improve target validation and preclinical development of novel anti-rheumatic drugs. Reference [1] Abdollahi-Roodsaz, J Clin Invest2008; Koenders, Arthritis Rheum 2012; Broeren, ALTEX 2019 Disclosure of Interests None declared

Background Psoriasis (PsO) and psoriatic arthritis (PsA) differentially impact patients’ quality of life (QoL) due to pain, mental changes in the context of chronic inflammation and impaired physical function. Effective anti-inflammatory therapy has shown to be effective to improve QoL in PsO and PsA patients. However, the impact of ant-inflammatory therapy on QoL may be different in the earliest stages of PsA as compared to established disease. Objectives To perform a detailed comparative investigation of the effect of interleukin (IL)-17 inhibition with 300 mg secukinumab (SEC) on QoL in patients with very early PsA/pre-PsA and established PsA. Methods Patients from the IVEPsA study (1) on very early PsA/pre-PsA (N=20) and the PSARTROS (2) study on established PsA (N=20) were longitudinally assessed for SF-36, DLQI, PsAID and HAQ-DI at baseline and after 4, 12 and 24 weeks. All patients received SEC treatment; 19/20 pre-PsA patients and 17/20 established PsA patients completed the study. Changes from baseline values were evaluated using linear mixed effects models adjusted for baseline values of each scale, gender, age and disease duration, and plotted as model coefficients and respective 95% confidence intervals that represent adjusted mean absolute improvement from baseline. Scale signs were inverted as necessary to ease interpretability. Further subgroup analysis was conducted using Mann-Whitney. Results Significant and rapid improvements were observed in both pre-PsA and established PsA treated with SEC with regard to pain (SF-36 bodily pain, BP), general health perception (GH), dermatology quality of life index (DLQI) and PsA impact of disease (PsAID), as well as in the SF-36 component scores (mental component score of SF-36, MCS and physical component score of SF-36, PCS). Physical function- oriented instruments like SF-36 physical functioning (PF), role limitation due to physical problem (RP) and HAQ-DI were preferentially affected in established PsA group due to the higher functional burden of disease (Figure). There were more differences with respect to the course of QoL improvements through week 12 and 24, as established PsA patients showed an incremental improvement in SF-36 BP, PF and GH from week 12 to 24 while most of the responses plateaued in the pre-PsA group. Furthermore, established PsA patients who achieved minimal disease activity showed a significantly higher improvement in PsAID, HAQ-DI, SF-36 PF, RP and BP (all p Conclusion Pain, mental health, general health perception and impact of disease rapidly improve in both very early PsA/pre-PsA and established PsA patients treated with SEC. These data support the concept that very early treatment of PsA leads to significant improvement in QoL with the additional benefit of prevention of bone damage as previously shown (1, 2). References [1] OP0305 Disease interception in psoriasis patients with subclinical joint inflammation by interleukin 17 inhibition with secukinumab – data from a prospective open label study. Kampylafka et al, aRD June 2018, Volume 77, Suppl. 2 [2] Resolution of synovitis and arrest of catabolic and anabolic bone changes in patients with psoriatic arthritis by IL-17A blockade with secukinumab: results from the prospective PSARTROS study. Kampylafka et al, arthritis Res ther. 2018Jul27;20(1):153 Acknowledgement This study was supported by an unrestricted grant from Novartis. Disclosure of interests Eleni Kampylafka: None declared, Matthias Englbrecht Grant/research support from: Roche Pharma aG, Chugai Pharma Europe Ltd., Consultant for: Roche Pharma aG, Chugai Pharma Europe Ltd., abbVie Deutschland GmbH & Co. KG, Celgene GmbH, Lilly Deutschland GmbH, Speakers bureau: Roche Pharma aG, Chugai Pharma Europe Ltd., abbVie Deutschland GmbH & Co. KG, Celgene GmbH, Lilly Deutschland GmbH, Koray Tascilar: None declared, Veronika Lerchen: None declared, Christina Linz: None declared, arnd Kleyer Grant/research support from: Lilly, Consultant for: Lilly, Speakers bureau: abbvie, David Simon Grant/research support from: Novartis, Consultant for: Lilly, Speakers bureau: Janssen, Jurgen Rech Grant/research support from: Bristol-Myers Squibb and Celgene (greater than $10,000), Consultant for: Bristol-Myers Squibb, Celgene, Chugai, GlaxoSmithKline, Janssen, Eli Lilly, Novartis, Roche, Sanofi aventis, and UCB (in total more than $10,000), Speakers bureau: Bristol-Myers Squibb, Celgene, Chugai, GlaxoSmithKline, Janssen, Eli Lilly, Novartis, Roche, Sanofi aventis, and UCB (in total more than $10,000), Georg Schett: None declared, axel Hueber Grant/research support from: Novartis, Pfizer, Consultant for: Lilly, Speakers bureau: Lilly, Novartis, Janssen, abbvie

Background Enthesitis can be a debilitating extra-articular spondyloarthritis (SpA) manifestation and cause of considerable pain and reduced quality of life/physical function.1,2 Objectives To evaluate the effect of secukinumab (SEC) on axial and peripheral enthesitis in ankylosing spondylitis (AS) patients (pts) with baseline enthesitis (BLE) across all Maastricht AS EnthesiS (MASES) sites (N=13), axial MASES sites [N=11; 13 MASES minus Achilles tendons (AT); AxS], peripheral sites (N=6; AT + lateral condyles of humerus/femur; PS) and the AT (N=2; AT) at Weeks (W) 16 and 52. Methods This post hoc analysis pooled data across 4 SEC studies in AS (MEASURE 1-4) from pts originally randomised to SEC 150mg (approved dose in AS), 300mg (MEASURE 3 only), or placebo (PBO) with BLE (MASES >0). Study designs have been reported previously. Evaluations include mean change from BL in MASES score, complete resolution (CR; MASES=0) and improvement from BL in MASES score of ≥5 counts. Mixed-effect model repeat measurement (MMRM) analysis was done on change from BL in MASES score and non-responder imputation for resolution of enthesitis at W16; data are reported as observed at W52. Results A total of 355 (70.4%), 58 (76.3%), and 280 (72%) pts had BLE in 150mg, 300mg and PBO groups, respectively. BL characteristics were generally comparable across groups. At W16, mean change from BL for overall MASES and at AxS was greater for SEC 150mg (-2.4 and -2.3) and 300mg (-2.9 and -2.9) vs PBO (-1.9 and -1.8; P Conclusion Secukinumab was associated with higher mean change in MASES and complete resolution of enthesitis compared to placebo at Week 16, which further improved through Week 52. References [1] Braun J, et al.Nat Clin Pract Rheumatol. 2006;2:536-45; 2. Schett G, et al. Nat Rev Rheumatol. 2017;13:731-741. Disclosure of Interests Georg Schett: None declared, Xenofon Baraliakos Grant/research support from: AbbVie, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Centocor, Chugai, Janssen, MSD, Novartis, Pfizer Inc, Roche and UCB, Grant/research support from: AbbVie, Pfizer, Merck Sharp & Dohme, UCB Pharma, Novartis, Consultant for: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Chugai, Janssen Biologics, Novartis, Pfizer, UCB Pharma, Galapagos, Speakers bureau: AbbVie, Chugai, Janssen, Novartis, Pfizer, UCB Pharma, Filip van den Bosch Consultant for: AbbVie, BMS, Galapagos, Janssen, Lilly, Merck, Novartis, Pfizer and UCB, Speakers bureau: AbbVie, BMS, Janssen, Lilly, Merck, Novartis, Pfizer and UCB., Atul Deodhar Grant/research support from: AbbVie, Amgen, Eli Lilly, GSK, Janssen, Novartis, Pfizer, and UCB, Consultant for: AbbVie, Amgen, BMS, Eli Lilly, Janssen, Novartis, Pfizer, and UCB, Lianne S. Gensler Grant/research support from: Abbvie, Amgen, UCB Pharma , Consultant for: Novartis, Lilly, Janssen, Mikkel Ǿstergaard Grant/research support from: Abbvie, Celgene, Centocor, Merck, Novartis, Consultant for: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, and UCB, Speakers bureau: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, and UCB, Shital Agawane Employee of: Novartis, Ayan Das Gupta Employee of: Novartis, Shephard Mpofu Employee of: Novartis, Todd Fox Employee of: Novartis, Adam Winseck Employee of: Novartis, Abhijit Shete Shareholder of: Novartis Pharma AG, Employee of: Novartis Pharma AG, Brian Porter Shareholder of: Novartis, Employee of: Novartis

Background Data regarding effectiveness and persistence to therapy with anti-IL17 agent secukinumab (SEC) in spondyloarthritis (SpA) patients of real world clinical practice are very limited. Objectives To assess characteristics of SpA patients starting therapy with SEC versus tumor necrosis factor inhibitors (TNFis) in routine clinical care and compare clinical responses and treatment retention at 2 years. Methods All patients starting a bDMARD in the Rheumatology Department of the University Hospital of Heraklion, Crete, are included in a prospective observational study after their written informed consent. Data concerning disease activity at pre-specified time-points, drugs, comorbidities and any adverse events are recorded. For the present study we analyzed all consecutive patients with axial (AxSpA) or peripheral SpA (pSpA) starting or switching bDMARD therapy, either a TNFi or SEC from 1/2015 till 12/2018. We excluded patients with IBD-related SpA, patients starting ustekinumab (or apremilast) and patients switching from a bio-originator to a biosimilar TNFi. We compared disease activity scores improvement at 6 months using linear regression analysis and treatment retention using Kaplan-Meier survival curves with log-rank test and Cox regression. Inverse propensity score weighting (IPW) was used to adjust for the potential confounding of gender, age, disease duration, previous bDMARDs and csDMARDs number, diagnosis (AxSpA vs pSpA), presence of peripheral arthritis and co-therapy with csDMARDs. Results A total of 239 patients with SpA started/switched bDMARD (SEC:69, TNFis:170). SEC was the ≥3rd bDMARD in 63% of patients compared to 17% of TNFis (p Unadjusted 2-year treatment retention was similar in the two groups, both overall (SEC: 63%, TNFi: 56%, p=0.18) and due to failure or adverse events. However, when we selected only patients on 1st or 2nd bDMARD (SEC:26, TNFis:131), 2-year survival of SEC was higher than that of TNFis (95% vs. 57%, p=0.027). Similarly, SEC tended to have higher survival than TNFis in patients with pSpA (p=0.11). After IPW, SEC administration was an independent predictor for higher bDMARD retention overall [HR (95%CI)=0.48(0.33-0.69), p Mean BASDAI and ASDAS improvements at 6 months were similar in patients with AxSpA receiving SEC or TNFis [Mean(SD) δBASDAI: 1.6 (2.5) vs 1.4(2.5) respectively (p=0.78) and δASDAS: 0.7 (1.4) vs 1.0 (1.5), p=0.44]. Similarly, in patients with peripheral arthritis, δDAS28 at 6 months was comparable in the two groups (p=0.88). Adjusted linear regression with IPW provided similar results to the unadjusted analyses in both axial and peripheral disease. Conclusion In SpA patients of real-world, administration of SEC results in similar clinical responses but higher treatment adherence compared to TNFis, especially if Secukinumab is the 1st or 2nd bDMARD. Larger number of patients and longer follow-up is needed to confirm these data. Disclosure of Interests None declared

