Key clinical point: Addition of a calcitonin gene-related peptide (CGRP)-targeted monoclonal antibodies (mAbs) in patients with chronic migraine (CM) receiving onabotulinumtoxinA (onabot) resulted in further reductions in monthly headache days (MHDs) without major tolerability issues.

Major finding: Patients reported an average decrease of 10.9 MHDs (P less than .001) after onabot treatment and a further decrease of 5.7 MHDs (P less than .001) after addition of CGRP-targeted mAbs resulting in a total decrease of 16.6 MHDs (P less than .001) with combined therapy. No serious adverse events were reported.

Study details: The data come from a retrospective review of 153 patients with CM receiving onabot and subsequently prescribed CGRP-targeted mAbs.

Disclosures: The study did not receive any funding. The lead author F Cohen reported no conflicts of interest. The other authors declared receiving honoraria and research support from various sources and serving as consultant and/or advisory board member for various pharmaceutical companies.

Source: Cohen F et al. Pain Med. 2021 Mar 8. doi: 10.1093/pm/pnab093.

Key clinical point: Addition of a calcitonin gene-related peptide (CGRP)-targeted monoclonal antibodies (mAbs) in patients with chronic migraine (CM) receiving onabotulinumtoxinA (onabot) resulted in further reductions in monthly headache days (MHDs) without major tolerability issues.

Major finding: Patients reported an average decrease of 10.9 MHDs (P less than .001) after onabot treatment and a further decrease of 5.7 MHDs (P less than .001) after addition of CGRP-targeted mAbs resulting in a total decrease of 16.6 MHDs (P less than .001) with combined therapy. No serious adverse events were reported.

Study details: The data come from a retrospective review of 153 patients with CM receiving onabot and subsequently prescribed CGRP-targeted mAbs.

Disclosures: The study did not receive any funding. The lead author F Cohen reported no conflicts of interest. The other authors declared receiving honoraria and research support from various sources and serving as consultant and/or advisory board member for various pharmaceutical companies.

Source: Cohen F et al. Pain Med. 2021 Mar 8. doi: 10.1093/pm/pnab093.

Key clinical point: Addition of a calcitonin gene-related peptide (CGRP)-targeted monoclonal antibodies (mAbs) in patients with chronic migraine (CM) receiving onabotulinumtoxinA (onabot) resulted in further reductions in monthly headache days (MHDs) without major tolerability issues.

Major finding: Patients reported an average decrease of 10.9 MHDs (P less than .001) after onabot treatment and a further decrease of 5.7 MHDs (P less than .001) after addition of CGRP-targeted mAbs resulting in a total decrease of 16.6 MHDs (P less than .001) with combined therapy. No serious adverse events were reported.

Study details: The data come from a retrospective review of 153 patients with CM receiving onabot and subsequently prescribed CGRP-targeted mAbs.

Disclosures: The study did not receive any funding. The lead author F Cohen reported no conflicts of interest. The other authors declared receiving honoraria and research support from various sources and serving as consultant and/or advisory board member for various pharmaceutical companies.

Source: Cohen F et al. Pain Med. 2021 Mar 8. doi: 10.1093/pm/pnab093.

Key clinical point: Intravenous eptinezumab demonstrated a favorable safety profile in patients with chronic migraine (CM).

Major finding: Overall, 71.1% of patients experienced 1 or more treatment-emergent adverse events (TEAEs) during the entire 2 years of study duration with majority (95.6%) being mild or moderate. TEAEs leading to drug discontinuation or withdrawal were observed in only 7.8% and 6.3% of patients, respectively. Incidence of serious TEAEs and drug-related AEs was low.

Study details: PREVAIL, an open-label phase 3 trial, included 128 adults with CM who received at least 1 dose of eptinezumab (300 mg) every 12 weeks for up to 8 doses.

Disclosures: This study was funded by H. Lundbeck A/S, Copenhagen, Denmark. D Kudrow reported receiving grant support from, being on advisory board, and/or being speaker for multiple sources. Some of the authors reported being current/former full-time employees at Lundbeck Seattle BioPharmaceuticals or Alder Biopharmaceuticals (CKA Lundbeck Seattle Biopharmaceuticals, Inc).

Source: Kudrow D et al. BMC Neurol. 2021 Mar 19. doi: 10.1186/s12883-021-02123-w.

Key clinical point: Intravenous eptinezumab demonstrated a favorable safety profile in patients with chronic migraine (CM).

