Vinod Chandran, MBBS, MD, DM, PhDRecent studies in psoriatic arthritis (PsA) have focused on transition from psoriasis to PsA. Patients with PsA are likely go through preclinical, subclinical, prodromal, and finally overt PsA. Zabotti and colleagues aimed to estimate the probability of developing PsA in patients with subclinical PsA defined as psoriasis and arthralgia. Of the 384 psoriasis patients from two European cohorts included in the study, 311 (80.9%) had subclinical PsA. The incidence rate of new-onset PsA was 7.7 per 100 patients-years in this group; the most predominant presentation was peripheral arthritis (82.1%). The risk for PsA was significantly higher in patients with subclinical PsA vs psoriasis (hazard ratio 11.7; 95% CI 1.57-86.7). In another cross-sectional study, Yao and colleagues compared 75 patients diagnosed with clinical PsA with 345 patients with psoriasis and without PsA, all of whom were aged 18-65 years. The authors demonstrated that at age 40 years or older, nail involvement, increased erythrocyte sedimentation rate (ESR), and high-sensitivity C-reactive protein (CRP) levels were associated with PsA. Moreover, MRI-detected enthesitis and tenosynovitis combined with these risk factors vs the risk factors alone showed better specificity (94.3% vs 69.0%) and similar sensitivity (89.0% vs 84.6%) in distinguishing PsA from psoriasis alone. Thus, psoriasis patients with arthralgia as well as those with nail disease and elevated ESR/CRP levels are at high risk for PsA. These patients should be carefully monitored to detect PsA early. These patients may also be ideal candidates to study interventions intended to prevent transition from psoriasis to PsA.
In regard to treatment, bimekizumab is a new monoclonal antibody that dually targets interleukin (IL)-17A and IL-17F and is highly efficacious for the treatment of psoriasis. In a meta-analysis of four placebo-controlled randomized clinical trials that included 1323 patients with PsA (age 18 years or older), of whom 853 received bimekizumab, Su and colleagues demonstrated that bimekizumab led to a significantly higher response rate for minimal disease activity (risk ratio [RR] 4.188; P < .001) and a 70% or greater improvement in the American College of Rheumatology (ACR) criteria (RR 7.932; P < .0001) when compared with placebo. Bimekizumab was superior to placebo in achieving ACR20/50/70 response at a dose of 160 mg. The risk for treatment-emergent adverse events was modestly higher with bimekizumab vs placebo (RR 1.423; P = .023), whereas the risk for serious cancers, upper respiratory tract infection, injection site reactions, and pharyngitis was similar for both. Thus, bimekizumab is an efficacious agent for the treatment of PsA. Future head-to-head studies will help clinicians determine the role of this drug in the management of PsA.
Not all patients respond equally well to targeted therapies, and the so-called challenging-to-treat patients are being increasingly described. Kivitz and colleagues recently described the efficacy of secukinumab, a monoclonal antibody targeting IL-17A, in these challenging-to-treat patients from the United States. In a post hoc subgroup analysis of four phase 3 studies that included 279 patients, they demonstrated that patients receiving 300 mg secukinumab and 150 mg with a loading dose had a higher rate of achieving the ACR20 response (59.7% and 43.4%, respectively) vs 15.6% for placebo (both P < .0001). The Psoriasis Area and Severity Index 90 response was 47.1% and 22.2%, respectively, vs 5.3% (both P < .05). Thus, secukinumab is efficacious in more challenging-to-treat patients. However, such patients need to be better characterized so that effective treatment strategies to achieve a state of low disease activity may be implemented.