Background Secukinumab (SEC) has provided significant and sustained improvement in the signs and symptoms of active psoriatic arthritis (PsA) and ankylosing spondylitis 1. Evidence on the efficacy of biologics in the treatment of PsA patients (pts) with axial manifestations affecting 30–70% of PsA pts is limited2, particularly as validated classification criteria for this subtype of PsA are not yet available; an effort to develop criteria is being undertaken by ASAS/GRAPPA. MAXIMISE is an ongoing study evaluating the efficacy and safety of secukinumab 300 or 150mg in managing axial manifestations in PsA pts Objectives To report the primary analysis results at Week (Wk) 12 from MAXIMISE (NCT02721966) trial Methods This phase 3b, double blind, placebo (PBO)-controlled, multicentre 52-wk trial included 498 pts (aged ≥18 years) with PsA (CASPAR criteria), clinician-diagnosed axial involvements, spinal pain VAS >40/100 and BASDAI >4 despite trial of at least two NSAIDs. Pts were randomised to subcutaneous (SC) SEC (300/150 mg) or PBO weekly for 4 wks and every 4 wks thereafter. At Wk 12, PBO pts were re-randomised to SC SEC 300/150 mg. The primary endpoint was proportion of pts achieving ASAS20 response with SEC 300 mg at Wk 12. The key secondary endpoint was ASAS20 response with SEC 150 mg at Wk 12 after superiority of 300 mg was established. Analyses used multiple imputation Results Demographic and baseline (BL) disease characteristics were comparable across groups (Table). Primary and key secondary endpoints were met; ASAS20 response rates at Wk 12 were 63.1% (SEC 300 mg; P Conclusion MAXIMISE is the first randomised controlled trial evaluating the efficacy of a biologic in the management of the axial manifestations of PsA. SEC 300 and 150 mg provided rapid and significant improvement in ASAS20 responses through Wk 12 in PsA pts with axial manifestations and inadequate responses to NSAIDs References [1] Lubrano E and Perrotta FM. Ther Clin Risk Manag. 2016;12:1587-92 [2] Feld J, et al. Rheum Rev.2018;14:363 M, number of pts with available HLA-B27 status Disclosure of Interests Xenofon Baraliakos Grant/research support from: AbbVie, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Centocor, Chugai, Janssen, MSD, Novartis, Pfizer Inc, Roche and UCB, Grant/research support from: AbbVie, Pfizer, Merck Sharp & Dohme, UCB Pharma, Novartis, Consultant for: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Chugai, Janssen Biologics, Novartis, Pfizer, UCB Pharma, Galapagos, Speakers bureau: AbbVie, Chugai, Janssen, Novartis, Pfizer, UCB Pharma, Laura C Coates Grant/research support from: AbbVie, Celgene, Lilly, Novartis and Pfizer, Consultant for: AbbVie, Amgen, BMS, Celgene, Galapagos, Gilead Sciences Inc., Janssen, Lilly, Novartis, Pfizer, Prothena Corp and UCB, Laure Gossec Grant/research support from: AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis-Sandoz, Pfizer, Sanofi, and UCB, Consultant for: AbbVie, Biogen, BMS, Celgene, Janssen, Lilly, MSD, Nordic Pharma, Novartis-Sandoz, Pfizer, Roche, Sanofi, and UCB, Consultant for: L Gossec has received honoraria from Celgene as investigator for this study, Slawomir Jeka: None declared, ANTONIO MERA VARELA: None declared, Barbara Schulz Employee of: Novartis, Michael Rissler Employee of: Novartis, Ayan Das Gupta Employee of: Novartis, Chiara Perella Employee of: Novartis, Effie Pournara Shareholder of: Novartis, Employee of: Novartis

Background Psoriatic arthritis (PsA), an inflammatory arthritis, manifests in joints and surrounding tendons and ligaments.1 As PsA progresses, patients may switch from 1 therapy to another, discontinue medication or use agents in combination. Previous real-world studies have demonstrated that treatment persistence and adherence rates for biologic-naive PsA patients initiating apremilast or biologics (ie, tumor necrosis factor [TNF] and interleukin [IL] inhibitors) are not different.2,3 Treatment switching is common among PsA patients. Objectives This study compares the rate of treatment switching among adult patients initiating treatment with apremilast, TNF inhibitor or IL inhibitors. Methods Adult patients with PsA were identified if they newly initiated treatment with apremilast, a TNF inhibitor (adalimumab, certolizumab, etanercept, golimumab, infliximab) or an IL inhibitor (ixekizumab, secukinumab, ustekinumab) between January 1, 2015, and December 31, 2016, and had a minimum of 12 months pre-index and post-index continuous enrollment in the Truven Health (now IBM Watson) MarketScan® Commercial and Medicare Supplemental Database. Propensity score matching, based on available demographic and clinical characteristics, up to 1:2, was utilized between apremilast and biologic patients. Switch was defined as a claim for a new PsA treatment after initiation of the index medication. Days to switch was defined as the number of days between the index date and date of switch. Adherence was assessed utilizing the proportion of days covered (PDC). Outcomes were assessed every 3 months, up to 24 months. T-test, Wilcoxon rank-sum test and chi-squared test were used to evaluate differences between cohorts for continuous and categorical variables, as appropriate. Results 471 biologic-naive PsA patients initiating apremilast were matched to 890 biologic-naive PsA patients initiating biologics (TNF: n=804; IL: n=86). Patient characteristics were similar between the 3 cohorts (mean age: 50 years; Charlson Comorbidity Index: 0.58 [apremilast], 0.55 [TNF] and 0.56 [IL]). There was a greater proportion of females in the apremilast vs IL cohorts (55% vs 42%; P=0.0249) and a lower proportion of patients with prior PsA systemic treatment (59% vs 79%; P=0.0046). In the TNF cohort, 64% patients received adalimumab, 29% etanercept, 4% infliximab, 2% certolizumab and 1% golimumab. In the IL cohort, 78% of patients received ustekinumab, 21% secukinumab and 1% ixekizumab. At 12 months, significantly fewer patients initiating apremilast switched treatment compared with those initiating TNF inhibitors (15.5% vs 26.6%; P Conclusion Biologic-naive PsA patients initiating apremilast demonstrated lower switch rates vs biologic-naive PsA patients initiating TNF inhibitors in a large US administrative claims database. No difference in rates of switching was observed between apremilast and IL patients. Reference [1] Stankler L. Clin Exp Dermatol. 1981;6:303-6. 2. Wu JJ. Poster presented at: ISPOR 2018. 3. Curtis JR. Poster presented at: ISPOR Europe 2018. Disclosure of Interests David Kaplan Consultant for: Celgene Corporation, Speakers bureau: Celgene Corporation. Abbvie, Pfizer, Brian Ung Shareholder of: Celgene Corporation, Employee of: Celgene Corporation, Corey Pelletier Shareholder of: Celgene Corporation, Employee of: Celgene Corporation, Chuka Udeze Shareholder of: Celgene Corporation, Employee of: Celgene Corporation, Marc Tian Shareholder of: Celgene Corporation, Employee of: Celgene Corporation

Background Secukinumab is a newly introduced biologic therapy against IL-17 which has been approved for Psoriatic arthritis and has showed efficacy in clinical trials, but real world data is still lacking. Objectives This study aims to analize secukinumab drug survival for psoriatic arthritis in a real world environment. Methods Multicentric observational, longitudinal retrospective study conducted at 4 tertiary hospitals in Madrid region. Patients with clinical diagnosis of psoriatic arthritis which had received at least one dose of secukinumab between january 2016 and october 2018 were included. With follow up period till December 31, 2018. Medical records were reviewed to collect data about psoriatic arthritis involvement, comorbidities, previos DMARD and bDMARD therapies and its reasons for discontinuation, duration of secukinumab therapy, reasons for discontinuating secukinumab therapy and adverse events. Statistical analysis was performed including bivariate analisys (considering withdrawal of drug during study period or not) and survival analysis with Kaplan-Meier and Cox regression. Results 177 patients that initiated secukinumab therapy in the recruitment period were included. 123 pacients were on 150 mg dose and 54 on 300 mg dose. Average follow up period was 13 months (SD 8,28; range 1-34) in the bivariate analysis, a higher proportion of biologic-naive patients was found among the group without secukinumab withdrawal during the study (40% vs 23%, p 0.07). No other differences were observed between both groups regarding demographic characteristics nor comorbidities (tobacco exposure, hypertension, diabetes mellitus, dyslipidemia, ischemic heart disease or malignancy). Median survival time for secukinumab in the Kaplan-Meier analysis was 21.2 months (IC 95%: 14.3 - 22.2), with an average of 19,9 months. One event was censored due to lost to follow-up. Secukinumab treatment was withdrawn in 79 patients (44.6%). Reasons for discontinuation were lack of effectiveness (37%), either primary (40 patients) or secondary (26 patients), adverse events (9 patients, 0,5%), elective surgery in one patient and latex allergy in other. The only variable associated to higher drug survival in Cox regression analysis was biologic-naive status. No differences in drug survival were found in all other variables studied (gender, age, secukinumab dosage, illness duration, clinical features, tobacco exposure and rest of comorbidities). Conclusion As secukinumab was marketed in 2016, real-word setting studies lack long term data. The mean follow up period in our study was 13 months. Most of withdrawals were to lack of effectiveness. Median survival was 21.2 months, significatively higher in biologic-naive patients. No other differences were found in all other variables studied. Probably real-world data differ from those of clinical trials. Disclosure of interests Marta Valero: None declared, Beatriz Joven-Ibanez Speakers bureau: Celgene, Novartis, MSD, Pfizer, abbVie, and Janssen, Maria Martin: None declared, Jose Campos Esteban: None declared, Carolina Merino argumanez: None declared, Valentina Emperiale: None declared, ana Perez Gomez: None declared, Javier Bachiller-Corral: None declared

Background The primary treatment goal in patient with axial Spondyloarthritis (axSpA) is to optimize health-related quality of life through control of signs and symptoms, no structural damage progression and preservation of function.1 The 2017 Treat to Target recommendations (T2T) outlined Ankylosing Spondylitis Disease Activity Score (ASDAS) -inactive disease (ID) as an optimal treatment target for axSpA patients.1 ASDAS states were shown to correlate with syndesmophyte formation as assessed with X-Ray and MRI changes.2 Secukinumab, a fully human monoclonal antibody that directly inhibits IL-17A, demonstrated sustained efficacy and low radiographic progression through 4 years in patient with ankylosing spondylitis (AS) in MEASURE 1 study (NCT01863732).3 Objectives To investigate the relationship between ASDAS states and inhibition of radiographic structural progression in patient with AS treated with secukinumab 150 mg from the MEASURE 1 study over 4-years using post hoc analysis. Methods Lateral radiographs of the cervical and lumbar spine were assessed using the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS: range 0-72). Images were scored twice at baseline/Week (Wk) 104 and baseline/Wk 208 by 2 central readers blinded to treatment/visit; mean change from baseline to Wk 104 or 208 in mSASSS scores were used. The ASDAS-CRP was used to define the disease activity states at Wks 16, 52, 104, and 208: ID (ASDAS-CRP Results The proportion of patients achieving each ASDAS state are shown in Table. Patients with ASDAS-ID were associated with numerically lower mSASSS mean change from baseline to Wks 104/208 compared to other ASDAS states (Figure). Conclusion In this post hoc analysis, patients with ASDAS-ID state and sustained ASDAS-ID state had lower radiographic progression than patients with higher disease activity at 2 and 4-years suggesting a potential relationship between ASDAS state and structural progression in patients with AS. Further confirmation is needed in larger prospective studies. References [1] Smolen JS, et al. Ann Rheum Dis. 2018;77:3-17. [2] Poddubnyy D, et al. Ann Rheum Dis. 2014;73:422. [3] Braun J, et al. Rheumatology (Oxford)2018. Doi: 10.1093/rheumatology/key375. Disclosure of Interests Xenofon Baraliakos Grant/research support from: AbbVie, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Centocor, Chugai, Janssen, MSD, Novartis, Pfizer Inc, Roche and UCB, Grant/research support from: AbbVie, Pfizer, Merck Sharp & Dohme, UCB Pharma, Novartis, Consultant for: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Chugai, Janssen Biologics, Novartis, Pfizer, UCB Pharma, Galapagos, Speakers bureau: AbbVie, Chugai, Janssen, Novartis, Pfizer, UCB Pharma, Helena Marzo-Ortega Grant/research support from: Janssen, Novartis and Pfizer, Consultant for: AbbVie, Celgene, Janssen, Eli-Lilly, Novartis and UCB, Speakers bureau: AbbVie, Celgene, Janssen, Eli-Lilly, Novartis and UCB, Filip van den Bosch Consultant for: AbbVie, BMS, Galapagos, Janssen, Lilly, Merck, Novartis, Pfizer and UCB, Speakers bureau: AbbVie, BMS, Janssen, Lilly, Merck, Novartis, Pfizer and UCB., Atul Deodhar Grant/research support from: AbbVie, Amgen, Eli Lilly, GSK, Janssen, Novartis, Pfizer, and UCB, Consultant for: AbbVie, Amgen, BMS, Eli Lilly, Janssen, Novartis, Pfizer, and UCB, Erhard Quebe-Fehling Shareholder of: Novartis, Employee of: Novartis, Eumorphia Maria Delicha Employee of: Novartis, Zsolts Talloczy Shareholder of: Novartis, Employee of: Novartis, Corine Gaillez Shareholder of: Novartis, BMS, Employee of: Novartis

