Ustekinumab, TNF Inhibitors Improve 6-Month Outcomes in Psoriatic Arthritis

The following article is part of conference coverage from the European League Against Rheumatism (EULAR) Congress 2018 in Amsterdam, The Netherlands. Rheumatology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in rheumatology. Check back for the latest news from EULAR 2018.

The first interim follow-up data on joint-related outcomes from the PsABio study (ClinicalTrials.gov identifier: NCT02627768), a routine care study conducted in 8 European countries, demonstrated that patients with psoriatic arthritis (PsA) who were treated with ustekinumab (UST) or tumor necrosis factor inhibitors (TNFi) had significant and considerable improvements after 6 months in a real-world setting, regardless of whether the agent was used as a first-line or a subsequent line of treatment. Findings from the analysis were presented at the European League Against Rheumatism (EULAR) Congress held in Amsterdam, June 13 to 16, 2018.

The investigators sought to evaluate the efficacy, tolerability, and persistence of TNFi and UST in patients with PsA initiating first-line, second-line, or third-line biologic disease-modifying antirheumatic drugs (bDMARDs) in real-world routine care. Among UST- and TNFi-treated patients consecutively enrolled between December 2015 and August 2017, a total of 152 and 151 patients, respectively, had data available at 6 months. Joint-related outcomes were compared between baseline and 6 months within the 2 treatment cohorts.

Results showed that 7.6% of participants in the UST group and 10.2% in the TNFi group stopped or switched to another bDMARD prior to the 6-month time point. Among participants with 6-month data available on their initial bDMARD, UST was a first-line bDMARD in 40.1% of participants, a second-line bDMARD in 35.5%, and a third-line bDMARD in 24.3%. Percentages among participants using TNFi as first-, second-, or third-line bDMARD therapy were 64.2%, 28.5%, and 7.3%, respectively.

The Disease Activity Score in 28 joints improved significantly at 6 months from mean baseline values of 4.3±1.2 and 4.3±1.2 with UST and TNFi, respectively, by means of -1.3 (95% CI, -1.6 to -1.0) and -1.3 (95% CI, -1.6 to -1.1). There were significant improvements observed in both cohorts across all lines of treatment and subtypes of PsA.

Minimal disease activity was attained at 6 months in 28.8% of UST-treated patients and 29.7% of TNFi-treated patients. Clinical Disease Activity Index results also improved significantly. With respect to Disease Activity in Psoriatic Arthritis (DAPSA), statistically significant improvements were reported: mean -18.4 (95% CI, -22.2 to -14.5) and -19.5 (95% CI, -22.5 to -16.5) with UST and TNFi treatments, respectively. In addition, 12.2% and 15.7% of participants, respectively, achieved DAPSA remission and 37.8% and 37.1% of participants, respectively, achieved low disease activity.

Axial joint involvement was significantly improved, and reductions in Bath Ankylosing Spondylitis Disease Activity Index and Ankylosing Spondylitis Disease Activity Score were reported in both groups.

The investigators concluded that treatment with both UST and TNFi was associated with significant improvements in joint-related measures after 6 months in patients with PsA, regardless of whether the agent was used as first-, second-, or third-line of therapy.

This study was sponsored by Janssen.

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Reference

Smolen JS, Bergmans P, Bondareva I, et al. Ustekinumab and TNF inhibitors in psoriatic arthritis: first follow-up dtata from a routine care study in 8 European countries (PsABio). Presented at: European League Against Rheumatism (EULAR) Congress 2018; June 13-16, 2018; Amsterdam, The Netherlands. Abstract AB0928.