Author and Disclosure Information
Vinod Chandran MBBS, MD, DM, PhD, FRCPC
Staff Physician, Department of Medicine/Rheumatology, University Health Network, Toronto, ON, Canada
Vinod Chandran, MBBS, MD, DM, PhD, has disclosed the following relevant financial relationships: Member of the board of directors of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA). Received research grant from: Amgen; AbbVie; Bristol-Myers Squibb; Eli Lilly. Received income in an amount equal to or greater than $250 from: Amgen; AbbVie; Bristol-Myers Squibb; Eli Lilly; Janssen; Novartis; UCB. Spousal employment: AstraZeneca
Staff Physician, Department of Medicine/Rheumatology, University Health Network, Toronto, ON, Canada
Vinod Chandran, MBBS, MD, DM, PhD, has disclosed the following relevant financial relationships: Member of the board of directors of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA). Received research grant from: Amgen; AbbVie; Bristol-Myers Squibb; Eli Lilly. Received income in an amount equal to or greater than $250 from: Amgen; AbbVie; Bristol-Myers Squibb; Eli Lilly; Janssen; Novartis; UCB. Spousal employment: AstraZeneca
Author and Disclosure Information
Vinod Chandran MBBS, MD, DM, PhD, FRCPC
Staff Physician, Department of Medicine/Rheumatology, University Health Network, Toronto, ON, Canada
Vinod Chandran, MBBS, MD, DM, PhD, has disclosed the following relevant financial relationships: Member of the board of directors of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA). Received research grant from: Amgen; AbbVie; Bristol-Myers Squibb; Eli Lilly. Received income in an amount equal to or greater than $250 from: Amgen; AbbVie; Bristol-Myers Squibb; Eli Lilly; Janssen; Novartis; UCB. Spousal employment: AstraZeneca
Dr. Chandran scans the journals, so you don't have to!
Dr. Chandran scans the journals, so you don't have to!
Vinod Chandran, MBBS, MD, DM, PhDRecent studies in psoriatic arthritis (PsA) have focused on transition from psoriasis to PsA. Patients with PsA are likely go through preclinical, subclinical, prodromal, and finally overt PsA. Zabotti and colleagues aimed to estimate the probability of developing PsA in patients with subclinical PsA defined as psoriasis and arthralgia. Of the 384 psoriasis patients from two European cohorts included in the study, 311 (80.9%) had subclinical PsA. The incidence rate of new-onset PsA was 7.7 per 100 patients-years in this group; the most predominant presentation was peripheral arthritis (82.1%). The risk for PsA was significantly higher in patients with subclinical PsA vs psoriasis (hazard ratio 11.7; 95% CI 1.57-86.7). In another cross-sectional study, Yao and colleagues compared 75 patients diagnosed with clinical PsA with 345 patients with psoriasis and without PsA, all of whom were aged 18-65 years. The authors demonstrated that at age 40 years or older, nail involvement, increased erythrocyte sedimentation rate (ESR), and high-sensitivity C-reactive protein (CRP) levels were associated with PsA. Moreover, MRI-detected enthesitis and tenosynovitis combined with these risk factors vs the risk factors alone showed better specificity (94.3% vs 69.0%) and similar sensitivity (89.0% vs 84.6%) in distinguishing PsA from psoriasis alone. Thus, psoriasis patients with arthralgia as well as those with nail disease and elevated ESR/CRP levels are at high risk for PsA. These patients should be carefully monitored to detect PsA early. These patients may also be ideal candidates to study interventions intended to prevent transition from psoriasis to PsA.
In regard to treatment, bimekizumab is a new monoclonal antibody that dually targets interleukin (IL)-17A and IL-17F and is highly efficacious for the treatment of psoriasis. In a meta-analysis of four placebo-controlled randomized clinical trials that included 1323 patients with PsA (age 18 years or older), of whom 853 received bimekizumab, Su and colleagues demonstrated that bimekizumab led to a significantly higher response rate for minimal disease activity (risk ratio [RR] 4.188; P < .001) and a 70% or greater improvement in the American College of Rheumatology (ACR) criteria (RR 7.932; P < .0001) when compared with placebo. Bimekizumab was superior to placebo in achieving ACR20/50/70 response at a dose of 160 mg. The risk for treatment-emergent adverse events was modestly higher with bimekizumab vs placebo (RR 1.423; P = .023), whereas the risk for serious cancers, upper respiratory tract infection, injection site reactions, and pharyngitis was similar for both. Thus, bimekizumab is an efficacious agent for the treatment of PsA. Future head-to-head studies will help clinicians determine the role of this drug in the management of PsA.