Background: Tofacitinib (TOFA) is the first inhibitor of JAK kinases with approval for the treatment of psoriatic arthritis (PsA) in Europe (July 2018)1. ToFA has shown efficacy in refractory patients to anti-TNF2. Objectives: A) to assess efficacy and safety of TOFA in the first cases in Spain in clinical practice. B) to compare the profile of clinical practice patients with clinical trial. Methods: Study of 41 patients of clinical practice with PsA treated with TOFA in Spain. The diagnosis of PsA was made using CASPAR criteria. Patients who received at least one dose of TOFA were included. Results are expressed as percentage, mean±SD or median [IRQ]. Results: 41 patients (23♀/18♂), mean age of 50.2±10.7 years (table 1). Pattern joint involvement was as follows: peripheral (n=25), axial (1) and mixed (15). During the PsA evolution, in addition to arthritis, patients also presented enthesitis (60.9%), nail involvement (39%) and dactylitis (31.7%). Prior TOFA, most patients had received oral prednisone or equivalent (max. 17.9±13.6 mg/d), synthetic immunosuppressants (mean 1.9±0.7) and biological therapy (TB) (3.4±1.9). TB were as follows: etanercept (29), adalimumab (29), infliximab (16), golimumab (13), certolizumab (14), secukinumab (30), ustekinumab (22). Apremilast was used in 10. After a mean follow-up of 12.6±9.1 years after the PsA diagnosis, TOFA was started (5 mg/12 h). 60.9% associated prednisone (9.4±6.1 mg/d). In 17 (41.5%) TOFA was started in combined therapy: methotrexate (9) and leflunomide (8); in the remaining 24, monotherapy was prescribed. In addition to active arthritis patients presented skin involvement (53.6%), enthesitis (26.8%), nail involvement (29.2%) and dactylitis (17.1%). Patients of clinical practice compared with clinical trial have a longer duration of PsA, functional disability (HAQ) and received a higher proportion of corticosteroids and TB (anti-TNF and non-anti-TNF) (table 1). After a median follow-up of 4 [3-10.5] months, patients showed prompt improvement in the main variables, both in activity indexes (PASI, DAS28, DAPSA) and laboratory test (table 2). Minor side effects were reported in 10 patients (gastrointestinal symptoms), and TOFA was discontinued in 1 due to persistent symptoms. Conclusion: In this preliminary study, first patients of clinical practice in Spain with TOFA in PsA had a longer evolution and received a greater number of TB than those of clinical trial. As in the TOFA clinical trial, it seems effective, rapid and relatively safe in daily clinical practice for refractory PsA. References [1] https://www.ema.europa.eu/documents/overview/xeljanz-epar-medicine-overview_es.pdf [2] Gladman D. N Engl J Med2017; 377: 1525-36. Disclosure of interests: Jose Luis Martin-Varillas: None declared, Eva Galindez: None declared, Esteban Rubio Romero: None declared, agusti Sellas-Fernandez: None declared, Roberto Daniel Gonzalez Benitez: None declared, Beatriz Joven-Ibanez Speakers bureau: Celgene, Novartis, MSD, Pfizer, abbVie, and Janssen, Jose Campos Esteban: None declared, Olga Rusinovich: None declared, Vanesa Calvo-Rio: None declared, Francisco Ortiz-Sanjuan: None declared, Clara Ventin-Rodriguez: None declared, Luis Fernandez-Dominguez Speakers bureau: Celgene, Novartis, Janssen, antia Crespo Golmar: None declared, Ximena Elizabeth Larco Rojas: None declared, Manuel Moreno : None declared, alejandro Escudero Contreras: None declared, Emma Beltran: None declared, Rafael Melero: None declared, Maria jose Moreno: None declared, Enrique Raya: None declared, Beatriz arca: None declared, Maria-Luisa Peral: None declared, Olga Maiz: None declared, Raul Veroz Gonzalez: None declared, alfonso Corrales: None declared, Natalia Palmou-Fontana: None declared, Belen atienza-Mateo: None declared, J. Loricera: None declared, Miguel a Gonzalez-Gay Grant/research support from: Prof. MA Gonzalez-Gay received grants/research supports from abbvie, MSD, Jansen and Roche., Speakers bureau: Consultation fees/participation in company sponsored speaker’s bureau from Pfizer, Lilly, Sobi, Celgene, Novartis, Roche and Sanofi., Ricardo Blanco Grant/research support from: abbvie, MSD, and Roche, Consultant for: abbvie, Pfizer, Roche, Bristol-Myers, Janssen, Speakers bureau: abbvie, Pfizer, Roche, Bristol-Myers, Janssen

Background: Secukinumab, a fully human interleukin 17 (IL-17A) monoclonal antibody, has demonstrated efficacy in psoriatic arthritis (PsA) in phase 3 clinical trials.1–4 The PsA core domain set, updated by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) and endorsed by Outcome Measures in Rheumatology (OMERACT), aims to improve and standardize the assessment of PsA outcomes.5 Objectives: To report the efficacy of secukinumab vs placebo across individual PsA core domains at week 16 in patients naive to tumor necrosis factor (TNF) inhibitors or who were inadequate responders (TNF-IR), using pooled data from 4 phase 3 FUTURE studies. Methods: Patients with active PsA participated in the phase 3 FUTURE 2, 3, 4, and 5 trials.1–4 Data were pooled for secukinumab 150 mg (load vs. no load), 300 mg, or placebo at the end of the 16-week double-blind period. Efficacy was assessed using multiple clinical and laboratory measures to evaluate the updated GRAPPA-OMERACT PsA core domain set for disease activity, pain, function, and quality of life (Table 1). Results: A total of 2049 patients were included (1436 TNF naive and 613 TNF-IR). Baseline demographics and disease characteristics were broadly similar in all treatment groups. Efficacy results for the core inner circle domains are shown in Table 1. Conclusion: Secukinumab demonstrated efficacy compared with placebo across GRAPPA-OMERACT PsA core domains in the phase 3 clinical trials program, regardless of prior TNF inhibitor use. Reference [1] McInnes IB, et al. Rheumatology. 2017;56:1993-2003; 2. Nash P, et al. Arthritis Res Ther. 2018;20:47; 3. Kivitz A, et al. PANLAR 2018 [abstract 364]; 4. Mease PJ, et al. Ann Rheum Dis. 2018;77:890-897; 5. Orbai AM, et al. Ann Rheum Dis. 2017;76:673-680. Disclosure of Interests: Ana-Maria Orbai Grant/research support from: AbbVie, Celgene, Horizon Pharma, Janssen, Lilly, and Novartis, Consultant for: Lilly, Janssen, Novartis, Pfizer, and UCB, M Elaine Husni Grant/research support from: Janssen, Dafna D Gladman Grant/research support from: AbbVie, Amgen, Celgene, Lilly, Novartis, Pfizer, and UCB, Consultant for: AbbVie, Amgen, BMS, Celgene, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, and UCB, Ying Ying Leung Grant/research support from: Abbvie, Novartis, Speakers bureau: Abbvie and Novartis, Speakers bureau: Novartis, Stefan Siebert Grant/research support from: AbbVie, Novartis, Pfizer, Janssen, BMS, Celgene, UCB, and Boehringer Ingelheim, Consultant for: AbbVie, UCB, Pfizer, Janssen, Boehringer Ingelheim, Celgene, and Novartis, Speakers bureau: AbbVie, UCB, Pfizer, Janssen, Boehringer Ingelheim, Celgene, and Novartis, William Tillett Grant/research support from: AbbVie, Celgene, and Lilly, Consultant for: AbbVie, Celgene, Lilly, Novartis, and Pfizer, Speakers bureau: Abbvie, Celgene, Lilly, Janssen, Novartis, UCB, and Pfizer, Marijn Vis Grant/research support from: Novartis, Olivier Chambenoit Shareholder of: Novartis, Employee of: Novartis, Xiangyi Meng Shareholder of: Novartis, Employee of: Novartis, Philip J Mease Grant/research support from: AbbVie, Amgen, BMS, Celgene, Janssen, Lilly, Novartis, Pfizer, SUN and UCB, Consultant for: AbbVie, Amgen, BMS, Galapagos, Gilead Sciences, Inc., Janssen, Lilly, Novartis, Pfizer, SUN and UCB, Speakers bureau: AbbVie, Amgen, BMS, Celgene, Genentech, Janssen, Lilly, Novartis, Pfizer and UCB

Background SAPHO syndrome has to be considered as a rare subtype of seronegative spondyloarthritis (SpA) showing typical manifestations with palmoplantar pustolosis and osteitis with hyperostosis; the clinical response of conventional or biological disease modifying drugs (DMARDs) in SAPHO syndrome are often disappointing. Whereas in SpA peripheral arthritis and inflammatory back pain represent the leading symptoms, the SAPHO patients often complain painful osteitis with hyperostosis in the sternal region as well as the palmoplantar pustulosis accompanied by synovitis preferentially in large joints including sacroiliitis. Recently, the detection of higher numbers of CD4+IL17+ lymphocytes in the peripheral blood of SAPHO patients has arisen the hypothesis that Th4/17 helper cells with their secretion of interleukin 17 (IL17) could be involved in the development of inflammation in SAPHO syndrome (1) Objectives Here we present an observational study of 12 SAPHO patients which were treated with the IL 17 blocking agent secukinumab. In addition, the fraction of CD4/17+ lymphocytes in peripheral blood specimen has been monitored on treatment. Methods Between January 2015 and February 2017 clinical activity of disease were measured in 37 SAPHO patients with a disease duration of 11 years (median). The disease activity were evaluated by the osteitis score and skin score (ranging from 0 to 6, assessed by physician), the HAQ score (ranging from 0 to 3, assessed by patient), and MRI of the osteitis lesion (activity score 0-3, analogously to 3 domains of OMERACT RAMRIS scoring synovitis, bone marrow edema, and erosions; assessed by radiologist). In this period of time 12 of them showed disease activity due to osteitis and/or skin disease, at which time the treatment of secukinumab at dosage of 300mg as monotherapy has been started, re-evaluated after at least 12 weeks (ranging from 12 to 18 weeks). For monitoring blood specimens were derived to assess the CD4+/IL17+ lymphocyte subpopulation using immunofluorescence technique commercial antibodies for CD4, IL17 (Boehringer Ingelheim, Germany). To analyse the differences between the disease activity scores prior to secukinumab treatment and after treatment we applied the nonparametric analysis according to Wilcoxon test. The p-value Results Secukinumab improved osteitis and palmoplantar pustolosis (osteitis score 3.8 to 2.4; p=0.007; PPP 3.4 to 2.4; p=0.071), the HAQ score was reduced from 1.25 to 1.0 (p=0.018), the MRI score from 2.08 to 1.58 (p=0.034). The reduction of at least two clinical activity parameters (osteitis, HAQ and/or MRI) after secukinumab treatment could be documented in all SAPHO patients who showed CD4+IL17+ lymphocytes in higher frequency of 0.4% of leukocytes of peripheral blood. Conclusion Secukinumab seems to control osteitis and PPP in SAPHO syndrome resulting in reduced burden of disease. High Th17 lymphocytes numbers seems to be associated with higher probability of clinical response to secukinumab. Reference: [1] Firinu D, Barca MP, Lorrai MM, Perra S, Cabras S, Muggianu E, Di Martino ML, Manconi PE, Del Giacco SR. TH17 cells are increased in the peripheral blood of patients with SAPHO syndrome. Autoimmunity. 2014Sep;47(6):389-94 Disclosure of Interests None declared

Background: Psoriatic arthritis (PsA) and ankylosing spondylitis (AS) can lead to reduced physical functioning and quality of life. Secukinumab has demonstrated clinical benefits in PsA and AS, however little is known about physician satisfaction with its ability to control disease in the real world. Objectives: Assess physician satisfaction with secukinumab’s ability to control disease in a real-world setting. Methods: This was a cross-sectional survey of rheumatologists and dermatologists (PsA only) in France, Germany, Italy, Spain, and UK. Data were collected from Jun-Aug 2018 via physician-completed patient record forms. Patients receiving any treatment were included in the survey. Patients receiving secukinumab >1 month were included in this analysis. Physicians rated satisfaction on a 5-point scale (Very satisfied to very dissatisfied), a binary variable of satisfied/not satisfied was created by grouping “Very satisfied” and “Satisfied” responses as satisfied and “Neutral”, “Dissatisfied”, and “Very dissatisfied” as not satisfied. Data were reported by disease, then stratified by overall physician-rated disease severity (mild/moderate/severe) at initiation of secukinumab, prior biologic use, treatment duration, and concomitant medication. Results: 438 PsA and 277 AS patients were receiving secukinumab >1month at time of data collection. Patient mean age was 46.9 years (48.2 PsA, 44.8 AS) with 35.2% female (41.8% PsA; 24.9% AS). On average, patients had received secukinumab for 8.8 months (9.2 PsA; 8.2 AS). At secukinumab initiation, 44.2% of patients were rated by their physician as severe vs. 3.5% at the current consultation (39.3% vs. 2.7% PsA; 52.0% vs. 4.7% AS). Overall, 87.6% of physicians were satisfied with the ability of secukinumab to control disease (87.9% PsA; 86.3% AS). Physicians report high satisfaction across each stratification (Table 1). Conclusion: This study provides insight into physician satisfaction with secukinumab in a real-world clinical setting. Physicians reported being highly satisfied with the ability of secukinumab to control PsA and AS disease, regardless of patient population subgroups. Disclosure of Interests: Elizabeth Holdsworth Employee of: Adelphi Real World, Nicola Booth Employee of: Adelphi Real World, Steve Lobosco Employee of: Adelphi Real World, Olivia Massey Employee of: Adelphi Real World, Amie Scott Consultant for: Novartis Pharmaceuticals Corporation, Haijun Tian Shareholder of: Novartis Pharmaceutical Corporations, Employee of: Novartis Pharmaceutical Corporations, Dorothy Keininger Shareholder of: Novartis, Employee of: Novartis

