Vinod Chandran, MBBS, MD, DM, PhDInterest is growing in understanding sex differences in psoriatic arthritis (PsA), especially in regard to disease manifestations and treatment response. A recent meta-analysis highlighted differential response to treatment in male vs female patients with PsA. Eder and colleagues conducted a meta-analysis of 54 randomized controlled trials that included 22,621 patients with PsA who received targeted advanced therapies (biological disease-modifying antirheumatic drugs [bDMARD] and targeted synthetic DMARD [tsDMARD]) or placebo. When considering bDMARD, they found that the odds of achieving ≥ 20% improvement in American College of Rheumatology score was significantly higher in men compared with women, with the difference being more pronounced in the case of all bDMARD, including tumor necrosis factor (TNF) inhibitors, interleukin (IL)-17 inhibitors, IL-23 inhibitors, and IL-12 and IL-23 inhibitors. Surprisingly, no such difference was found with tsDMARD (JAK inhibitors). Another retrospective observational study, from 13 European registries, analyzed treatment response and retention rates in 7679 and 17,842 PsA patients who received their first TNF inhibitor, respectively. Hellamand and colleagues found that, at 6 months, women were 17% less likely than men to achieve low disease activity according to Disease Activity Score-28 C-reactive protein measurements. Women had less TNF inhibitor treatment retention rates at all time points compared with men. These studies highlight the sex differences in response to bDMARD and the intriguing possibility that such differences might not be present with JAK inhibitors. If confirmed in future prospective interventional and observational studies, treatment strategies would need to be tailored to the sex of the patient, and the underlying mechanisms will need to be explored.
Treatment of enthesitis can be challenging. Head-to-head clinical trials using clinical enthesitis indices have indicated that TNF inhibitors and IL-17 inhibitors have similar efficacy in treating enthesitis. However, clinically determined enthesitis may not be true inflammatory enthesitis. Ultrasonography-confirmed enthesitis probably reflects true enthesitis. Therefore, Elliot and colleagues conducted an observational study that compared the change in MAdrid Sonographic Enthesitis Index (MASEI) at 16 weeks of treatment with either TNF inhibitors or secukinumab. They observed that the mean reduction in MASEI that assesses both active and chronic entheseal disease was not significantly different with TNF inhibitors vs secukinumab treatment. However, TNF inhibitors were significantly more effective than secukinumab when only active entheseal lesions were considered. Thus, TNF inhibitors may be more effective for active enthesitis; randomized trials using ultrasonographic enthesitis indices comparing the two treatments are required.
Serum drug levels have previously been shown to be associated with response to bDMARD therapy, but use of drug-level measurement is not routine in rheumatology practice. Moreover, trough levels are emphasized and may not often be feasible to obtain. Curry and colleagues investigated the relationship between serum non-trough drug levels (SDL) and treatment response at 3 months in patients with PsA who initiated treatment with adalimumab (n = 104) or etanercept (n = 97). They demonstrated that patients with higher etanercept SDL or higher adalimumab SDL were significantly more likely to be responders. A non-trough etanercept SDL of 2.0 µg/mL and adalimumab SDL of 3.6 µg/mL could differentiate between responders and nonresponders with ~50% specificity and > 60% sensitivity. However, the area under the receiver operating characteristic curves were only about 65%; thus, the ability of SDL to discriminate between responders and nonresponders is low.
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, PhDInterest is growing in understanding sex differences in psoriatic arthritis (PsA), especially in regard to disease manifestations and treatment response. A recent meta-analysis highlighted differential response to treatment in male vs female patients with PsA. Eder and colleagues conducted a meta-analysis of 54 randomized controlled trials that included 22,621 patients with PsA who received targeted advanced therapies (biological disease-modifying antirheumatic drugs [bDMARD] and targeted synthetic DMARD [tsDMARD]) or placebo. When considering bDMARD, they found that the odds of achieving ≥ 20% improvement in American College of Rheumatology score was significantly higher in men compared with women, with the difference being more pronounced in the case of all bDMARD, including tumor necrosis factor (TNF) inhibitors, interleukin (IL)-17 inhibitors, IL-23 inhibitors, and IL-12 and IL-23 inhibitors. Surprisingly, no such difference was found with tsDMARD (JAK inhibitors). Another retrospective observational study, from 13 European registries, analyzed treatment response and retention rates in 7679 and 17,842 PsA patients who received their first TNF inhibitor, respectively. Hellamand and colleagues found that, at 6 months, women were 17% less likely than men to achieve low disease activity according to Disease Activity Score-28 C-reactive protein measurements. Women had less TNF inhibitor treatment retention rates at all time points compared with men. These studies highlight the sex differences in response to bDMARD and the intriguing possibility that such differences might not be present with JAK inhibitors. If confirmed in future prospective interventional and observational studies, treatment strategies would need to be tailored to the sex of the patient, and the underlying mechanisms will need to be explored.
