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You're listening to a RheumNow podcast coming to you from Barcelona, Spain and EULAR twenty twenty five. Hope you enjoy it.

I'm Anthony Chan reporting for RheumNow in EULAR twenty twenty five in Barcelona and some interesting new ways of delivering care in axial spondyloarthritis was presented at EULA twenty twenty five. And one of the interesting abstracts was poster 122 which was presented by Doctor. Ute Kils from Germany. This is using digital behavioral therapy for patients with persistent pain in axial spondyloarthritis. So I'm very happy and delighted that Ute Kils can actually join us here to describe the abstract and also to discuss this in a bit more detail.

So Ute, welcome. And I wonder whether you could take us through your poster and abstract.

Yeah, Antoni, thank you very much for this possibility to present my data. So we ask ourselves how can we improve care for patients with actual SPA and a problem that quite frequently occurs in patients with axSpA is chronic pain. So we thought about investigating whether digital behavioral therapy would be, efficacious in our patients. So we designed a randomised control study by randomising patients to a treatment arm, that's patients with a stable medication, but we prescribed a digital health application. And the other group were a standard of care group who did not receive the digital behavioural technique app.

So we used an app which is approved by regulatory authorities in Germany that consists of seven different lessons on which the patient learned what is pain, some pathophysiological background, but more importantly, all these aspects of behavioural change techniques. And the patient was also able to practice and to use the knowledge and also to have some background information by psychologists if needed by the patients. So ultimately we started our trial in patients with actual SPA diagnosis, chronic pain and a stable medication. Majority of patients were on biologic treatment. We included altogether 136 patients and the patients were randomized one to one in the treatment arm.

So patients with the app prescription were able to use the app. However, we investigated that not all patients use the app actively. So in terms of the analysis, we compared in our analysis only the patient who actively used the adverse of the standard of care group. And we were able to show that especially the multidimensional pain inventory, who is assessing the interference of pain in daily activity, significantly reduced over the period of the study trial, which was not so much the case for the pain level itself. And we were also able to show that health related quality of life improved.

So as a limitation for our study, we saw that one fifth of patients did not use the app that had multiple reasons. One reason was that the prescription was not allowed by the healthcare insurance. But for the majority of patients, the main limitation was that the patients were not able to integrate the app education, app training in their daily routine life. So we were able to show with this study that digital behavioral technique might be beneficial for a selected patient population with actual SPDA. And we start thinking about investigating this further on.

That was very nice work. It's very clear that the ACT app group did better than the standard of care group in your study. Was there any particular subgroup of patients who in your study would seem to benefit more from the ACT app maybe based on their age or digital literacy? Did you notice any subgroup?

So we had a quite good age representation and we didn't see a rate age restriction for patient groups for either younger or older patient groups. So no, we did not have this separation. We did a pragmatic trial, for sure health literacy would be a wonderful outcome, but we didn't test that in our patient population. Of course, we also talked to our patient. We didn't assess their opinion about the app.

We did that in a standardized manner by using the usability score and also the Net Promoter Score. And we identified those patients who actively used the app had a much more better Net Promoter Score and also rated the patient global impression of change much more in favor to the app compared to those who didn't use it. But in our subgroup analysis, and I think that's also partly of the sample for the quite small sample size, we didn't see a specific subgroup that benefit from the app.

So very interesting and also at this conference we did see a lot of new digital technologies in the field. Do you think that these ACT based digital therapy will be maybe part of routine care in Expo in the future?

I think yes. But I think you also have to need a healthcare system that is supporting these digital technologies. And I think in this respect, especially for Germany, we now have the regulatory pathways to improve such devices. However, we also have to speak about costs and that's not a small amount of costs if we are prescribing the digital ACT apps to our patients. We really have to investigate further on who will benefit from the app so that we can prescribe the app in a more targeted way.

I really appreciate that Germany is allowing this digital health application in a regulatory pathway because we as physicians do not have to take care anymore for, the, safety of the patient in this digital health area and also the data security options, because that already has been approved by the regulatory authority. So we just can focus on our patients. And yes, I would really love to prescribe that in a more frequent way.

Yeah, that is good news and I'm sure it's good news for your patients as well, that they have the opportunity to participate in this form of treatment. And I think you raised a very important point that the rollout or the implementation of such digital tools or apps is going to be also related to the healthcare system, renumeration and also the insurers so that whether they could facilitate the access to these digital interventions. So you've done a twelve week study here. Are you planning a longer term study to see how this goes in the long term?

Yes, indeed, we are planning that. However, if you are thinking about that the app will then be used over a longer period of time, that's not totally foreseen in the regulatory way in Germany because our ASK group prescribed the app once for twelve weeks and then the patient should be educated enough to use all these techniques without the prescription of the app. We can re prescribe the app in patients who need more support. But I foresee that for the majority of patients we will be only have a limited availability to prescribe the app on a frequent basis. I think that's the limitation at the system at the moment.

It's great to hear from you about your poster. We are very excited to hear how this develops and where we can learn a lot from each other through the different experiences that we have with our system. So Uta, thank you for your time. It's been great to hear your work, we look forward to seeing how this develops in the future. Thank you very much.

Yeah, thank you.

Hi, everyone. This is Aurelie Najm from Glasgow reporting live from EULA in Barcelona. I was very excited when I saw this presentation and I wanted to share it with you. I've been working in the field of digital health for quite a while. We published a recommendation, the points to consider for digital health implementation in rheumatology that was back in 2019.

And I remember doing the systematic literature review and there was pretty much not a lot of higher quality evidence as in randomized controlled trials and so on. Then I was part of the remote care, the points you can see there from you Ula for remote care back in 2022. And again, the SLR, the systematic literature review did not show a lot of RCTs. And so I was really waiting for a randomized controlled trial in the field of digital health. And today it was presented on the last day of EULA, LB zero zero zero two.

And so it's a randomized controlled trial crossover in spondyloarthritis. It's a German trial. And they looked at an app called Axia. So it was a digital health app trial where 200 patients were randomized. There was a control group that was standard of care without the app.

And a group that were given the app and given access to it. And the app itself on the smartphone had a lot of exercises for self rehabilitation, exercise for movement, a lot of information about the disease, knowledge, gamification and then some elements of photogenic training as well. And so the patients were able to use that app and the outcome was assessed at twelve weeks. So I was surprised. I was very impressed by the outcome because everything improves.

VASTY, VASTY, ASKOL. And when it in terms of improvements, we're talking about a magnitude of minus 1.5 points roughly, which is clearly, you know, clinically significant, pretty much as much as biologic at that point, which is pretty impressive. And in terms of ASAS response, ASAS 20, we were in the range of the forty percent versus nine percent in the control group. So really a profoundly impressive outcome for something that is a non pharmacologic intervention. So very promising, in my opinion.

There's one thing I wanted to highlight, though, is that what we've seen in the past in digital health interventions is that there's usually a big enthusiasm at the start and people use the app a lot. But what we see, the adherence and the usage of the app itself drops quite quickly over time and so, if you look at the cabs, usually people use the app a lot is the new and shiny thing and they have fun with it and they like it and then, they get bored of it and then, they don't use it anymore. So I'd be quite interested to see if this study is planning to have a longer term follow-up to see if that how is the retention of usage of the app and if people still get a benefit if they use it less or don't use it anymore. So that's definitely But still, that's something that I found was quite exciting in the field. And so I'm hoping to see more of it.

I'm hoping to see more of it. I wanted to invite you to tune in on roomnat.com, follow RheumNow on Twitter, follow me AurelyRomo and I'll see you guys soon.