Ustekinumab May Benefit Subclinical Enthesopathy in Patients With Psoriasis

Researchers investigated whether sonographically determined subclinical enthesopathy in patients with moderate to severe psoriasis regressed under therapy with ustekinumab.

The interleukin (IL)-12/23 inhibitor, ustekinumab, may improve ultrasound-confirmed subclinical enthesitis in patients with moderate to severe plaque psoriasis, according to results published in Arthritis & Rheumatology.

Researchers conducted a 52-week pilot study of 73 biologic therapy-naive adult patients with chronic plaque psoriasis, defined as having a Psoriasis Area and Severity Index score greater than 10, with no clinical signs of inflammation related to psoriatic arthritis. The investigators also included 23 healthy controls, and both groups were screened using ultrasound sonography for markers of subclinical enthesopathy. A group of 23 participants with psoriasis, who also exhibited inflammatory markers on ultrasound, were treated with ustekinumab for one year and assessed for any sonographic changes at baseline, 12, 24, and 52 weeks post-ustekinumab therapy initiation.

After analysis, the investigators found that 49.3% of screened therapy-naive patients had a minimum of one entheseal abnormality on ultrasound. In patients treated with ustekinumab, mean inflammatory scores decreased significantly by 42.2% (P <.001) and 47.5% (P =.001) from baseline to 24 weeks and 52 weeks, respectively. In addition, the researchers reported that entheseal structural irregularities were not significantly altered over the course of therapy.

The primary study limitation was the small sample size, which limited conclusions that could be drawn for the use of ustekinumab in the treatment of subclinical enthesopathy.

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“Overall, the results of our study support the role of IL-12/23 in entheseal-driven pathology in the earliest stages of psoriatic arthritis and promote the need for larger trials to ascertain whether the regression of subclinical arthropathy is indeed associated with [psoriatic arthritis] prevention,” the researchers wrote.

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Savage L, Goodfield M, Horton L, et al. Regression of peripheral subclinical enthesopathy in therapy-naive patients treated with ustekinumab for moderate-to-severe chronic plaque psoriasis [published online November 22, 2018]. Arthritis Rheumatol. doi: 10.1002/art.40778