Treatment of enthesitis can be challenging. Head-to-head clinical trials using clinical enthesitis indices have indicated that TNF inhibitors and IL-17 inhibitors have similar efficacy in treating enthesitis. However, clinically determined enthesitis may not be true inflammatory enthesitis. Ultrasonography-confirmed enthesitis probably reflects true enthesitis. Therefore, Elliot and colleagues conducted an observational study that compared the change in MAdrid Sonographic Enthesitis Index (MASEI) at 16 weeks of treatment with either TNF inhibitors or secukinumab. They observed that the mean reduction in MASEI that assesses both active and chronic entheseal disease was not significantly different with TNF inhibitors vs secukinumab treatment. However, TNF inhibitors were significantly more effective than secukinumab when only active entheseal lesions were considered. Thus, TNF inhibitors may be more effective for active enthesitis; randomized trials using ultrasonographic enthesitis indices comparing the two treatments are required.
Serum drug levels have previously been shown to be associated with response to bDMARD therapy, but use of drug-level measurement is not routine in rheumatology practice. Moreover, trough levels are emphasized and may not often be feasible to obtain. Curry and colleagues investigated the relationship between serum non-trough drug levels (SDL) and treatment response at 3 months in patients with PsA who initiated treatment with adalimumab (n = 104) or etanercept (n = 97). They demonstrated that patients with higher etanercept SDL or higher adalimumab SDL were significantly more likely to be responders. A non-trough etanercept SDL of 2.0 µg/mL and adalimumab SDL of 3.6 µg/mL could differentiate between responders and nonresponders with ~50% specificity and > 60% sensitivity. However, the area under the receiver operating characteristic curves were only about 65%; thus, the ability of SDL to discriminate between responders and nonresponders is low.
Vinod Chandran, MBBS, MD, DM, PhDInterest is growing in understanding sex differences in psoriatic arthritis (PsA), especially in regard to disease manifestations and treatment response. A recent meta-analysis highlighted differential response to treatment in male vs female patients with PsA. Eder and colleagues conducted a meta-analysis of 54 randomized controlled trials that included 22,621 patients with PsA who received targeted advanced therapies (biological disease-modifying antirheumatic drugs [bDMARD] and targeted synthetic DMARD [tsDMARD]) or placebo. When considering bDMARD, they found that the odds of achieving ≥ 20% improvement in American College of Rheumatology score was significantly higher in men compared with women, with the difference being more pronounced in the case of all bDMARD, including tumor necrosis factor (TNF) inhibitors, interleukin (IL)-17 inhibitors, IL-23 inhibitors, and IL-12 and IL-23 inhibitors. Surprisingly, no such difference was found with tsDMARD (JAK inhibitors). Another retrospective observational study, from 13 European registries, analyzed treatment response and retention rates in 7679 and 17,842 PsA patients who received their first TNF inhibitor, respectively. Hellamand and colleagues found that, at 6 months, women were 17% less likely than men to achieve low disease activity according to Disease Activity Score-28 C-reactive protein measurements. Women had less TNF inhibitor treatment retention rates at all time points compared with men. These studies highlight the sex differences in response to bDMARD and the intriguing possibility that such differences might not be present with JAK inhibitors. If confirmed in future prospective interventional and observational studies, treatment strategies would need to be tailored to the sex of the patient, and the underlying mechanisms will need to be explored.
Treatment of enthesitis can be challenging. Head-to-head clinical trials using clinical enthesitis indices have indicated that TNF inhibitors and IL-17 inhibitors have similar efficacy in treating enthesitis. However, clinically determined enthesitis may not be true inflammatory enthesitis. Ultrasonography-confirmed enthesitis probably reflects true enthesitis. Therefore, Elliot and colleagues conducted an observational study that compared the change in MAdrid Sonographic Enthesitis Index (MASEI) at 16 weeks of treatment with either TNF inhibitors or secukinumab. They observed that the mean reduction in MASEI that assesses both active and chronic entheseal disease was not significantly different with TNF inhibitors vs secukinumab treatment. However, TNF inhibitors were significantly more effective than secukinumab when only active entheseal lesions were considered. Thus, TNF inhibitors may be more effective for active enthesitis; randomized trials using ultrasonographic enthesitis indices comparing the two treatments are required.
Serum drug levels have previously been shown to be associated with response to bDMARD therapy, but use of drug-level measurement is not routine in rheumatology practice. Moreover, trough levels are emphasized and may not often be feasible to obtain. Curry and colleagues investigated the relationship between serum non-trough drug levels (SDL) and treatment response at 3 months in patients with PsA who initiated treatment with adalimumab (n = 104) or etanercept (n = 97). They demonstrated that patients with higher etanercept SDL or higher adalimumab SDL were significantly more likely to be responders. A non-trough etanercept SDL of 2.0 µg/mL and adalimumab SDL of 3.6 µg/mL could differentiate between responders and nonresponders with ~50% specificity and > 60% sensitivity. However, the area under the receiver operating characteristic curves were only about 65%; thus, the ability of SDL to discriminate between responders and nonresponders is low.