Background Secukinumab (SEC) provided sustained clinical efficacy, and inhibition of radiographic progression over 52 Weeks (Wks) in patients (pts) with psoriatic arthritis (PsA) in the FUTURE 5 study1. Objectives To report the effect of SEC on radiographic progression at Wk 104 (2 years) in PsA pts in the FUTURE 5 study. Methods Adults (N=996) with active PsA, stratified by prior anti-TNF therapy (naive and inadequate response/intolerance [IR]) were randomised 2:2:2:3 to subcutaneous SEC 300mg with loading dose (LD; 300mg), 150mg LD (150mg), 150mg no LD, or placebo at baseline (BL), Wks 1, 2, 3, 4, and every 4 wks thereafter. Pts could have SEC dose escalated from 150 to 300 mg starting from Wk 52, based on physicians9 judgement. Data are shown for pts originally randomised to SEC; 150mg groups include pts who had dose escalated to 300mg. Concomitant MTX (≤25 mg/week) was allowed. Radiographic progression (mean change in van der Heijde-modified total Sharp score [vdH-mTSS] and its components: erosion and joint space narrowing [JSN] scores, was based on hand/wrist/foot X-rays obtained at BL and Wk 104, and assessed by two blinded readers (plus an adjudicator if required). Other efficacy endpoints included ACR20/50, PASI90 and resolution of dactylitis and enthesitis. Results Overall, 84.7% (300mg), 82.3% (150mg) and 75.2% (150mg no LD) pts completed 2 years of treatment. A total of 86 (39%) and 92 (41%) pts had their dose escalated to 300mg in the 150mg and 150mg no LD groups, respectively. Inhibition of radiographic progression was sustained with SEC through 2 years (Table 1). Proportions of pts with no radiographic progression (change from BL in mTSS ≤0.5) with SEC were 89.5% (300 mg), 82.3% (150 mg), and 81.1% (150 mg no LD) at 2 years; corresponding proportion of pts for change from BL in mTSS ≤0.0 were: 81.2%, 69.1% and 73.4%, respectively. Clinical responses were also sustained through 2 years (Table 1). Conclusion Subcutaneous secukinumab provided sustained inhibition of radiographic progression and sustained clinical responses through 2 years of treatment in pts with active PsA. Reference [1] Mease PJ et al. Arthritis Rheumatol 2018;70(suppl 10). Disclosure of Interests Philip J Mease Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Janssen, Leo, Eli Lilly, Merck, Novartis, Pfizer, Sun Pharmaceutical Industries, Inc., and UCB., Consultant for: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Galapagos, Gilead, Janssen, Leo, Eli Lilly, Merck, Novartis, Pfizer, Sun Pharmaceutical Industries, Inc., and UCB., Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Genentech, Janssen, Leo, Merck, Novartis, Pfizer and UCB.., Robert B.M. Landewe: None declared, Proton Rahman Grant/research support from: Investigator for Janssen Research & Development, LLC and Novartis, Consultant for: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Janssen, Eli Lilly,Novartis, and UCB, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Janssen, Eli Lilly, and Novartis, Hasan Tahir Grant/research support from: Novartis, Eli-Lilly, Speakers bureau: AbbVie, Janssen, Eli Lilly, and Novartis, Atul Singhal Grant/research support from: AAbbVie, Gilead, Sanofi, Regeneron, Amgen, Roche, BMS, Janssen, Lilly, Novartis, Pfizer, UCB, Astra Zeneca, MedImmune, FujiFilm, Nichi-Iko, Mallinckrodt, Speakers bureau: AbbVie, Elke Boettcher Consultant for: Amgen, Roche, Eli Lilly, Pfizer, MSD, Novartis, Speakers bureau: Amgen, Roche, Eli Lilly, Pfizer, MSD, Novartis, Sandra Navarra Speakers bureau: Astellas, Johnson & Johnson, Novartis, Pfizer, Aimee Readie Shareholder of: Novartis, Employee of: Novartis, Shephard Mpofu Shareholder of: Novartis, Employee of: Novartis, Eumorphia Maria Delicha Consultant for: Novartis, Luminita Pricop Shareholder of: Novartis, Employee of: Novartis, Desiree van der Heijde Consultant for: AbbVie, Amgen, Astellas, AstraZeneca, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Daiichi, Eli-Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, Union Chimique Belge

Background Guselkumab (GUS, an antibody against IL-23) and secukinumab (SEC, an antibody against IL-17A) are both approved for the treatment of psoriasis (PsO). Up to 30% of patients with PsO may have psoriatic arthritis (PsA). Objectives The ECLIPSE study compared efficacy and safety of GUS vs SEC in patients with plaque PsO. Post hoc analyses examined outcomes in the subgroup of patients with self-reported psoriatic arthritis (PsA). Methods ECLIPSE was a randomized, double-blind trial of adults with moderate-to-severe plaque PsO who received GUS 100 mg at Weeks 0, 4, then every 8 weeks, or SEC 300 mg at Weeks 0, 1, 2, 3, and 4, then every 4 weeks, both through Week 44. The primary endpoint was the proportion of patients achieving ≥90% improvement compared to baseline in the Psoriasis Area and Severity Index (PASI) score at Week 48. Cochran-Mantel Haenszel chi-square testing stratified by investigator was used to compare treatment-group responses. Results Overall, treatment groups [GUS (n=534), SEC (n=514)] were comparable at baseline: weight 89kg, 24% body surface area PsO, and Investigator Global Assessment (IGA) moderate (76%) or severe (24%). These characteristics were similar to those of subgroups with self-reported PsA [GUS (n=97), SEC (n=79)]. In the overall population, the primary endpoint of PASI 90 response at Week 48 was achieved by 84.5% of GUS vs 70.0% of SEC patients (treatment difference 14.2 [95% CI=9.6%,18.8%], P Conclusion In the subset of patients with self-reported PsA in the ECLIPSE study, GUS demonstrated better maintenance of response and higher efficacy at approximately one year compared with SEC in the treatment of moderate to severe plaque PsO. These findings were consistent with those for the overall study population of patients with plaque PsO. AEs observed were generally consistent with the established safety profiles for GUS and SEC. Disclosure of Interests Joseph F Merola Grant/research support from: Janssen, Shu Li Employee of: Janssen Research & Development, LLC, Ming-Chun Hsu Employee of: Janssen Research & Development, LLC, Chetan Karyekar Shareholder of: J&J, Employee of: Janssen Scientific Affairs, LLC, Abbott, BMS, Novartis, Susan Flavin Employee of: Janssen Research & Development, LLC, Bruce Randazzo Employee of: Janssen Research & Development, LLC, Laura C Coates Grant/research support from: AbbVie, Celgene, Lilly, Novartis and Pfizer, Consultant for: AbbVie, Amgen, BMS, Celgene, Galapagos, Gilead Sciences Inc., Janssen, Lilly, Novartis, Pfizer, Prothena Corp and UCB

Background: The lack of a formal indication for Non-Radiographic axial Spondyloarthritis (nr-axSpA) has meant that many US rheumatologists fundamentally treat it as an early manifestation of ankylosing Spondylitis (AS) and seldom differentiate their treatment approach when using biologics/small molecules. Objectives: This study sought to gain a better understanding of the number of aS and nr-axSpA patients rheumatologists manage, recent changes made in treatment, and how aS and nr-axSpa patients are differentiated beyond radiographic evidence. The study also evaluated the differences in use of biologics/small molecules for the treatment of aS and nr-axSpA and rheumatologist projected changes in the management of these two conditions. Methods: An independent market analytics firm administered a survey with US rheumatologists (n=104) on the treatment landscape for aS and nr-axSpA. To qualify, rheumatologists had to spend the majority of their professional time in clinical practice, manage a minimum of 50 aS or nr-axSpA patients, and have been in practice between 2 and 35 years. Respondents answered questions pertaining to their practice, the demographics of their aS/nr-axSpA patients, their treatment approaches for each type, as well as attitudinal statements. The survey was administered online in February 2018 and respondents were compensated for their participation. A similar study was also conducted in 2017 allowing for year over year comparison. The data were collected and analyzed in SPSS. Results: Three-quarters of rheumatologists reported they treated their aS and nr-axSpA patients in a similar manner, though there was a higher use of NSAIDs and local steroids in non-radiographic disease, and more biologic/JAK use in aS. More established TNF inhibitors such as adalimumab, etanercept, and infliximab dominated biologics/small molecule preference, collectively accounting for approximately three-quarters of all biologic-treated aS and nr-axSpA patients. However, use of adalimumab, etanercept, and infliximab was expected to decline or stay flat in the next three months, while use of secukinumab, tofacitinib, golimumab IV, and both infliximab biosimilars, was anticipated to increase. Although not indicated for either condition, 28% of respondents reported off-label use of tofacitinib for aS, and 25% for nr-axSpA, a significant increase from 2017. Projected off-label use of tofacitinib in the following three months is also expected to increase. Conclusion: Rheumatologists are less likely to use biologics/small molecules for nr-axSpA, but when they do, use of brands is similar to those used in aS. While TNF inhibitors continue to account for the majority of biologic/small molecule prescriptions for these conditions, rheumatologists project increased use of agents with alternative mechanisms of action in the future. Disclosure of interests: None declared

Background Ankylosing spondylitis (AS) is a chronic rheumatic condition that has a negative impact on health-related quality of life (HRQoL). Secukinumab (SEC), a fully human anti-IL-17A monoclonal antibody, has been shown to effectively control AS symptoms and improve HRQoL. Objectives To evaluate the impact of SEC on HRQoL, assessed by the Short Form-36 Health Survey (SF-36), in pts with active AS stratified by time since first diagnosis ( Methods Pts were randomized to placebo (PBO) or SEC in MEASURE 1 (10 mg/kg intravenously followed by 150 or 75 mg SC), MEASURE 2 (150 or 75 mg SC) and MEASURE 4 (150 mg SC with/without SC loading). At Wk 16 or Wk 24, depending on ASAS 20 response, pts on PBO were re-randomized to SEC. Mixed-models for repeated measures were used to evaluate changes in SF-36 from baseline (BL) to Wk 16; observed data are presented at Wk 52. The proportion of pts reporting improvements meeting/exceeding the minimal clinically important differences (MCID) for SF-36 physical (PCS responders) and mental component summary (MCS responders), and individual SF-36 domains was also assessed. Missing data were recorded as non-response and Fisher’s exact test was used to compare the proportion of responders between groups at Wk 16. Only pooled data for pts receiving the licensed dose of SEC (150 mg) are shown. Results Overall 739 patients were included, with 427 and 312 in the SEC 150 mg and PBO groups, respectively. Of those, 37% and 36% of the SEC and PBO groups, respectively, were classified as Conclusion Treatment with SEC 150 mg resulted in significant, clinically meaningful, and sustained improvements in HRQoL. Although reported irrespective of time since AS diagnosis, improvements were more prominent in earlier diagnosed pts. Acknowledgement Study sponsored by Novartis. Medical writing support by Seren Communications, funded by Novartis. Disclosure of Interests Atul Deodhar Grant/research support from: AbbVie, Amgen, Eli Lilly, GSK, Janssen, Novartis, Pfizer, and UCB, Consultant for: AbbVie, Amgen, BMS, Eli Lilly, Janssen, Novartis, Pfizer, and UCB, Annelies Boonen: None declared, Gianfranco Ferraccioli Speakers bureau: LILLY, ROCHE, NOVARTIS, Filip van den Bosch Consultant for: AbbVie, BMS, Galapagos, Janssen, Lilly, Merck, Novartis, Pfizer and UCB, Speakers bureau: AbbVie, BMS, Janssen, Lilly, Merck, Novartis, Pfizer and UCB., David Martinez Consultant for: I developed the analyses of this study paid by the pharmaceutical., Brian Porter Shareholder of: Novartis, Employee of: Novartis, Abhijit Shete Shareholder of: Novartis Pharma AG, Employee of: Novartis Pharma AG, Isabelle Gilloteau Employee of: Employee of Novartis, Aurore Yocolly Employee of: Employee of Novartis, Vibeke Strand Consultant for: Samumed, LLC, AbbVie, Amgen, EMD Serono, Eupraxia, Flexion, Iroko, Novartis, Pfizer, Regeneron, Sanofi, SKK

