Ustekinumab and tumor necrosis factor inhibitor (TNFi) have comparable efficacy, safety, and persistence at 1 year after initiation for the treatment of psoriatic arthritis (PsA), according to study results published in Annals of the Rheumatic Diseases.

Researchers evaluated the real-world treatment persistence and effectiveness at 1 year after the initiation of ustekinumab or TNFi for PsA treatment.

Patients with PsA were enrolled in a prospective, exploratory, observational 1-year analysis (A Study on Assessment of STELARA and Tumor Necrosis Factor Alpha Inhibitor Therapies in Participants With Psoriatic Arthritis [PsABio]; ClinicalTrials,gov Identifier: NCT02627768).


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Treatment efficacy was measured every 6 months using the Disease Activity Index for Psoriatic Arthritis (cDAPSA) benchmarks of low disease activity (LDA), very LDA, and remission and minimal disease activity (MDA). Other 6-month measures included drug persistence and safety. Intercohort comparisons were adjusted for propensity score.

A total of 893 patients with PsA (438 receiving ustekinumab and 455 receiving TNFi) were included in the effectiveness cohort and 927 patients with PsA (457 receiving ustekinumab and 470 receiving TNFi) were included in the safety cohort.

The ustekinumab and TNFi cohorts showed similar persistence at 12±3 months (72.4% vs 70.5%; P =.4192). The adjusted hazard ratio for stopping or switching ustekinumab vs TNFi was 0.82 (95% CI, 0.60-1.13). Among those who received treatment with ustekinumab, a cDAPSA benchmark of LDA including remission was achieved by 55.9% and remission was achieved by 22.1%, and 67.1% and 31.7%, respectively, among those who received treatment with TNFi. Adjusted odds ratio (aOR) of 0.80 (95% CI, 0.57-1.10) for cDAPSA LDA and 0.73 (95% CI, 0.49-1.07) for cDAPSA remission. Among those who received treatment with ustekinumab, MDA and very LDA were achieved by 34.2% and 11.9%, respectively, and 43.1% and 12.6%, respectively, among those who received treatment with TNFi. An aOR of 0.89 (95% CI, 0.63-1.26) was observed for MDA and 0.90 (95% CI, 0.54-1.49) for very LDA. Both cohorts had similar safety profiles.

A limitation to this study was the necessity to base intercohort comparisons on propensity-score adjustments rather than randomization.

The study researchers concluded that this study showed “generally comparable drug persistence, efficacy and safety following 1 year of treatment with ustekinumab or a TNFi,” and that participants “were more likely to remain on ustekinumab than TNFi when extensive skin disease was present and when [methotrexate] was not used as concomitant treatment.” Unadjusted analysis revealed that women “may require more comprehensive multidimensional therapy.”

Disclosure: This clinical trial was supported by Janssen. Please see the original reference for a full list of authors’ disclosures.

Reference

Gossec L, Siebert S, Bergmans P, et al. Persistence and effectiveness of the IL-12/23 pathway inhibitor ustekinumab or tumour necrosis factor inhibitor treatment in patients with psoriatic arthritis: 1-year results from the real-world PsABio Study. Ann Rheum Dis. Published online February 24, 2022. doi:10.1136/annrheumdis-2021-221640