Major finding: Overall, 71.1% of patients experienced 1 or more treatment-emergent adverse events (TEAEs) during the entire 2 years of study duration with majority (95.6%) being mild or moderate. TEAEs leading to drug discontinuation or withdrawal were observed in only 7.8% and 6.3% of patients, respectively. Incidence of serious TEAEs and drug-related AEs was low.

Study details: PREVAIL, an open-label phase 3 trial, included 128 adults with CM who received at least 1 dose of eptinezumab (300 mg) every 12 weeks for up to 8 doses.

Disclosures: This study was funded by H. Lundbeck A/S, Copenhagen, Denmark. D Kudrow reported receiving grant support from, being on advisory board, and/or being speaker for multiple sources. Some of the authors reported being current/former full-time employees at Lundbeck Seattle BioPharmaceuticals or Alder Biopharmaceuticals (CKA Lundbeck Seattle Biopharmaceuticals, Inc).

Source: Kudrow D et al. BMC Neurol. 2021 Mar 19. doi: 10.1186/s12883-021-02123-w.

Key clinical point: Intravenous eptinezumab demonstrated a favorable safety profile in patients with chronic migraine (CM).

Major finding: Overall, 71.1% of patients experienced 1 or more treatment-emergent adverse events (TEAEs) during the entire 2 years of study duration with majority (95.6%) being mild or moderate. TEAEs leading to drug discontinuation or withdrawal were observed in only 7.8% and 6.3% of patients, respectively. Incidence of serious TEAEs and drug-related AEs was low.

Study details: PREVAIL, an open-label phase 3 trial, included 128 adults with CM who received at least 1 dose of eptinezumab (300 mg) every 12 weeks for up to 8 doses.

Disclosures: This study was funded by H. Lundbeck A/S, Copenhagen, Denmark. D Kudrow reported receiving grant support from, being on advisory board, and/or being speaker for multiple sources. Some of the authors reported being current/former full-time employees at Lundbeck Seattle BioPharmaceuticals or Alder Biopharmaceuticals (CKA Lundbeck Seattle Biopharmaceuticals, Inc).

Source: Kudrow D et al. BMC Neurol. 2021 Mar 19. doi: 10.1186/s12883-021-02123-w.

Sandy was placed in memory care recently.

In my world, as a 23-year veteran of the neurology frontline trenches, this is a pretty common occurrence for my patients.

But Sandy isn’t my patient.

She’s a longtime friend.

My parents met Sandy and her husband on New Year’s Eve, 1968. I was 2. Phoenix wasn’t a particularly big city back then.

Growing up we had summer pool parties and get-togethers with them and other families. My mom and Sandy have close birthdays, and when they both turned 50 their husbands threw them a combined 100-year surprise party. As couples they made occasional trips to Las Vegas.

In adolescence, when my voice changed, I sounded a lot like my dad, and Sandy could never tell us apart. So when I answered the phone and she thought it was him, I’d just fly with the conversation, becoming increasingly preposterous until she said: “Okay, now I know who this is. Let me talk to your mom.” Maybe she was just humoring me the whole time. But it was good for a laugh.

Ten years ago my mom mentioned Sandy had been diagnosed with Alzheimer’s disease by another neurologist in town. For a long time her deterioration was slow.

I last saw her 8 years ago, at my dad’s services. At that time we had a nice conversation. I didn’t go into my trained “neurology mode” – I’ve never been her doctor – but enjoyed talking to her as a family friend I hadn’t seen in years. There were a few gaps in her memory, but she was still the person I’d always been fond of.

Eight years is a long time in Alzheimer’s disease, and she finally reached the point where placement was no longer an option. My mom had spoken to her the week before, but told me Sandy couldn’t really carry a conversation now.

Sandy isn’t dead, but by the same token she is. Placement in memory care is often the realization that the person we knew and loved isn’t there anymore. In a world where we can often keep people physically up and around, our ability to do the same with their minds and souls is still desperately in need of a truly effective treatment. Such treatment isn’t even on the horizon ... yet.

As a neurologist, I know this reality. I explain it to families every day.

But when it comes to someone I know outside of my profession, that doesn’t make it any easier.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Sandy was placed in memory care recently.

In my world, as a 23-year veteran of the neurology frontline trenches, this is a pretty common occurrence for my patients.

But Sandy isn’t my patient.

She’s a longtime friend.

My parents met Sandy and her husband on New Year’s Eve, 1968. I was 2. Phoenix wasn’t a particularly big city back then.

