Remission, low disease activity and improvement of pain and function in psoriatic arthritis patients treated with IL-12/23 and IL-17 inhibitors. A multicenter prospective study

Abstract

The development of new biologic and targeted synthetic DMARDs can lead to good disease control. The aim of the present study was to assess the rate of remission and low disease activity, and the improvement of pain and function, in psoriatic arthritis (PsA) patients treated with new anti-IL-12/23 and anti-IL-17 biologic agents. A prospective 6-month study was performed. Patients fulfilling the CASPAR criteria for PsA that started ustekinumab, secukinumab and ixekizumab were enrolled and prospectively followed in a setting of clinical practice. Patients were considered in minimal disease activity (MDA), when they met at least 5/7 of the criteria previously defined. DAPSA score ≤4 was also evaluated as a remission criterion. Pain on VAS, PtGA and HAQ were also assessed in all patients. Patients achieving MDA were compared to non-MDA to identify outcome predictive factors. Of the 70 patients treated with ustekinumab, secukinumab and ixekizumab, at baseline, no patients were in MDA or had a DAPSA score ≤4. Ten patients (14.2%) were lost during the follow-up. After 6 months, MDA was achieved in 22 (31.4%) patients. DAPSA≤4 was achieved in 17 (24.2%) patients. Significant improvement in pain, PtGA and HAQ was also found. Patients naïve to anti-TNF treatment achieved more frequently MDA compared to anti-TNF-experienced patients. Male sex, high levels of CRP and absence of comorbidities were found to be predictors of MDA. In our prospective observational study, MDA was achieved in 31.4% and DAPSA remission in 24.2% of patients treated with inhibitors of IL-12/23 and IL-17, thus making this target achievable in PsA patients treated with these drugs.

A Machine Learning Approach to Predict Remission in Patients With Psoriatic Arthritis on Treatment With Secukinumab

“…We found a significant decrease in disease activity at 12-month treatment with SEC and remission occurred with a similar frequency as in other Italian and international cohorts ( 8 , 20 ). Furthermore, SEC was proven to improve LEI, PASI, and BASDAI at 12 months.…”

“…Secukinumab (SEC), a human monoclonal antibody that directly inhibits interleukin-17A, has demonstrated efficacy in patients with PsA in phase III FUTURE studies (5), but only sparse data exist about predictors of disease remission in PsA patients in real-life settings (6,7). While logistic regression (LR) was the algorithm of choice to find independent predictors in multivariable models, it must be noted that in previous real-life studies, the hypotheses were usually based on the unreal assumption that the association between the prognostic factors and PsA remission is direct and isolated (8)(9)(10).On the contrary, LR is not suitable for modelling non-independent variables (6), being inadequate to explicitly describe the complex relationship between prognostic factors and remission for complex multifactorial diseases such as PsA. Additionally, previous multivariable models often lacked rigorous internal and external validation (11,12), leaving internal consistency unchecked and raising doubts on model validity in the general PsA population.…”

Impact of Comorbidities on Disease Activity, Patient Global Assessment, and Function in Psoriatic Arthritis: A Cross-Sectional Study

“…Our results are in keeping with other studies, in which some domains such as function (assessed by HAQ-DI), patient's impact (assessed by PsAID), and quality of life were affected by the presence of comorbidities [12,31,32]. Our study comes from two centers devoted to the management and treatment of PsA and the patients enrolled were, generally, in a condition of low disease activity.…”

Comorbidities, pain and fatigue in psoriatic arthritis, psoriasis and healthy controls: a clinical cohort study

“…depression, anxiety. The selection of comorbidities was based on previous research regarding comorbidities as prognostic factors for treatment outcomes in PsA (5,7,8,(10)(11)(12)14,18) and on expected frequencies of the various comorbidities (2). It was prioritized that the comorbidities were relatively frequent among patients with PsA.…”

“…Comorbidities such as hypertension, obesity, and depression/anxiety have previously been identified as negative prognostic factors for clinically relevant treatment outcomes in PsA (4)(5)(6)(7)(8)(9)(10)(11)(12), and comorbidities significantly impact patients' quality of life (13). Moreover, the presence of comorbidities according to the Charlson Comorbidity Index (CCI) and other comorbidity scores have been associated with higher disease activity, shorter treatment persistence and/or reduced clinical treatment response rates (14)(15)(16)(17)(18). Thus, growing evidence indicates that comorbidities play an important role in PsA concerning disease activity and response to treatment.…”