Hello, my name's Laura Coates from the University of Oxford in the UK, and I'm here to share with you some data that I've just presented at the ACR meeting in Chicago, in America. So this data was a post-hoc analysis of the FOREMOST study. So this is a study in oligoarticular psoriatic arthritis where patients were randomized to receive either apremilast or placebo for the first 16 weeks, and then those on placebo switched over to active treatment. And it's one of the few studies where a group of specifically oligoarticular disease have been recruited, as I'm sure most of our trials, the big phase 3 trials of drugs tend to have tender joint counts of 20, swollen joint counts of 10—very polyarticular disease. So I think the oligoarthritis patients are often missed, but they do account for quite a large proportion of the patients that we see in clinic.

So it's important to really understand how to treat them and how their disease might progress. So the main data from the foremost study has been presented previously that showed that apremilast was superior to placebo. But the aim of this analysis was to look at what factors predicted progression from oligoarticular disease less than 5 active joints to polyarticular disease with 5 or more active joints. And that's important. I think historically, we've often thought of oligoarthritis as being a mild disease, but we do know from quite a lot of old studies in fact, that a lot of oligoarthritis patients or a proportion will go on to develop polyarticular disease. So it's kind of useful to think about which patients are the highest risk, where we may need to monitor them more closely or intervene more strongly. So the first thing they did in this analysis was they looked at the whole population.

So those who received apremilast and those who received placebo, and they showed that those receiving apremilast were much less likely to go on to get polyarticular disease. That makes sense, because they were receiving active treatment. The patients that were more likely to show progression to oligo- to polyarthritis were women. Those who were not receiving a conventional DMARD like methotrexate alongside their apremilast or placebo, those who had enthesitis, those who had a higher BMI, and those who had dactylitis as well. So we can see associations with types of psoriatic arthritis or patterns of disease as well as sex and BMI. Then what they went on to do was look specifically at the placebo group.

Obviously those receiving apremilast were much less likely to get progression of disease, but actually in terms of natural history of the disease, what happens in patients who are not treated with systemic medication? Again, what are the factors at play here? And I think some of these were the same. So we saw more progression again in women and in those who have not had prior DMARD use. So again, treatment comes out. We saw actually less progression in those with nail psoriasis, which is maybe surprising. Maybe you would expect that to be associated with more progression, consistently. Again, more progression in those who were more overweight, so with the BMI of over 30, and again, those who had active dactylitis.

So I think this is really useful data because this is a group of patients that we don't study often. They're not included in a lot of the trials. And it's really important for us to think about how we personalize treatment in psoriatic arthritis. Not all oligoarthritis patients require systemic therapy or biologics, but a proportion of them can have very severe disease or can go on to progress to much more severe disease. And so understanding those factors that predict who's more likely to go on to develop more significant or widespread disease really helps us to understand who we need to intervene in a little bit more aggressively from the beginning. Thank you very much.