In a real-world analysis of people with psoriatic arthritis (PsA) taking either a TNF or IL-17 inhibitor, peripheral arthritis and skin disease were the most common disease domains; dactylitis and axial disease were the least common. Improvements occurred across all domains at the 6-month follow-up.
The paper appeared in ACR Open Rheumatology.
Of the 1,005 eligible patients in the study, 63% received TNF inhibitors, and 37% received IL-17 inhibitors. Peripheral arthritis and skin disease appeared in 86% and 82% of patients, respectively. More than two-thirds of participants continued therapy at 6 months of follow-up. Improvements in disease activity and patient-reported outcomes (PRO) were observed in both groups and across all PsA domains.
The study was sponsored by Amgen Inc. The following excerpts were edited for length and clarity.
What was the intent of the study?
Real-world studies assessing treatment response by PsA domains are limited. Further, little is known about how the treatment response varies with different manifestations of PsA.
This study aimed to assess and describe patient characteristics, frequency, and combinations of disease domains, disease activity, and PROs by PsA domains in patients who initiated treatment with a TNFi or IL-17i.
How was the study conducted?
Data were collected from patients enrolled in the CorEvitas PsA/SpA Registry (formerly known as the Corrona PsA/SpA Registry) — a prospective, longitudinal, noninterventional, observational registry of patients with PsA or spondyloarthritis under the care of a licensed rheumatologist. The registry includes data on roughly 4,500 patients recruited from 64 private and academic practice sites across the U.S. Data were collected during routine clinical encounters in the following areas: demographics; disease duration and severity; medical history, including disease treatments; smoking status; alcohol use; comorbidities; pain and function; PROs; and clinical effectiveness measures.
The study included adults ages 18 years or older with a physician-confirmed PsA diagnosis who had initiated treatment with a TNFi (adalimumab, etanercept, certolizumab pegol, infliximab, or golimumab) or an IL-17i (ixekizumab or secukinumab) between January 2013 and January 2021 and who had a follow-up visit 6 months after therapy initiation.
What were the key findings?
The prevalence of PsA domains identified in the population was as follows: peripheral arthritis (86%, 860 of 1,005), skin disease (82%, 823 of 1,005), nail psoriasis (57%, 571 of 1,005), enthesitis (38%, 385 of 1,005), dactylitis (23%, 228 of 1,005), and axial disease (20%, 199 of 1,005).
At 6 months of follow-up, the proportion of patients still taking TNFi or IL-17i was 68%, 68%, respectively. People with enthesitis and axial disease were less likely to remain on therapy (56% and 52%, respectively), whereas patients with dactylitis were more likely to remain on therapy (72%). Inadequate response or loss of efficacy over time were the most common reasons for discontinuation of therapy.
At 6 months, improvements in disease activity and PROs were observed across all PsA domains in all patients.
Among TNFi initiators, the mean change from baseline in Physician’s Global Assessment (PGA) scores ranged from -11.4 in patients with nail psoriasis to -18.8 in patients with dactylitis. The proportion of patients who achieved minimal disease activity (MDA) at 6 months among those not at MDA at baseline ranged from 19.5% to 34.1% across PsA domains.
Among IL-17i initiators, the mean change from baseline in PGA scores ranged from -10.8 in patients with nail psoriasis to -21.8 in patients with dactylitis, and the proportion of patients who achieved MDA at 6 months ranged from 15.1% to 21.7% across PsA domains.
What are the clinical implications of these findings?
According to researchers, the study demonstrated the effectiveness of these therapies in diverse patient groups exhibiting different PsA phenotypes in a real-world setting.
Clinical implications
- In a real-world study, TNFis and IL-17is were effective across PsA disease domains and patient groups.
- Most patients with PsA tended to stick with the medications at 6 months; those with enthesitis and axial disease were less likely to do so.
- Peripheral arthritis and skin disease were the most common PsA domains.
Read the study here and expert commentary on the clinical implications here.
The study was sponsored by Amgen Inc.