Growing up we had summer pool parties and get-togethers with them and other families. My mom and Sandy have close birthdays, and when they both turned 50 their husbands threw them a combined 100-year surprise party. As couples they made occasional trips to Las Vegas.

In adolescence, when my voice changed, I sounded a lot like my dad, and Sandy could never tell us apart. So when I answered the phone and she thought it was him, I’d just fly with the conversation, becoming increasingly preposterous until she said: “Okay, now I know who this is. Let me talk to your mom.” Maybe she was just humoring me the whole time. But it was good for a laugh.

Ten years ago my mom mentioned Sandy had been diagnosed with Alzheimer’s disease by another neurologist in town. For a long time her deterioration was slow.

I last saw her 8 years ago, at my dad’s services. At that time we had a nice conversation. I didn’t go into my trained “neurology mode” – I’ve never been her doctor – but enjoyed talking to her as a family friend I hadn’t seen in years. There were a few gaps in her memory, but she was still the person I’d always been fond of.

Eight years is a long time in Alzheimer’s disease, and she finally reached the point where placement was no longer an option. My mom had spoken to her the week before, but told me Sandy couldn’t really carry a conversation now.

Sandy isn’t dead, but by the same token she is. Placement in memory care is often the realization that the person we knew and loved isn’t there anymore. In a world where we can often keep people physically up and around, our ability to do the same with their minds and souls is still desperately in need of a truly effective treatment. Such treatment isn’t even on the horizon ... yet.

As a neurologist, I know this reality. I explain it to families every day.

But when it comes to someone I know outside of my profession, that doesn’t make it any easier.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Sandy was placed in memory care recently.

In my world, as a 23-year veteran of the neurology frontline trenches, this is a pretty common occurrence for my patients.

But Sandy isn’t my patient.

She’s a longtime friend.

My parents met Sandy and her husband on New Year’s Eve, 1968. I was 2. Phoenix wasn’t a particularly big city back then.

Growing up we had summer pool parties and get-togethers with them and other families. My mom and Sandy have close birthdays, and when they both turned 50 their husbands threw them a combined 100-year surprise party. As couples they made occasional trips to Las Vegas.

In adolescence, when my voice changed, I sounded a lot like my dad, and Sandy could never tell us apart. So when I answered the phone and she thought it was him, I’d just fly with the conversation, becoming increasingly preposterous until she said: “Okay, now I know who this is. Let me talk to your mom.” Maybe she was just humoring me the whole time. But it was good for a laugh.

Ten years ago my mom mentioned Sandy had been diagnosed with Alzheimer’s disease by another neurologist in town. For a long time her deterioration was slow.

I last saw her 8 years ago, at my dad’s services. At that time we had a nice conversation. I didn’t go into my trained “neurology mode” – I’ve never been her doctor – but enjoyed talking to her as a family friend I hadn’t seen in years. There were a few gaps in her memory, but she was still the person I’d always been fond of.

Eight years is a long time in Alzheimer’s disease, and she finally reached the point where placement was no longer an option. My mom had spoken to her the week before, but told me Sandy couldn’t really carry a conversation now.

Sandy isn’t dead, but by the same token she is. Placement in memory care is often the realization that the person we knew and loved isn’t there anymore. In a world where we can often keep people physically up and around, our ability to do the same with their minds and souls is still desperately in need of a truly effective treatment. Such treatment isn’t even on the horizon ... yet.

As a neurologist, I know this reality. I explain it to families every day.

But when it comes to someone I know outside of my profession, that doesn’t make it any easier.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

A novel technique for pulmonary nodule ablation is feasible and safe for the treatment of early-stage lung cancers, lung metastases, and highly suspicious lung nodules, according to investigators.

The technique – bronchoscopic transbronchial microwave ablation – had a 100% technical success rate and produced low rates of complications in a single-center study.

“We combined the best of both worlds [for this] technique,” said investigator Joyce Chan, MBBS, of Prince of Wales Hospital in Hong Kong, when describing the method at the European Lung Cancer Virtual Congress 2021 (Abstract 64MO).

Dr. Chan explained that microwave ablation of lung nodules is faster and produces larger ablation zones, compared with radiofrequency ablation, and bronchoscopic ablation is thought to produce fewer pleural-based complications than percutaneous ablation.

Bronchoscopic transbronchial microwave ablation is performed in a hybrid operating room. First, the patient is intubated and anesthetized. Then, electromagnetic navigation bronchoscopy is used to zero in on the lung nodule, which is punctured by a microwave catheter. Cone-beam CT is used to confirm the location of the catheter.

