Louis Bessette, MD, MSc: Pain Improvement and Patient-Reported Outcomes in Patients with Psoriatic Arthritis

Rheumatology Network interviewed Louis Bessette, MD, MSc, to discuss his ACR presentation, “Impact of Early Pain Improvement on Patient-reported Outcomes in Patients with Psoriatic Arthritis: Results from a Phase 3 Trial.” Bessette is affiliated with the Center for Osteoporosis and Rheumatology of Quebec. He explains why pain is a largely unmet need in this patient population, the study design, and further research his team plans on tackling in the future.

Below is a preview of our conversation:

Rheumatology Network: What first inspired you to evaluate if clinically meaningful improvements in pain is associated with greater improvements in other prs.

Louis Bessette, MD, MSc: As a rheumatologist, most patients come into the clinic because they have pain and pain has a major impact on quality of life. And the main reason why patients come to treatment is to improve their pain and functions. So, I think pain is related to many aspects of patient lives. It's very important to understand how can we manage pain, how can we improve pain, how can we maintain pain improvement over time, and what is the impact of managing pain over time as well as the impact on quality of life of our patients.

RN: Why is pain a largely unmet need, particularly in patients with inadequate response to non-biologic disease-modifying antirheumatic drugs (DMARDs)?

LB: I think there's 2 different aspects of pain and pain still an unmet need. I think as rheumatologists we’re able to control disease activity or inflammation, but there are a lot of patients complaining of pain, not always related to their disease activity, but musculoskeletal conditions. Sometimes original pain is also related to inflammatory activity in patients that we're not able to control. And we need better medication to control pain over time and also to control information. Maybe some medications have better impact on residual pain than others. So, I think there's a lot of research going on how to manage pain in our patients and what can we use that to improve pain management.

RN: What were the results of your study?

LB: What we show is that there was a significantly greater proportion of patients who had a meaningful improvement with upadacitinib, both 15 and 30 milligrams. The other group also improved compared to placebo. However, we also found that compared to our daily demand, there were a significantly greater proportion of patients achieving meaningful pain improvement with upadacitinib 15 milligram and that differences started at 20 weeks. And in the 30 milligrams route, the differences started at 4 weeks. We know that 30 milligrams are indicated in clinics that 15 milligrams is used to treat a psoriatic arthritis (PsA). So that was the first finding. The second finding is that for those which achieve this meaningful pain improvement, as I described before, in that group compared to the group who did not met this criteria for meaningful pain improvement at 4 and 24 weeks, they also obtain that meaningful improvement at a better quality of life, higher score or the EuroQoL-5 Dimension (EQ-5D), better improvement in their function as measured by the Health Assessment Questionnaire-Disability Index (HAQ-DI), better quality of life as measured by 36-Item Short-Form Health Survey (SF-36), and better improvement in work capacity and activity impairment.

RN: What do you believe is the clinical significance of these results?

LB: I think clinical significance is that a lot of patients obtain meaningful pain improvement and are able to maintain that for 24 weeks if they're still on treatment. And the other aspect is relating pain improvement to quality of life. So when you can achieve what we call in our study meaningful pain improvement, these patients have better function and have better quality of life. So, I think pain, as I mentioned before, is really related to many aspects of quality of life of patients. And you know, patient come into our office complaining of pain, not because of swollen joints. Pain improvement is a major, major driver of all the other aspects of quality of life in our patients.