Background: Secukinumab is a novel treatment for psoriatic arthritis (PsA) but data from real life are still missing. Objectives: The aim of this study is to evaluate a wide cohort of PsA patients on secukinumab followed in 7 Italian rheumatologic centers. Methods: Two-hundred and seventy-nine patients affected by PsA and on secukinumab were enrolled. Data on disease characteristics, previous and ongoing treatments, comorbidities and duration of follow-up were collected. In particular DAPSA and aSDAS were used to assess articular and axial disease activity. Results: Mean age of our cohort was 53±11 years and BMI 26.4±5.1 kg\m2 with the majority of patients being female (63.8%). Mean disease duration was 9.7±7.5 years and mean follow-up was 10.9±6.8 years. For 100 patients (35.8%) secukinumab was their first line biologic treatment and 41 (50.5%) were in monotherapy. DAPSA was 25.9±10.5 at baseline, 15.9±9.7 at M3, 12.9±8.4 at M6, 9.8±7.1 at M12 with a significant downward decrease at every visit as compared to baseline (p Forty patients (14.3%) stopped the treatment during the follow up mainly because of primary or secondary loss of efficacy (18 and 10, respectively). Only 9 patients suspended the treatment because of adverse events, of which 5 because of reactions at site of injection. The retention rate at 12 months was very good in the whole population (figure), and in particular in patients with entesitis at the baseline (10.5 vs, 11.2, p=0.038). No differences in survival were found when dividing patients accordingly to BMI, although overweight or obese patients showed a trend for a better retention rate (10.6 vs 10.9, p=0.089). Interestingly no differences were found between naive and non-naive patients (p=0.895) and between those in monotherapy or in combination therapy (p=0.925). Conclusion: This is one of the first real life studies on secukinumab and shows a very good efficacy and safety of this treatment in PsA patients, also for the articular manifestations, as shown by a significant decrease of DAPSA over a 12-months follow up. Disclosure of interests: Federica Martinis: None declared, Cristian Caimmi: None declared, Rosario Foti: None declared, Elisa Visalli: None declared, Giorgio amato: None declared, Roberta Ramonda: None declared, augusta Ortolan: None declared, Mariagrazia Lorenzin: None declared, angelo Semeraro: None declared, Leonardo Santo: None declared, Emanuela Praino: None declared, Maria Sole Chimenti: None declared, Roberto Perricone: None declared, Favia Sunzini: None declared, Raffaele Scarpa: None declared, Francesco Caso: None declared, Luisa Costa: None declared, Elena Fracassi Speakers bureau: Novartis, Maurizio Rossini: None declared, antonio Carletto Speakers bureau: Roche, Novartis, MSD, abbvie, Bristol, Jannsen, Celgene, Pfizer

Background There is evidence that fibromyalgia (FM) can increase the burden of disease in patients affected with psoriatic arthritis (PsA) and interfere with the assessment of clinical disease activity, but studies focusing the impact of FM on long-term clinical outcomes are lacking. Objectives We aimed at evaluating the impact of FM on the achievement of clinical remission or minimal disease activity (MDA) in naive PSA patients on treatment with a first biologic drug in real life settings. Methods We retrospectively assessed PsA patients, fulfilling CASPAR criteria, from 1st January 2010 through 30th June 2017, starting a first biologic drug or apremilast. At baseline and at each visit thereafter, DAPSA, PASI, MDA, ASDAS-CRP, and HAQ were evaluated. Rate of patients achieving DAPSA based low disease activity (LDA) was assessed at 3 months, and MDA or DAPSA-remission at 12 months. LOCF method was carried out for those patients who did not reach 12 months follow-up or discontinue the treatment before 12 months. The persistence on the first treatment was evaluated by Kaplan-Mayer survival curves. Estimated hazard ratios (HRs) of discontinuing therapy or achieving remission or MDA at last observation were assessed by a multivariate stepwise backward Cox regression model, adjusting for patient demographics (gender, age, BMI, comorbidities) and disease characteristics (co-therapy with MTX or glucocorticoids, DAPSA). Results Upon excluding pure axial PsA without peripheral involvement, 238 patients (126 female) with mean age 51 years (95% CI, 40-59), BMI 26 (95% CI, 23-30), disease duration 24 (95% CI, 10-60) months were analyzed. At baseline, 120 had polyarticular involvement (≥ 5 joints), 118 had oligoarticular pattern, and 64 had concomitant spine involvement. One hundred-fifteen begun a treatment with anti-TNF-receptor, n.106 with anti-TNF-mAb, n.9 with ustekinumab, n.6 with apremilast, and n.2 with secukinumab. FM was diagnosed, according to both 1990 and 2019 ACR classification criteria, in 58 (female 74%) patients. Crude drug survival rate was significantly lower in FM-PsA patients (50%) (mean survival time (MST, 95% CI) 32 (25-38) months than in PsA patients without FM (74%) MST 42 (38-45) months (log rank=15.6, p=0.0001) (Figure 1a). This large difference was also seen estimating drug survival by ineffectiveness, FM-PsA 58.6% (MST 35 (28-42) months) vs PsA 82% (MST 45 (42-48) months) (log rank=18.5, p=0.0001) (Figure 1b), but not by adverse events (data not shown). LDA at 3 months was reached by 78% of PsA patients and by 21% of FM-PsA patients (p=0.0001). At 12 months, MDA was achieved by 62% of PsA and only by 2% (1 out of 58) of FM-PsA (p=0.0001), and likewise remission was seen in 47% of PsA and in 2% of FM-PsA p=0.0001) Figure 2. FM was the only independent factor associated to drug discontinuation (HR 2.5, 1.6-4.1 (95% CI), or to the achievement of either MDA (HR 0.23, 0.1-0.5 (95% CI) and clinical remission (HR 0.26, 0.1-0.6 (95% CI), with the first biologic drug within the time span of the study. Conclusion Our findings clearly demonstrate the FM has a striking negative impact on clinical outcomes in PsA, as early as 3 months of treatment. Clinicians should be aware that treating PsA patients with comorbid FM is demanding, and appropriate patient shared strategies should be adopted in these settings. Disclosure of Interests Florenzo Iannone Consultant for: F Iannone has received consultancy fees and/or speaker honoraria from Pfizer, AbbVie, MSD, BMS, Novartis, Lilly, UCB outside this work, Speakers bureau: F Iannone has received consultancy fees and/or speaker honoraria from Pfizer, AbbVie, MSD, BMS, Novartis, Lilly, UCB outside this work, Mariangela Nivuori: None declared, Giuseppe Lopalco Speakers bureau: SOBI, BMS, Maria Grazia Anelli Speakers bureau: BMS, Abbvie, Laura Coladonato: None declared, Gaetana Laselva: None declared, Crescenzio Scioscia Speakers bureau: Abbvie

Background Psoriatic arthritis (PsA) can have a profound impact on health-related quality of life (HRQoL). Secukinumab (SEC), a fully-human IL-17A inhibitor, has been shown to improve symptoms and HRQoL in patients (pts) with PsA.1 Objectives To evaluate the impact of SEC on HRQoL, assessed using the Short form-36 Health Survey (SF-36), in pts with PsA stratified by time since first diagnosis ( Methods Pts were randomized to either subcutaneous placebo (PBO) or SEC 150 mg (FUTURE 2, 3, 4, 5), 150 mg no load (NL; FUTURE 4, 5), or 300 mg (FUTURE 2, 3, 5). Doses were administered at baseline (BL) and Wks 1–4, followed by every 4 wks (or every 4 wks from BL in NL groups). Pts on PBO were re-randomized to SEC at Wk 16 or 24. Mixed-models for repeated measures were used to assess changes from BL to Wk 16; observed data are presented at Wk 52. The proportion of pts reporting improvements ≥ minimum clinically important differences (MCID) in SF-36 physical (PCS responders), mental component summary (MCS responders), and individual SF-36 domains was also assessed. Non-responder imputation was employed for missing values in responder analyses. Fisher’s exact test was used to compare the proportion of responders. Results A total of 2049 pts were included: 681, 461, 572, and 335 in the PBO, SEC 300 mg, 150 mg, and 150 mg NL groups, respectively. Of these, 34%, 30%, 32%, and 33%, were classified as Conclusion SEC offered significant, clinically meaningful and sustained improvements in HRQoL (SF-36) in pts with PsA, regardless of time since diagnosis. References [1] Mease PJ, et al. Ann Rheum Dis. 2018;77:890–7 Acknowledgement This study was sponsored by Novartis Pharma aG. Medical writing support was provided by Seren Communications, an ashfield Company, a division of UDG, and was funded by Novartis. Disclosure of interests Vibeke Strand Consultant for: Samumed, LLC, abbVie, amgen, EMD Serono, Eupraxia, Flexion, Iroko, Novartis, Pfizer, Regeneron, Sanofi, SKK, Oliver FitzGerald: None declared, Laura C Coates Grant/research support from: abbVie, Celgene, Lilly, Novartis and Pfizer, Consultant for: abbVie, amgen, BMS, Celgene, Galapagos, Gilead Sciences inc., Janssen, Lilly, Novartis, Pfizer, Prothena Corp and UCB, Jessica a. Walsh Grant/research support from: abbvie, Pfizer , Consultant for: abbvie, Celgene, Lilly, Novartis , Juan D. Canete: None declared, Peter Nash Grant/research support from: abbVie, Bristol-Myers Squibb, Eli Lilly, Janssen, Novartis, Pfizer inc, Roche, Sanofi, UCB, Consultant for: abbVie, Bristol-Myers Squibb, Eli Lilly, Janssen, Novartis, Pfizer inc, Roche, Sanofi, UCB, Speakers bureau: abbVie, Bristol-Myers Squibb, Eli Lilly, Janssen, Novartis, Pfizer inc, Roche, Sanofi, UCB, Eric Davenport Employee of: E. Davenport is an employee of RTI Health Solutions., Luminita Pricop Shareholder of: Novartis, Employee of: Novartis, Gregory Hustache Shareholder of: Novartis Pharma aG, Employee of: Novartis Pharma aG, Isabelle Gilloteau Employee of: Employee of Novartis, aurore Yocolly Employee of: Employee of Novartis, Matthias augustin Grant/research support from: Prof. Augustin has served as consultant and/or paid speaker for and/or has received research grants and/or honoraries for consulting and/or scientific lectures for and/or got travel expenses reimbursed and/or participated in clinical trials sponsored by companies that manufacture drugs used for the treatment of Psoriasis including abbVie, almirall, amgen, Biogen (Biogen Idec), Boehringer ingelheim, Celgene, Centocor, Eli Lilly, Galderma, Janssen-Cilag, Leo, Medac, MSD, Mundipharma, Novartis, Pfizer, Sandoz, Xenoport., Consultant for: Prof. Augustin has served as consultant and/or paid speaker for and/or has received research grants and/or honoraries for consulting and/or scientific lectures for and/or got travel expenses reimbursed and/or participated in clinical trials sponsored by companies that manufacture drugs used for the treatment of Psoriasis including abbVie, almirall, amgen, Biogen (Biogen Idec), Boehringer ingelheim, Celgene, Centocor, Eli Lilly, Galderma, Janssen-Cilag, Leo, Medac, MSD, Mundipharma, Novartis, Pfizer, Sandoz, Xenoport., Speakers bureau: Prof. Augustin has served as consultant and/or paid speaker for and/or has received research grants and/or honoraries for consulting and/or scientific lectures for and/or got travel expenses reimbursed and/or participated in clinical trials sponsored by companies that manufacture drugs used for the treatment of Psoriasis including abbVie, almirall, amgen, Biogen (Biogen Idec), Boehringer ingelheim, Celgene, Centocor, Eli Lilly, Galderma, Janssen-Cilag, Leo, Medac, MSD, Mundipharma, Novartis, Pfizer, Sandoz, Xenoport.