“Next, we connect the system externally to a console, and then we just press the button to microwave it, just like what you do to food,” Dr. Chan explained.

Ablation takes about 10 minutes, and another CT is done to assess success. Ground-glass opacities are seen in the ablated area.
 

Study results

Dr. Chan and colleagues performed a retrospective analysis of 36 patients who underwent bronchoscopic transbronchial microwave ablation between March 2019 and December 2020.

The patients were unfit for or unwilling to undergo surgical resection. They had to have stage 1a lung cancers, isolated lung oligometastases, or radiologically suspicious lesions. The nodules had to be less than 3 cm in size, preferably with a bronchus leading directly to the lesion.

The patients had a mean age of 68 years. Their lesions had a mean maximal diameter of 15.2 mm, and 68% were in the peripheral one-third of the lung.

In all, 44 nodules were treated with bronchoscopic transbronchial microwave ablation. The technical success rate was 100%, although eight nodules required double ablation.

The majority of patients (95%) were discharged within 3 days, with 77% discharged on day 1. Complications included mild pain (15.9%), pneumothorax (9.1%), fever/ablation reaction (4.5%), self-limiting hemoptysis (2.3%), and bronchopleural fistula (2.3%).

The ablation zone volume decreased “rapidly” in the first 6-9 months, then leveled off, Dr. Chan noted.

In the 16 nodules with 1 year of follow-up, there were 2 complete responses, 13 partial responses, and no progressions.

It’s too soon to know if the recurrence rate will be lower than the up to 30% recurrence rate with percutaneous microwave ablation, and it’s too soon to know if, without transpleural puncture, the risk of tumor seeding is lower, Dr. Chan said.

“This presentation ... is extremely important,” said invited discussant John Edwards, MBChB, PhD, of Sheffield (England) Teaching Hospitals National Health Service Foundation Trust. “There is a great novelty value in the combination. The complications and the radiologic response rates were quite acceptable.”

The research was funded by the University Grants Committee in Hong Kong. Dr. Chan reported having no disclosures. Her colleagues disclosed relationships with Medtronic, Siemens Healthineers, and Johnson & Johnson. Dr. Edwards disclosed relationships with AstraZeneca, Zimmer Biomet, Stryker Leibinger, Pacific Biosciences, BioNano Genomics, Argenx, and Moderna.

[email protected]

A novel technique for pulmonary nodule ablation is feasible and safe for the treatment of early-stage lung cancers, lung metastases, and highly suspicious lung nodules, according to investigators.

The technique – bronchoscopic transbronchial microwave ablation – had a 100% technical success rate and produced low rates of complications in a single-center study.

“We combined the best of both worlds [for this] technique,” said investigator Joyce Chan, MBBS, of Prince of Wales Hospital in Hong Kong, when describing the method at the European Lung Cancer Virtual Congress 2021 (Abstract 64MO).

Dr. Chan explained that microwave ablation of lung nodules is faster and produces larger ablation zones, compared with radiofrequency ablation, and bronchoscopic ablation is thought to produce fewer pleural-based complications than percutaneous ablation.

Bronchoscopic transbronchial microwave ablation is performed in a hybrid operating room. First, the patient is intubated and anesthetized. Then, electromagnetic navigation bronchoscopy is used to zero in on the lung nodule, which is punctured by a microwave catheter. Cone-beam CT is used to confirm the location of the catheter.

“Next, we connect the system externally to a console, and then we just press the button to microwave it, just like what you do to food,” Dr. Chan explained.

Ablation takes about 10 minutes, and another CT is done to assess success. Ground-glass opacities are seen in the ablated area.
 

Study results

Dr. Chan and colleagues performed a retrospective analysis of 36 patients who underwent bronchoscopic transbronchial microwave ablation between March 2019 and December 2020.

The patients were unfit for or unwilling to undergo surgical resection. They had to have stage 1a lung cancers, isolated lung oligometastases, or radiologically suspicious lesions. The nodules had to be less than 3 cm in size, preferably with a bronchus leading directly to the lesion.

The patients had a mean age of 68 years. Their lesions had a mean maximal diameter of 15.2 mm, and 68% were in the peripheral one-third of the lung.

In all, 44 nodules were treated with bronchoscopic transbronchial microwave ablation. The technical success rate was 100%, although eight nodules required double ablation.