Not all patients respond equally well to targeted therapies, and the so-called challenging-to-treat patients are being increasingly described. Kivitz and colleagues recently described the efficacy of secukinumab, a monoclonal antibody targeting IL-17A, in these challenging-to-treat patients from the United States. In a post hoc subgroup analysis of four phase 3 studies that included 279 patients, they demonstrated that patients receiving 300 mg secukinumab and 150 mg with a loading dose had a higher rate of achieving the ACR20 response (59.7% and 43.4%, respectively) vs 15.6% for placebo (both P < .0001). The Psoriasis Area and Severity Index 90 response was 47.1% and 22.2%, respectively, vs 5.3% (both P < .05). Thus, secukinumab is efficacious in more challenging-to-treat patients. However, such patients need to be better characterized so that effective treatment strategies to achieve a state of low disease activity may be implemented.
Vinod Chandran, MBBS, MD, DM, PhDRecent studies in psoriatic arthritis (PsA) have focused on transition from psoriasis to PsA. Patients with PsA are likely go through preclinical, subclinical, prodromal, and finally overt PsA. Zabotti and colleagues aimed to estimate the probability of developing PsA in patients with subclinical PsA defined as psoriasis and arthralgia. Of the 384 psoriasis patients from two European cohorts included in the study, 311 (80.9%) had subclinical PsA. The incidence rate of new-onset PsA was 7.7 per 100 patients-years in this group; the most predominant presentation was peripheral arthritis (82.1%). The risk for PsA was significantly higher in patients with subclinical PsA vs psoriasis (hazard ratio 11.7; 95% CI 1.57-86.7). In another cross-sectional study, Yao and colleagues compared 75 patients diagnosed with clinical PsA with 345 patients with psoriasis and without PsA, all of whom were aged 18-65 years. The authors demonstrated that at age 40 years or older, nail involvement, increased erythrocyte sedimentation rate (ESR), and high-sensitivity C-reactive protein (CRP) levels were associated with PsA. Moreover, MRI-detected enthesitis and tenosynovitis combined with these risk factors vs the risk factors alone showed better specificity (94.3% vs 69.0%) and similar sensitivity (89.0% vs 84.6%) in distinguishing PsA from psoriasis alone. Thus, psoriasis patients with arthralgia as well as those with nail disease and elevated ESR/CRP levels are at high risk for PsA. These patients should be carefully monitored to detect PsA early. These patients may also be ideal candidates to study interventions intended to prevent transition from psoriasis to PsA.
In regard to treatment, bimekizumab is a new monoclonal antibody that dually targets interleukin (IL)-17A and IL-17F and is highly efficacious for the treatment of psoriasis. In a meta-analysis of four placebo-controlled randomized clinical trials that included 1323 patients with PsA (age 18 years or older), of whom 853 received bimekizumab, Su and colleagues demonstrated that bimekizumab led to a significantly higher response rate for minimal disease activity (risk ratio [RR] 4.188; P < .001) and a 70% or greater improvement in the American College of Rheumatology (ACR) criteria (RR 7.932; P < .0001) when compared with placebo. Bimekizumab was superior to placebo in achieving ACR20/50/70 response at a dose of 160 mg. The risk for treatment-emergent adverse events was modestly higher with bimekizumab vs placebo (RR 1.423; P = .023), whereas the risk for serious cancers, upper respiratory tract infection, injection site reactions, and pharyngitis was similar for both. Thus, bimekizumab is an efficacious agent for the treatment of PsA. Future head-to-head studies will help clinicians determine the role of this drug in the management of PsA.
Not all patients respond equally well to targeted therapies, and the so-called challenging-to-treat patients are being increasingly described. Kivitz and colleagues recently described the efficacy of secukinumab, a monoclonal antibody targeting IL-17A, in these challenging-to-treat patients from the United States. In a post hoc subgroup analysis of four phase 3 studies that included 279 patients, they demonstrated that patients receiving 300 mg secukinumab and 150 mg with a loading dose had a higher rate of achieving the ACR20 response (59.7% and 43.4%, respectively) vs 15.6% for placebo (both P < .0001). The Psoriasis Area and Severity Index 90 response was 47.1% and 22.2%, respectively, vs 5.3% (both P < .05). Thus, secukinumab is efficacious in more challenging-to-treat patients. However, such patients need to be better characterized so that effective treatment strategies to achieve a state of low disease activity may be implemented.