Background Nail psoriasis (PsO) is present in up to 80% in psoriatic arthritis (PsA) patients (pts) and associated with significant pain, psychosocial disability, decreased physical function and quality of life (QoL).1 Nail PsO is considered as one of the six core PsA domains by GRAPPA2 and is a predictor of severe disease with joint involvement and structural damage. Secukinumab (SEC) has demonstrated efficacy for pts with nail PsO in the TRANSFIGURE study3 and significant improvement in signs and symptoms of PsA in the FUTURE 5 study4 Objectives To evaluate the efficacy of SEC on nail PsO and other facets of disease in the nail subset from the FUTURE 5 study through 52 weeks (wks). Methods Pts (N=996) with active PsA, were randomised to subcutaneous SEC 300 mg loading dosage (LD; 300 mg), 150 mg LD (150 mg), 150 mg no LD or placebo (PBO). All groups received SEC or PBO at baseline (BL), Wks 1, 2, 3, and 4, and then every 4 wks. Efficacy assessments through Wk 52 included mNAPSI, ACR, PASI, HAQ-DI, SF-36 PCS, PsAQoL and resolution of dactylitis and enthesitis. Analyses through Wk 16 used non-responder imputation (NRI) for binary and mixed-effect model repeated measure (MMRM) for continuous variables. Observed data are presented from Wk 20-52. Results A total of 663/996 (66.6%) PsA pts had concomitant nail PsO at BL. Demographics and BL disease characteristics were balanced between treatment groups in the nail subset, which were comparable with overall population. The total mean mNAPSI score at BL was 16.4. SEC 300 and 150 mg doses improved nail PsO vs. placebo (PBO) at Wk 8, 12 and 16 (P Conclusion Secukinumab provided sustained improvements in nail disease, signs and symptoms of PsA, physical function and QoL through 52 wks in pts with PsA and moderate to severe nail PsO. References [1] Baran R. Dermatology2010;221(Suppl1):1-5. [2] Coates LC, et al. Arthritis Rheumatol. 2016;68:1060-71. [3] Reich K, et al. Br J Dermatol. 2018. Doi: 10.1111/bjd.17351. [4] Mease PJ, et al. Ann Rheum Dis. 2018;77:890-7. Disclosure of Interests Peter Nash Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly, Janssen, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Consultant for: AbbVie, Bristol-Myers Squibb, Eli Lilly, Janssen, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, Janssen, Novartis, Pfizer Inc, Roche, Sanofi, UCB, Philip J Mease Grant/research support from: AbbVie, Amgen, BMS, Celgene, Janssen, Lilly, Novartis, Pfizer, SUN and UCB, Consultant for: AbbVie, Amgen, BMS, Galapagos, Gilead Sciences, Inc., Janssen, Lilly, Novartis, Pfizer, SUN and UCB, Speakers bureau: AbbVie, Amgen, BMS, Celgene, Genentech, Janssen, Lilly, Novartis, Pfizer and UCB, Bruce Kirkham Grant/research support from: Abbvie, Janssen, Lilly, Novartis, Roche, UCB, Consultant for: Abbvie, Janssen, Lilly, Novartis, Roche, UCB, Speakers bureau: Abbvie, Janssen, Lilly, Novartis, Roche, UCB, Alejandro Balsa Grant/research support from: Abbvie, Pfizer, Novartis, BMS, Nordic, Sanofi, Consultant for: Abbvie, Pfizer, Novartis, BMS, Nordic, Sanofi, Sandoz, Lilly, Paid instructor for: Pfizer, Speakers bureau: Pfizer, Novartis, UCB, Nordic, Sanofi, Sandoz, Lilly, Atul Singhal Grant/research support from: AbbVie, Gilead, Sanofi, Regeneron, Amgen, Roche, BMS, Janssen, Lilly, Novartis, Pfizer, UCB, Astra Zeneca, MedImmune, FujiFilm, Nichi-Iko, Mallinckrodt, Speakers bureau: AbbVie, Erhard Quebe-Fehling Shareholder of: Novartis, Employee of: Novartis, Luminita Pricop Shareholder of: Novartis, Employee of: Novartis, Corine Gaillez Shareholder of: Novartis, BMS, Employee of: Novartis

Background: Ankylosing spondylitis (AS) is an inflammatory disease resulting in progressive disability due to structural damage in the spine. The identification of predictors of progression would allow treating physicians to personalize treatments but requires an approach accounting for a relatively short follow-up of clinical studies, large between-patient variability, and low sensitivity of X-ray images which generate intra-patient variability when repeated measurements are taken. Objectives: 1) To identify patient characteristics predicting faster structural damage progression. 2) To quantify the progression over four years of secukinumab treatment, depending on dose/exposure. Methods: Data came from the phase 3 randomized placebo-controlled trial MEASURE 1 (NCT01358175)1 in which patients were treated with secukinumab (intravenous loading of 10 mg/kg at weeks 0, 2, and 4, followed by secukinumab subcutaneously at a dose of either 75 mg or 150 mg every 4 weeks) over 208 weeks. Only patients treated with secukinumab with at least two assessments of structural damage were included. We explored the effect of multiple baseline demographic traits, disease stage, severity, bone cartilage biomarkers as well as prior and current treatment on change in modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) using a longitudinal Bayesian mixture model with random effects, which accounted simultaneously for the probability of progression, magnitude of progression and inter-patient variability. Posterior predictive check was performed. Results: Out of 249 patients randomized to secukinumab, 167 had their structural damage assessed at least twice. These patients contributed in total 409 assessments of change in structural damage between weeks 0, 52, 104 and 208. Of the factors tested, a higher baseline BASMI score was associated with faster progression rate in a statistically significant way (+0.60 in mSASSS/year for each additional standard deviation of baseline BASMI (SD=1.74), 95% interval 0.03 to 1.14). Trends were also detected for association between faster mSASSS progression and younger age, prior exposure to TNFα inhibitor, HLA-B27 positivity, and higher osteocalcin levels. Increased exposure to secukinumab was associated with slower structural damage progression (-0.23 in mSASSS/year for each additional standard deviation in exposure, 95% interval -0.58 to 0.10). Model estimation suggested that secukinumab 150 mg was associated with a yearly progression of -0.2 (95% interval -1.2 to 0.8) in the first two years of treatment and 0.1 mSASSS (95% interval -0.8 to 1.0) in the third and fourth year of treatment. Analogously, secukinumab 75mg (currently not approved for clinical use) was associated with a progression of -0.2 mSASSS/year (95% interval -1.3 to 0.9) in the first two years of treatment and 0.5 mSASSS/year (95% interval -0.5 to 1.6) in the third and fourth year of treatment. Conclusion: Potential predictors of structural progression suggested by the model were higher baseline BASMI, younger age, prior exposure to TNFα inhibitor, HLA-B27 positivity, and higher osteocalcin at baseline, although only baseline BASMI showed statistical significance. Further analyses using larger, deeper and real-world data are needed to confirm these findings and to estimate progression rates in AS patients in daily practice. Reference [1] Baeten D, Sieper J, Braun J, et al. Secukinumab, an Interleukin-17A Inhibitor, in Ankylosing Spondylitis. N Engl J Med. 2015;373(26):2534-2548. Disclosure of Interests: Olivier Luttringer Shareholder of: Novartis, Employee of: Employee of Novartis Pharma AG, Todd Fox Employee of: Novartis, Brian Porter Shareholder of: Novartis, Employee of: Novartis, Abhijit Shete Shareholder of: Novartis Pharma AG, Employee of: Novartis Pharma AG, Hanno Richards Shareholder of: Novartis Pharma AG, Employee of: Novartis Pharma AG, Witold Wiecek Consultant for: Employee of CERTARA Strategic Consulting., Zuzanna Angehrn Shareholder of: Owns funds which might occassionaly invest in pharmaceutical companies’ stocks., Consultant for: Employee of CERTARA strategic consulting., Helene Karcher Consultant for: Former employee of Analytica Laser, a Certara company. Former independent consultant. Current employee of PAREXEL., Employee of: Former employee of Novartis., Billy Amzal Consultant for: Employee of CERTARA Strategic Consulting., Employee of: Former employee of Novartis.

Background Ustekinumab (UST) and secukinumab (SEK) are new Biologic Disease-modifying antiRheumatic Drugs (bDMARDs) available in psoriatic arthritis (PsA), targeting respectively IL12-23 and IL 17. Real-world data are missing for these drugs, despite the wide use. There is only one previous published study including 160 patients (1) receiving UST, but not SEK. Objectives To evaluate the characteristics of the patients with PsA treated by UST or SEK and to assess real life drug survival and efficacy of UST and SEK in PsA. Methods This is a national, retrospective, multicentric study from patients suffering from PsA (CASPAR criteria) from July 2011 to april 2018. Drug survival was defined as the time from initiation to discontinuation (stop/switch) of bDMARDs. Kaplan-Meier survival curves and Cox-regression analyses [hazard ratios (HR) and 95% confidence intervals (CIs)] were used adjusting for patient demographics, disease characteristics, co-therapy with methotrexate, and line of treatment with ustekinumab. For peripheral involvement, treatment was considered to be effective for patients with a combined favorable expert opinion and/or > 30% clinical improvement of swollen and tender joint counts. For axial involvement, efficacy criteria were: improvement of BASDAI by at least 2 points on a scale from 0 to 10 or 50% improvement and/or expert opinion. Results 186 patients were included with a mean follow-up ≥ 6 months: 111 patients under UST and 75 under SEK. The mean age was 51.5 (12.9) years old, 55% of patients were women and the body mass index was 27.3 (5.8) kg/m². The disease duration was 10.8 (8.1) years. Patients were bDMARDs-naive in 15%. The median drug survivals for UST and SEK were respectively 12 and 14 months (Fig1). A propensity score cannot be used to compare the two bDMARDs, since the number of patients was too small. Smoking was associated with an unfavourable drug survival for SEK (HR= 0.22, 95%CI 0.91), whereas CRP levels were associated with a favorable one for UST (HR=1.009, 95%CI 1.003–1.016). Nine patients under SEK and 2 under UST stopped their treatments due to side effects. Conclusion This is the first real-world study for drug survival on PsA for SEK and one with the largest number of patients for UST. Drug survival of UST and SEK seems similar to TNF inhibitors’ (2). References [1] Iannone F, et al. Drug survival and effectiveness of ustekinumab in patients with psoriatic arthritis. Real-life data from the biologic apulian registry (BIOPURE). Clin Rheumatol. 2018;37:667–75. [2] Walsh JA, et al. Care Spec Pharm. 2018;24:623-631 Disclosure of interests Jean-Guillaume Letarouilly: None declared, Jeremie Sellam: None declared, Pascal Richette Consultant for: Grunenthal, Horizon, Speakers bureau: astraZeneca, Grunenthal, Philippe Dieude: None declared, Pascal Claudepierre Consultant for: Honoraria from Novartis as steering committe of this survey, Corinne Miceli Richard Grant/research support from: MSD, Pfizer, abbVie, Biogen, UCB, Novartis, Consultant for: abbvie, Novartis, BMS, Eric Houvenagel Speakers bureau: Lilly, Novartis, Janssen, Chi Duc Nguyen: None declared, Marie-Helene Guyot: None declared, Nicolas Segaud: None declared, Laurent Marguerie: None declared, Xavier Deprez Speakers bureau: Novartis Janssen, Jean-Hugues Salmon Speakers bureau: Janssen Novartis, Guy Baudens Grant/research support from: Financial Grant from NordicPharma, Consultant for: Roche SAS, Maeva Kyheng: None declared, Julien Paccou Speakers bureau: Novartis Janssen, Elisabeth Gervais Grant/research support from: Roche, Pfizer, Consultant for: Bristol-Myers Squibb, UCB, Rene-Marc Flipo Consultant for: Honoraria from Novartis as steering committe of this survey