The majority of patients (95%) were discharged within 3 days, with 77% discharged on day 1. Complications included mild pain (15.9%), pneumothorax (9.1%), fever/ablation reaction (4.5%), self-limiting hemoptysis (2.3%), and bronchopleural fistula (2.3%).

The ablation zone volume decreased “rapidly” in the first 6-9 months, then leveled off, Dr. Chan noted.

In the 16 nodules with 1 year of follow-up, there were 2 complete responses, 13 partial responses, and no progressions.

It’s too soon to know if the recurrence rate will be lower than the up to 30% recurrence rate with percutaneous microwave ablation, and it’s too soon to know if, without transpleural puncture, the risk of tumor seeding is lower, Dr. Chan said.

“This presentation ... is extremely important,” said invited discussant John Edwards, MBChB, PhD, of Sheffield (England) Teaching Hospitals National Health Service Foundation Trust. “There is a great novelty value in the combination. The complications and the radiologic response rates were quite acceptable.”

The research was funded by the University Grants Committee in Hong Kong. Dr. Chan reported having no disclosures. Her colleagues disclosed relationships with Medtronic, Siemens Healthineers, and Johnson & Johnson. Dr. Edwards disclosed relationships with AstraZeneca, Zimmer Biomet, Stryker Leibinger, Pacific Biosciences, BioNano Genomics, Argenx, and Moderna.

[email protected]

A novel technique for pulmonary nodule ablation is feasible and safe for the treatment of early-stage lung cancers, lung metastases, and highly suspicious lung nodules, according to investigators.

The technique – bronchoscopic transbronchial microwave ablation – had a 100% technical success rate and produced low rates of complications in a single-center study.

“We combined the best of both worlds [for this] technique,” said investigator Joyce Chan, MBBS, of Prince of Wales Hospital in Hong Kong, when describing the method at the European Lung Cancer Virtual Congress 2021 (Abstract 64MO).

Dr. Chan explained that microwave ablation of lung nodules is faster and produces larger ablation zones, compared with radiofrequency ablation, and bronchoscopic ablation is thought to produce fewer pleural-based complications than percutaneous ablation.

Bronchoscopic transbronchial microwave ablation is performed in a hybrid operating room. First, the patient is intubated and anesthetized. Then, electromagnetic navigation bronchoscopy is used to zero in on the lung nodule, which is punctured by a microwave catheter. Cone-beam CT is used to confirm the location of the catheter.

“Next, we connect the system externally to a console, and then we just press the button to microwave it, just like what you do to food,” Dr. Chan explained.

Ablation takes about 10 minutes, and another CT is done to assess success. Ground-glass opacities are seen in the ablated area.
 

Study results

Dr. Chan and colleagues performed a retrospective analysis of 36 patients who underwent bronchoscopic transbronchial microwave ablation between March 2019 and December 2020.

The patients were unfit for or unwilling to undergo surgical resection. They had to have stage 1a lung cancers, isolated lung oligometastases, or radiologically suspicious lesions. The nodules had to be less than 3 cm in size, preferably with a bronchus leading directly to the lesion.

The patients had a mean age of 68 years. Their lesions had a mean maximal diameter of 15.2 mm, and 68% were in the peripheral one-third of the lung.

In all, 44 nodules were treated with bronchoscopic transbronchial microwave ablation. The technical success rate was 100%, although eight nodules required double ablation.

The majority of patients (95%) were discharged within 3 days, with 77% discharged on day 1. Complications included mild pain (15.9%), pneumothorax (9.1%), fever/ablation reaction (4.5%), self-limiting hemoptysis (2.3%), and bronchopleural fistula (2.3%).

The ablation zone volume decreased “rapidly” in the first 6-9 months, then leveled off, Dr. Chan noted.

In the 16 nodules with 1 year of follow-up, there were 2 complete responses, 13 partial responses, and no progressions.

It’s too soon to know if the recurrence rate will be lower than the up to 30% recurrence rate with percutaneous microwave ablation, and it’s too soon to know if, without transpleural puncture, the risk of tumor seeding is lower, Dr. Chan said.

“This presentation ... is extremely important,” said invited discussant John Edwards, MBChB, PhD, of Sheffield (England) Teaching Hospitals National Health Service Foundation Trust. “There is a great novelty value in the combination. The complications and the radiologic response rates were quite acceptable.”

The research was funded by the University Grants Committee in Hong Kong. Dr. Chan reported having no disclosures. Her colleagues disclosed relationships with Medtronic, Siemens Healthineers, and Johnson & Johnson. Dr. Edwards disclosed relationships with AstraZeneca, Zimmer Biomet, Stryker Leibinger, Pacific Biosciences, BioNano Genomics, Argenx, and Moderna.

[email protected]

Psoriatic arthritis may be associated with excess mortality risk but the current evidence to support excess mortality in psoriatic arthritis is inconclusive. Nevertheless, identifying risk factors for mortality in patients with psoriatic arthritis is important so that modifiable factors could be addressed. Vela et al investigated whether the cumulative pain experienced by psoriatic arthritis patients was associated with increased mortality. Using data from the Danish nationwide registry of biological therapies (DANBIO), the authors showed that although there was a significant association between pain intensity and mortality (odds ratio 1.06 (95%CI 1.02 to 1.10) per 5 VAS unit increase), no association was found when the analyses was adjusted for confounders including age, CRP, joint counts, HAQ score, treatment, and comorbidities. As expected, recent glucocorticoid use, chronic obstructive pulmonary disease, diabetes mellitus, cancer and cardiovascular disease were associated with excess mortality. The results indicate that mortality in psoriatic arthritis is primarily driven by associated comorbidities; holistic management of psoriatic disease should include management of associated comorbidities.

Comorbidities have a major impact on patients with psoriatic arthritis and influence a patient’s quality of life and function as well as treatment response. Neuropsychiatric comorbidities have been less studied in psoriatic arthritis. An intriguing study by Garcia et al indicate that cognitive impairment may be associated with psoriatic arthritis. In a small cross-sectional study, they demonstrated that patients with psoriatic arthritis score worse on the Montreal Cognitive Assessment (MoCA) tool compared to controls, with executive skills, naming, language, and abstraction being most affected. Further research is required to explore whether other comorbidities such as cerebrovascular disease, depression or sleep disturbances explain the cognitive impairment. Depression and anxiety are also associated with reduced likelihood of achieving remission or low disease activity state in psoriatic arthritis. In a study of 743 patients, Wong et al demonstrated that patients with depression or anxiety are less likely to achieve a state of sustained minimal disease activity. These studies once again highlight the management of comorbidities to achieve improved outcomes in patients with psoriatic arthritis.

New data also indicate efficacy of targeted therapy in psoriatic arthritis. In two phase 3 trials funded by LEO pharma, Mease et al report that brodalumab, an interleukin 17 receptor inhibitor that is already available for the treatment for psoriasis, is efficacious in the treatment of psoriatic arthritis. Although the trial was terminated early, pooled data from the two trials showed that higher proportions of patients on 140 mg and 210 mg of brodalumab achieved American College of Rheumatology (ACR)20 response at week 16 compared to placebo group (45.8% and 47.9%, respectively vs. 20.9%; P less than .0001).

There are limited data on treatment withdrawal in patients with psoriatic arthritis. Coates et al investigated whether continued treatment with ixekizumab, an interleukin 17A inhibitor was superior to withdrawing ixekizumab in maintaining minimal disease activity state in patents with psoriatic arthritis. They showed that more patients relapsed rapidly after ixekizumab was withdrawn compared to those continuing ixekizumab treatment. Importantly, >95% of patients who relapsed with treatment withdrawal re-achieved MDA on retreatment with ixekizumab within a median duration of 4.1 weeks. Thus, ixekizumab treatment is best maintained after a patient achieves a state of minimal disease activity. If the treatment needs to be interrupted (e.g., infection, surgery), most patients will re-achieve the state of minimal disease activity on retreatment.

Finally, research continues to demonstrate delayed diagnosis of psoriatic arthritis. Karmacharya et al showed that only 45% of patients receive a diagnosis of psoriatic arthritis by 2 years after symptom onset. This study from the population-based Rochester Epidemiology Project indicates that earlier age of onset of symptoms, the presence of higher body mass index and enthesitis are associated with diagnostic delay. Further education of health care providers and patients with psoriasis about psoriatic arthritis may help reduce diagnostic delay; delayed diagnosis leads to poorer long-term outcomes.