Background Ankylosing spondylitis (AS) is characterized by chronic inflammation of the spine and is at high risk to cause inflammation, pain, and stiffness extraspinal as well. Thus, important aims in therapy of AS are pain reduction and maintenance of physical functioning. Secukinumab, a fully human monoclonal antibody that selectively neutralizes interleukin (IL)-17A, has already shown significant efficacy in the treatment of AS in clinical trails1. Objectives The aim of this interim analysis is to evaluate the effectiveness of secukinumab on disease activity, physical functioning and quality of life in AS patients (pts) in a real world setting. Methods AQUILA is an ongoing, multi-center, 52-week (wk) non-interventional study enrolling 2000 pts with active AS and psoriatic arthritis in Germany. Here, we report interim results of effectiveness in a subgroup of AS pts treated with secukinumab. Validated questionnaires were used to measure the effectiveness of secukinumab on: disease activity Physician’s Global Assessment (PhGA: 0=no disease activity, 10=most intense disease activity), Bath Ankylosing Disease Activity Index (BASDAI), C–reactive protein (CRP) physical functioning global functioning: Assessment of Spondyloarthritis Health Index, (ASAS–HI), and key aspects of sleep Medical outcomes Study Sleep Scale (MOS), severity of depression Beck’s Depression Inventory Version II (BDI–II). Pts who were already under secukinumab treatment or just about initiating secukinumab therapy, based on medical therapeutic need, were included; in both scenarios, disease activity at start of secukinumab treatment was used as starting point for analysis. Treatment decision was made independently of participating in this study. Pts were observed from BL up to wk 52 according to clinical routine. Real-world effectiveness of secukinumab was assessed prospectively and analyzed as observed. Results This interim analysis describes 311 AS pts who were included at BL and of whom 178 (57.2%) have completed wk 52 so far (i.e. at the time of data cut-off for this interim analysis). 63.3% (n=197) of the pts were male and 36.7% (n=114) female, mean age was 47 years. About 70% (n=221) of the pts were pre-treated with biologics. Physicians reported a mean PhGA value of 5.9 at BL (n=282, 90.7%) which improved to 2.6 at wk 52 (n=168, 54.0%). Mean BASDAI value was reduced from 5.6 at BL (n=301, 96.8%) to 4.0 at wk 52 (n=171, 55.0%). With regard to inflammation parameters, the percentage of pts with a CRP of >5mg/L decreased from 54.7% (n=140) to 40.0% (n=58) at wk 52. Further, mean ASAS-HI value decreased over time from 8.2 at BL (n=274, 88.1%) to 6.3 at wk 52 (n=156, 50.2%). MOS sleep scale did not change over time, yet only few BL documentations for these scales were available (range n=26 to 44). Regarding depressive mood of the pts, while at BL 40.7% (n=101) of the pts suffered from mild to severe depression (BDI-II score between 14 and 63), 30.3% (n=46) did so in wk 52. This is reflected by a drop of mean BDI-II value from 13.0 at BL (n=248, 79.7%) to 10.6 at wk 52 (n=152, 48.9%). Conclusion Within this limited subset of AS pts, secukinumab reduced disease activity and improved quality of life for up to one year as assessed by validated physicians’ as well as pt-reported outcomes. Overall, this interim analysis gives promising insights into treatment effects of secukinumab on pts’ physical and mental well-being under real-world conditions. References [1] Baeten D, et al. N Engl J Med. 2015;373:2534-4 Disclosure of Interests Uta Kiltz Grant/research support from: AbbVie, Chugai, Eli Lilly, Grunenthal, Janssen, MSD, Novartis, Pfizer, Roche, and UCB., Consultant for: AbbVie, Chugai, Eli Lilly, Grunenthal, Janssen, MSD, Novartis, Pfizer, Roche, and UCB., Daniel Peterlik Employee of: Novartis Pharma GmbH, Veronika Winkelmann Employee of: Novartis Pharma GmbH, Hans-Peter Tony Consultant for: Eli Lilly and Company, Speakers bureau: Eli Lilly and Company

Background IL-17 inhibition has been proved effective in patients with ankylosing spondylitis (AS) in clinical trials and it has been added to the most recent national and international treatment guidelines. However, real-world data of its use is still scarce. Objectives This study aims to describe the axial spondyloartrhtitis (AxSpA) population receiving secukinumab therapy under non-experimental conditions. Methods Multicentric observational, retrospective, longitudinal study conducted in 4 tertiary hospitals of the Madrid region. Patients over 18 y.o. With clinical diagnosis of axSpa and having received at least one dose of secukinumab were included. Medical records were reviewed to collect demographic and clinical data related to axSpA, its features and treatment. Descriptive statstic analysis with measures of central tendency and measures of variability was performed. Results 143 patients, of which 68 women (47.6%) were included. Mean age was 50.6 y.o.(26-74) and average duration of the disease was 12.4 years (1-54). 105 aS patients (73.4%) and 38 non radiographic axSpA patients (26.6%). 85 of them were HLAB27 positive (62%) Observed comorbidities were hypertension (37pt, 25.8%), diabetes mellitus (12pt, 8.4%), dyslipidemia (43 pt,30.1%) and active smoking (41pt,28.7%) average BMI was 27.1 (15.8-43.4), with an obesity rate of 27.6% (29pt). Other comorbidities highlighted were ischemic heart disease (10pt, 7%), HBV infection (10pt, 7.5%), malignancy (14pt, 9.8%) and renal transplantation (2 pt, 1.4%). No HVC nor HIV infections were detected. In terms of axial disease, 97 (65.7%) patients showed grade 2 or higher sacroilitis. In sacroiliac joint MRI studies 35 patients (42.7%) had acute and chronic lesions, 13 (15.9%) had acute lesions, 17 (20.7%) had chronic lesions and 17 (20.7%) were normal. Syndesmophytes were present in 49 patients (34.5%) and hip arthropathy in 15 patients (11.4%). In addition, peripheral disease was present: 77 patients (53.8%) had arthritis, 80 patients (55.9%) had enthesitis and 9 patients (6.3%) showed dactilitis. Joint erosions in hand and feet X-rays were reported in 6 patients (6.8%). Extraarticular SpA features found were inflammatory bowel disease in 3 patients (2.1%), uveitis in 17 pts (11.9%) and psoriasis in12 pts (8.4%). 2 patients (1.4%) presented secondary amiloidosis. Regarding previous treatments, 97.2% had used NSAIDs and 38.5% glucocorticoids. 100 patients (84.1%) had received DMARDs, particularly sulfasalazine (84 pts, 58.7%). 38 patients were naive to biologic therapy (26.6%); 36 (34.3%) had been exposed to one bDMARD, 39 (37.1%) to two and 30 (28.6%) to three or more. Besides all TNF inhibitors, 13 treatments with abatacept, tocilizumab, rituximab or ustekinumab were recorded. Average baseline BASDAI was 6.54 (0.4-12.8), and 5.01 (0-10) after 6 mo SCK therapy. Baseline BASFI was 5.8 (0.4-10) and 4.8 (0-9.6) at 6 months. Adverse events did not differ from those reported in clinical trials. Conclusion Population receiving SCK in real-world setting is different to clinical trials: more complex patientes, with higher disease activity, higher use of previous bDMARDs and higher comorbidity, particularly cardiovascular risk, infections or malignancy that could preclude the use of other biologic therapies. A relevant percentage of off-label prescription in nrAxSpA is reported. Further studys are needed to characterize this population and its clinical response and tolerability to SCK therapy. Disclosure of interests Valentina Emperiale: None declared, Jose Campos Esteban: None declared, Carolina Merino argumanez: None declared, Javier Bachiller-Corral: None declared, Marta Valero: None declared, Beatriz Joven-Ibanez Speakers bureau: Celgene, Novartis, MSD, Pfizer, abbVie, and Janssen, Maria Martin: None declared, ana Perez Gomez: None declared

Background Psoriatic disease is composed of skin, entheseal and joint disease, which can manifest isolated or combined. Little is known about the systemic inflammation levels in psoriatic disease as a robust IL-6 signal is missing and therefore acute phase reactants such as C-reactive protein are often normal. Measuring systemic inflammation in the different manifestations of psoriatic disease is therefore a continuous unmet need. Objectives To better define systemic inflammation in patients with psoriatic disease limited to the skin (S), the entheses (E) or the joints (arthritis, A) or with a combination of these disease manifestations (SE, SA, EA, SEA). Methods Hypothesis-driven approach selecting markers that are (i) either targets of IL-23/IL-17 pathway activation (b-defensin 2, lipocalin 2, IL-22), (ii) associated with neutrophil/monocyte activation (calprotectin, IL-8) and (iii) achieve serum concentrations sufficient for reliable detection by standard ELISA. Parameters were assessed in 210 individuals comprising 105 healthy controls and 105 patients with psoriatic disease (each 15 for isolated (S, E, A) and composed disease manifestations SE, SA, EA, SEA). Results are expressed as percent positive patients with levels above three standard deviations over the mean level in healthy controls. In addition, 6-months sequential data on levels of these markers were collected in 20 patients treated with secukinumab or adalimumab to test treatment effects. Results CRP levels were normal in the majority of individuals. The respective percentages of patients with normal CRP ( 1.88 ng/mL) and lipocalin-2 (>24.7 ng/mL) were elevated in the majority of patients with isolated skin and entheseal, but not joint disease. Conversely, elevations of calprotectin (>3.58 mig/mL) and IL-8 (>10.3 pg/mL) were found in the majority of patients with isolated joint disease. IL-22 was elevated (>17.1 pg/mL) in all three manifestations of psoriatic disease. Reflecting a combination of the findings the vast majority of patients with composed disease manifestation (SE, SA, EA, SEA) showed widespread marker elevation. IL-17 and TNF inhibition differentially lowered and partially normalized elevated markers of inflammation. Conclusion Systemic inflammation is detectable in the majority of patients with psoriatic disease, even if CRP is normal. The respective marker pattern depends on the manifestation (skin, entheses, joints) of psoriatic disease, with beta-defensin 2 and lipocalin-2 reflecting skin and entheseal disease, calprotectin and IL-8 joint disease and IL-22 a combination of these disease manifestations. Disclosure of Interests Maria Sokolova Grant/research support from: M. Sokolova was a PARTNER Fellow, Celgene Sarl, Kemal Nas: None declared, Yubin Luo: None declared, David Simon Grant/research support from: Novartis, Consultant for: Lilly, Speakers bureau: Janssen, Yi Zhao: None declared, Jurgen Rech Grant/research support from: Bristol-Myers Squibb and Celgene (greater than $10,000), Consultant for: Bristol-Myers Squibb, Celgene, Chugai, GlaxoSmithKline, Janssen, Eli Lilly, Novartis, Roche, Sanofi Aventis, and UCB (in total more than $10,000), Speakers bureau: Bristol-Myers Squibb, Celgene, Chugai, GlaxoSmithKline, Janssen, Eli Lilly, Novartis, Roche, Sanofi Aventis, and UCB (in total more than $10,000), Mario Zaiss: None declared, Georg Schett: None declared

Background: Secukinumab (SEC) has been shown to be an effective treatment for patients (pts) with ankylosing spondylitis (AS) and psoriatic arthritis (PsA) in several phase III studies1,2. Clinical studies reduce confounding factors, but do not guarantee the same results in real world where treating physicians deal with comorbidities, adherence and persistence challenges. Especially medication adherence has a direct impact on health outcomes. However, there is limited information on the adherence and persistence of SEC in routine care. Objectives: The aim of this interim analysis is to report baseline (BL) characteristics and to assess adherence rate as well as treatment persistence of SEC in aS and PsA pts under real world conditions. Methods: AQUILA is an ongoing, non-interventional study enrolling 2000 pts with active aS or PsA in Germany. Adherence was calculated as the proportion of the accumulated actual dose divided by the accumulated target dose (according to summary of product characteristics) during the maintenance phase (week 6 to 52). Adherence rate was calculated as the proportion of pts who achieved an adherence of >80% at wk 52. These calculations included pts who discontinued treatment with SEC; still ongoing pts were excluded from this interim analysis. Treatment persistence (time from study inclusion, i.e. date of informed consent, until treatment discontinuation) stratified by biologic/biosimilar (Bx) pretreatment was analyzed using Kaplan-Meier plots. Results: This interim analysis describes 952 pts (AS n=311, PsA n=641) who were included at BL. In total, 51.4% (n=489) of the pts were female and 48.6% (n=463) male, mean age was 50.8 years, and 67.8% (n=645) were pretreated with Bx. At treatment start with SEC, pts presented with a number of extra-articular manifestations/comorbidities: plaque psoriasis 11.6% (n=36) in aS and 66.3% (n=425) in PsA, uveitis 6.4% (n=20) in aS and 1.7% (n=11) in PsA, depression 15.4% (n=48) in aS and 15.4% (n=99) in PsA, coronary heart disease 3.5% (n=11) in aS and 7.9% (n=51) in PsA, stroke 0.6% (n=2) in aS and 1.9% (n=12) in PsA, and heart insufficiency 1.6% (n=5) in aS and 3.0% (n=19) in PsA. Adherence rates for SEC [95% CI] at week 52 were 64.5% [58.3,70.5] and 56.0% [51.5; 60.4] for aS and PsA, respectively. In both aS and PsA, more Bx-pretreated pts discontinued treatment than Bx-naive pts (AS: 38.0% versus 18.9%; PsA: 32.3% versus 20.7%). The most frequent reason for discontinuation was “adverse event/insufficient response/loss of efficacy” in both Bx-pretreated (n=73, 33.0%/n=111, 26.2%) as well as in Bx-naive (n=10, 11.1%/n=34, 15.7%) aS/PsA pts. Moreover, Kaplan-Meier analysis showed that in both aS (Figure 1a) and PsA (Figure 1b) groups, Bx-naive pts who received SEC as first line therapy had a higher persistence rate than those pretreated with Bx. Conclusion: AQUILA study revealed high disease burden at BL across aS and PsA pts characterized by the presence of extra-articular manifestations and cardiovascular diseases. Adherence rates under real-world conditions were consistent and comparable with published literature regarding immune-mediated inflammatory diseases3. SEC demonstrated a high drug persistence in real world in particular in Bx-naive pts. Overall, this interim analysis demonstrated that SEC is a reliable treatment in Bx-naive as well as Bx-pretreated pts with aS or PsA in a daily routine setting. References [1] Baeten D et al. Lancet. 2013;382(9906):1705-13; [2] McInnes IB et al. Lancet. 2015;386(9999):1137-46; [3] Vangeli E et al. Adv ther. 2015;32:983-1028 Disclosure of interests: Uta Kiltz Grant/research support from: abbVie, Chugai, Eli Lilly, Grunenthal, Janssen, MSD, Novartis, Pfizer, Roche, and UCB., Consultant for: abbVie, Chugai, Eli Lilly, Grunenthal, Janssen, MSD, Novartis, Pfizer, Roche, and UCB. Daniel Peterlik Employee of: Novartis Pharma GmbH, Veronika Winkelmann Employee of: Novartis Pharma GmbH, Hans-Peter Tony Consultant for: Eli Lilly and Company, Speakers bureau: Eli Lilly and Company