Psoriatic arthritis may be associated with excess mortality risk but the current evidence to support excess mortality in psoriatic arthritis is inconclusive. Nevertheless, identifying risk factors for mortality in patients with psoriatic arthritis is important so that modifiable factors could be addressed. Vela et al investigated whether the cumulative pain experienced by psoriatic arthritis patients was associated with increased mortality. Using data from the Danish nationwide registry of biological therapies (DANBIO), the authors showed that although there was a significant association between pain intensity and mortality (odds ratio 1.06 (95%CI 1.02 to 1.10) per 5 VAS unit increase), no association was found when the analyses was adjusted for confounders including age, CRP, joint counts, HAQ score, treatment, and comorbidities. As expected, recent glucocorticoid use, chronic obstructive pulmonary disease, diabetes mellitus, cancer and cardiovascular disease were associated with excess mortality. The results indicate that mortality in psoriatic arthritis is primarily driven by associated comorbidities; holistic management of psoriatic disease should include management of associated comorbidities.

Comorbidities have a major impact on patients with psoriatic arthritis and influence a patient’s quality of life and function as well as treatment response. Neuropsychiatric comorbidities have been less studied in psoriatic arthritis. An intriguing study by Garcia et al indicate that cognitive impairment may be associated with psoriatic arthritis. In a small cross-sectional study, they demonstrated that patients with psoriatic arthritis score worse on the Montreal Cognitive Assessment (MoCA) tool compared to controls, with executive skills, naming, language, and abstraction being most affected. Further research is required to explore whether other comorbidities such as cerebrovascular disease, depression or sleep disturbances explain the cognitive impairment. Depression and anxiety are also associated with reduced likelihood of achieving remission or low disease activity state in psoriatic arthritis. In a study of 743 patients, Wong et al demonstrated that patients with depression or anxiety are less likely to achieve a state of sustained minimal disease activity. These studies once again highlight the management of comorbidities to achieve improved outcomes in patients with psoriatic arthritis.

New data also indicate efficacy of targeted therapy in psoriatic arthritis. In two phase 3 trials funded by LEO pharma, Mease et al report that brodalumab, an interleukin 17 receptor inhibitor that is already available for the treatment for psoriasis, is efficacious in the treatment of psoriatic arthritis. Although the trial was terminated early, pooled data from the two trials showed that higher proportions of patients on 140 mg and 210 mg of brodalumab achieved American College of Rheumatology (ACR)20 response at week 16 compared to placebo group (45.8% and 47.9%, respectively vs. 20.9%; P less than .0001).

There are limited data on treatment withdrawal in patients with psoriatic arthritis. Coates et al investigated whether continued treatment with ixekizumab, an interleukin 17A inhibitor was superior to withdrawing ixekizumab in maintaining minimal disease activity state in patents with psoriatic arthritis. They showed that more patients relapsed rapidly after ixekizumab was withdrawn compared to those continuing ixekizumab treatment. Importantly, >95% of patients who relapsed with treatment withdrawal re-achieved MDA on retreatment with ixekizumab within a median duration of 4.1 weeks. Thus, ixekizumab treatment is best maintained after a patient achieves a state of minimal disease activity. If the treatment needs to be interrupted (e.g., infection, surgery), most patients will re-achieve the state of minimal disease activity on retreatment.

Finally, research continues to demonstrate delayed diagnosis of psoriatic arthritis. Karmacharya et al showed that only 45% of patients receive a diagnosis of psoriatic arthritis by 2 years after symptom onset. This study from the population-based Rochester Epidemiology Project indicates that earlier age of onset of symptoms, the presence of higher body mass index and enthesitis are associated with diagnostic delay. Further education of health care providers and patients with psoriasis about psoriatic arthritis may help reduce diagnostic delay; delayed diagnosis leads to poorer long-term outcomes.

Psoriatic arthritis may be associated with excess mortality risk but the current evidence to support excess mortality in psoriatic arthritis is inconclusive. Nevertheless, identifying risk factors for mortality in patients with psoriatic arthritis is important so that modifiable factors could be addressed. Vela et al investigated whether the cumulative pain experienced by psoriatic arthritis patients was associated with increased mortality. Using data from the Danish nationwide registry of biological therapies (DANBIO), the authors showed that although there was a significant association between pain intensity and mortality (odds ratio 1.06 (95%CI 1.02 to 1.10) per 5 VAS unit increase), no association was found when the analyses was adjusted for confounders including age, CRP, joint counts, HAQ score, treatment, and comorbidities. As expected, recent glucocorticoid use, chronic obstructive pulmonary disease, diabetes mellitus, cancer and cardiovascular disease were associated with excess mortality. The results indicate that mortality in psoriatic arthritis is primarily driven by associated comorbidities; holistic management of psoriatic disease should include management of associated comorbidities.