Background: Spondyloarthritis (SpA) is characterized by extensive angiogenesis, tissue remodeling and inflammation of both the enthesis and the synovial tissue. Several studies have shown a relation between angiogenic/tissue remodeling serum markers and disease progression. Secukinumab, an anti-IL-17A inhibitor, is an effective treatment in SpA, but it’s effects on serum markers of angiogenesis, tissue remodeling and inflammation are largely unknown. Objectives: The purpose of this study was to analyze several candidate biomarkers of these processes in patients with SpA treated with anti-IL-17A. Methods: Serum samples from 20 active peripheral SpA patients that were included in a 12 week open-label trial with secukinumab were analyzed for several markers with luminex technology. Study design and primary results were previously published (1). Results: Serum levels of IL-6, MMP-3, osteopontin (all P Conclusion: These results indicate that anti-IL-17A not only diminishes inflammation, but also impacts on other processes such as angiogenesis and tissue remodeling. Whether these observations are predictive of disease progression or outcome remains to be determined. References [1] van Mens, L. J. J. et al. IL-17 blockade with secukinumab in peripheral spondyloarthritis impacts synovial immunopathology without compromising systemic immune responses. Arthritis Rheumatol. (2018). doi:10.1002/art.40581 Disclosure of Interests: Merlijn Kaaij: None declared, Leonieke van Mens: None declared, Jan Piet van Hamburg: None declared, Dominique Baeten Employee of: UCB Pharma, Marleen van de Sande Grant/research support from: Research support from Janssen, Novartis, Eli Lily, Consultant for: Received consultation fees from Abbvie and Novartis, Sander W. Tas: None declared

Background Secukinumab (SECU) is a human IgG1κ monoclonal antibody that binds to the protein interleukin-17A approved for the treatment of psoriasis, ankylosing spondylitis, and psoriatic arthritis (PsA). Recently presented data suggest that combination with methotrexate (MTX) in patients with PsA may not be as necessary as in rheumatoid arthritis as it improves neither efficacity nor sustainability (1,2,3,4). Objectives This analysis describes the use of SECU with or without MTX. Methods The data of patients with psoriatic arthritis seen since January 1, 2015 (date at which SECU appeared in the Canadian market) at the Institut de Recherche en Rhumatologie de Montreal (IRRM) and the Centre de l’Osteoporose et de Rhumatologie de Quebec (CORQ) was extracted from the Rhumadata® clinical database and registry on January 7, 2019. Selected patients initiated SECU either without (MTX-) or with MTX (MTX+). The collected data include baseline characteristics (socio-demographic variables, concomitant and past medication, comorbidities and the Charlson comorbidity index (CCI)), variables measured over time (laboratory test results, patient and physician-reported outcomes, and disease activity measures such as minimal disease activity (MDA), CDAI and DAS28(4)-ESR) and persistence data (treatment duration, reason for cessation). The groups were compared to identify potential confounder, and persistence data were analyzed using Kaplan-Meier and proportional hazard methods. Results A total of 96 patients were prescribed SECU since January 1, 2015. Of those, 49% (n=47) treated with MTX. No significant differences in baseline (at treatment initiation) were observed between the MTX+ and MTX- groups. Average age at treatment initiation was 52.4 (standard deviation=11.3) and 53.7 (13.4) in the MTX+ and MTX- groups respectively. Women represent 45% and 55% of these groups, and the average body mass index was 29.9 (6.2) and 28.1 (6.0) kg/m2. Patient global, pain and fatigue assessments, made on a visual analogue scale ranging from 1 to 10, were 4.9 (2.6), 5.3 (2.9) and 4.3 (2.9) in the MTX+ group and 6.3 (2.2), 6.9 (2.1) and 6.5 (2.9) in the MTX- group. Among the 38 (40%) patients ceasing therapy, the principal reason for cessation was “inefficacy” (MTX+: 15/17 (88%) vs MTX-: 15/21 (71%)). Patients remaining on treatment at last follow-up had an average treatment duration of 1.7 (0.8) and 1.5 (0.7) years. The improvement in CDAI, HAQ and the percentage of patients reaching MDA are similar for both groups. No difference in retention was observed between the MTX+ and MTX- groups (log-rank p=0.4867). These results remain unchanged when we adjust for age at treatment initiation, gender, disease duration, and comorbidities (Charlson comorbidity index). Conclusion Combining MTX to SECU does not improve its sustainability over time. Efficacy was also the same for both cohorts. References [1] Mease PJ, et al. Arthritis Rheumatol. 2018; 70 (suppl 10). Abstract L11 [2] Benryane O, et al. Arthritis Rheumatol. 2018; 70 (suppl 10). Abstracts 693 and 694 [3] Benryane O, et al. CRA-2019, Montreal, Canada. Disclosure of interests Denis Choquette Grant/research support from: abbvie, amgen, Eli Lilly, Novartis, Pfizer, Sandoz, Consultant for: abbvie, amgen, Eli Lilly, Novartis, Pfizer, Sandoz, Speakers bureau: abbvie, amgen, Eli Lilly, Novartis, Pfizer, Sandoz, Louis Bessette Grant/research support from: abbVie, amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Novartis, Pfizer inc, Roche, Sanofi, UCB, Consultant for: abbVie, Celgene, Eli Lilly, Novartis, Pfizer inc, Loic Choquette Sauvageau: None declared, Isabelle Ferdinand Consultant for: abbVie, amgen, Novartis, Pfizer, Speakers bureau: amgen, Pfizer, Paul Haraoui Grant/research support from: abbvie, amgen, Pfizer, UCB, Consultant for: abbvie, amgen, Lilly, Pfizer, Sandoz, UCB, Speakers bureau: Pfizer, Frederic Massicotte Consultant for: abbVie, Pfizer, Janssen, Eli Lilly, Speakers bureau: Janssen, Jean-Pierre Pelletier Shareholder of: Shareholder in arthroLab inc., Grant/research support from: Study funded by TRB Chemedica SA, Consultant for: TRB Chemedica SA, Jean-Pierre Raynauld Consultant for: arthroLab inc., Marie-Anais Remillard Consultant for: abbvie, amgen, Eli Lilly, Novartis, Pfizer, Sandoz, Paid instructor for: abbvie, amgen, Eli Lilly, Novartis, Pfizer, Sandoz, Speakers bureau: abbvie, amgen, Eli Lilly, Novartis, Pfizer, Sandoz, Diane Sauvageau: None declared, Edith Villeneuve Consultant for: abbVie, UCB, Celgene, Roche, Pfizer, amgen, BMS, Sanofi-Genzyme, Paid instructor for: abbVie, Speakers bureau: abbVie, Pfizer, BMS, Roche, Louis Coupal: None declared

Career situation of first and presenting author Student for a master or a PhD. Introduction IL 17-A blocking with Secukinumab (SEK) has proved efficacy in the treatment of psoriasis and psoriasic artritis (PsoAr). Inflammatory bowel disease (IBD) is more common among patients with psoriasis and is cosidered as a part of the spectrum of spondyloarthritis. IL-17 is a cytokine required for the normal homesotasis of the bowel and its inhibition could initiate a subclinic disease. Objectives We have observed 2 patients with IBD during therapy anti-IL17 for PsoAr. Results Case 1 A 20-year-old woman with a diagnosis of plaque psoriasis since 12 years; she has been treated with topic treatment, phototherapy and Methotrexate. In November 2017 She presented skin worsening, (PASI 20, DLQI 20 and started treatment with SEK at a dose of 300 mg every 4 weeks. After the 2nd dose she began with abdominal pain and increased depositions. Acute phase reactants were increased major PCR 194 mg/dl ESR 87 mg/dl. In colonoscopy, biopsies objective and inflammatory lesions with extensive areas of mucosal ulceration compatible with Crohn’s disease were observed. Case 2 A 59-year-old man with a diagnosis of ankylosing spondylitis of 30 years of evolution without a clinical response to NSAIDs and sulphasalazine, was treated with SEK 150 mg. After the second dose during induction, He presented fever 38.9°C, abdominal pain, bloody diarrhea, and nocturnal tenesmo. A colonoscopy showed typical ulcerative colitis lesions with severe activity. Conclusions SEK is a very potent treatment for psoriasis and psoriatis arthitis, with positive results n Spondylitis, but not effective for IBD. Il-17 is a cytokine with a role in the normal intestinal homeostasis. Psoriasis and Spondyloarthritis patients have an association with IBD and uveitis. We present 2 patients who were diagnosed of IBD shortly after start SEK, anti-IL17. We think they could have a previous undiagnosed IBD; SEK could have trigger a flare but We can’t rule out a role of IL-17 inhibition. During clinical trials for SEK, only 0.7 cases per 100 patients-year of IBD were reported. Caution must be taken before start SEK for patients to detect posible symptoms of IBD. Reference Schreiber S, Sands B, Deodhar A, et al. OP0113No Increased Incidence of Inflammatory Bowel Disease among Secukinumab-Treated Patients with Moderate To Severe Psoriasis, Psoriatic Arthritis, or Ankylosing Spondylitis: Data from 14 Phase 2 and Phase 3 Clinical Studies. Annals of the Rheumatic Diseases 2016;75(Suppl 2):97–98. Disclosure of Interest None declared.

Career situation of first and presenting author Student for a master or a PhD. Introduction Recently new therapeutic targets have been approved for the treatment of psoriatic arthritis (PSA). We have limited experience in real clinical practice. Objectives To assess efficacy, safety and tolerability of secukinumab in patients with active PsA. Methods Descriptive, retrospective observational study on the efficacy and safety of secukinumab in patients who met CASPAR clasification criteria for PsA in follow-up in the Virgen de Valme hospital area. We evaluate, measures of disease activity by DAPSA in peripheral forms and ASDAS in axial forms. Statistical analysis The quantitative variables are expressed with means and standard deviations or medians and quartiles if the distributions are asymmetric, and the qualitative variables with percentages. Results 12 patients were reviewed. 58.3% were male.The average age of these patients is 47.67 years.The mean time of evolution in years of the disease was 8.33. 75% of the sample was not a smoker, and 83.3% of patients didn´t consume alcohol excessively. 25% were hypertensive. 8.3% had an associated dyslipidemia, and 16.7% had a symptomatic hyperuricemia. Oligoarthritis form was the most frequent patterns of presentation with 46%, followed by polyarthritis with 27%. All patients had previously failed at least one DMARD, the most frequent being Methotrexate (41.7%), Up to 75% of the patients were naive to biological therapy. In patients refractory to biological therapy, the most commonly used drug in first choice was etanercept. In peripheral presentation 80% of the patients had a moderate DAPSA at the beginning of the treatment and of these 62% passed to a low activity, while 38% they remained with moderate activity. In patients with high activity, up to 70% went to a low activity DAPSA, and in 30% it decreased to moderate activity. We have survival with the drug that has been 12.67 months with a DS of 7.07 months. Treatment has been suspended in 3 patients, in one of them due to severe skin and joint breakout, in another due to nausea and headaches, and the last due to ineffectiveness. Finally, regarding the safety data we have not had any severe adverse effects. 8.3% had mild adverse effects, the most frequent being infectious symptoms of the upper respiratory tract. 8.3% had a primary failure (no response at any time) compared to 25% that has presented a secondary failure after a good initial response to treatment. Conclusions Secukinumab provided sustained improvements in signs and symptoms in patients of active and was well tolerated, with a safety profile consistent with that reported previously. Reference McInnes IB, Mease PJ, et al. Secukinumab, a human anti-interleukin-17A monoclonal antibody, in patients with psoriatic arthritis (FUTURE 2): Future 2 Study Group. Lancet 386(9999):1137–46. Disclosure of Interest None declared.