Comorbidities have a major impact on patients with psoriatic arthritis and influence a patient’s quality of life and function as well as treatment response. Neuropsychiatric comorbidities have been less studied in psoriatic arthritis. An intriguing study by Garcia et al indicate that cognitive impairment may be associated with psoriatic arthritis. In a small cross-sectional study, they demonstrated that patients with psoriatic arthritis score worse on the Montreal Cognitive Assessment (MoCA) tool compared to controls, with executive skills, naming, language, and abstraction being most affected. Further research is required to explore whether other comorbidities such as cerebrovascular disease, depression or sleep disturbances explain the cognitive impairment. Depression and anxiety are also associated with reduced likelihood of achieving remission or low disease activity state in psoriatic arthritis. In a study of 743 patients, Wong et al demonstrated that patients with depression or anxiety are less likely to achieve a state of sustained minimal disease activity. These studies once again highlight the management of comorbidities to achieve improved outcomes in patients with psoriatic arthritis.

New data also indicate efficacy of targeted therapy in psoriatic arthritis. In two phase 3 trials funded by LEO pharma, Mease et al report that brodalumab, an interleukin 17 receptor inhibitor that is already available for the treatment for psoriasis, is efficacious in the treatment of psoriatic arthritis. Although the trial was terminated early, pooled data from the two trials showed that higher proportions of patients on 140 mg and 210 mg of brodalumab achieved American College of Rheumatology (ACR)20 response at week 16 compared to placebo group (45.8% and 47.9%, respectively vs. 20.9%; P less than .0001).

There are limited data on treatment withdrawal in patients with psoriatic arthritis. Coates et al investigated whether continued treatment with ixekizumab, an interleukin 17A inhibitor was superior to withdrawing ixekizumab in maintaining minimal disease activity state in patents with psoriatic arthritis. They showed that more patients relapsed rapidly after ixekizumab was withdrawn compared to those continuing ixekizumab treatment. Importantly, >95% of patients who relapsed with treatment withdrawal re-achieved MDA on retreatment with ixekizumab within a median duration of 4.1 weeks. Thus, ixekizumab treatment is best maintained after a patient achieves a state of minimal disease activity. If the treatment needs to be interrupted (e.g., infection, surgery), most patients will re-achieve the state of minimal disease activity on retreatment.

Finally, research continues to demonstrate delayed diagnosis of psoriatic arthritis. Karmacharya et al showed that only 45% of patients receive a diagnosis of psoriatic arthritis by 2 years after symptom onset. This study from the population-based Rochester Epidemiology Project indicates that earlier age of onset of symptoms, the presence of higher body mass index and enthesitis are associated with diagnostic delay. Further education of health care providers and patients with psoriasis about psoriatic arthritis may help reduce diagnostic delay; delayed diagnosis leads to poorer long-term outcomes.

Key clinical point: More than half of patients with PsA had a diagnostic delay of >2 years.

Major finding: The percentage of patients receiving a diagnosis of PsA by 2 years after symptom onset was 45%. Factors associated with a diagnostic delay of >2 years included earlier age at onset of symptoms, higher body mass index, and enthesitis.

Study details: The data come from a retrospective, population-based cohort of 164 incident adult PsA patients.

Disclosures: The study used resources of the Rochester Epidemiology Project, which is supported by various National Institutes of Health grants. P Karmacharya and A Duarte-García reported receiving individual research grants. A Ogdie and JM Davis reported ties with various pharmaceutical companies. The remaining authors declared no conflicts of interest.

Source: Karmacharya P et al. J Rheumatol. 2021 Feb 15. doi: 10.3899/jrheum.201199.

Key clinical point: More than half of patients with PsA had a diagnostic delay of >2 years.

Major finding: The percentage of patients receiving a diagnosis of PsA by 2 years after symptom onset was 45%. Factors associated with a diagnostic delay of >2 years included earlier age at onset of symptoms, higher body mass index, and enthesitis.

Study details: The data come from a retrospective, population-based cohort of 164 incident adult PsA patients.

Disclosures: The study used resources of the Rochester Epidemiology Project, which is supported by various National Institutes of Health grants. P Karmacharya and A Duarte-García reported receiving individual research grants. A Ogdie and JM Davis reported ties with various pharmaceutical companies. The remaining authors declared no conflicts of interest.

Source: Karmacharya P et al. J Rheumatol. 2021 Feb 15. doi: 10.3899/jrheum.201199.

Key clinical point: More than half of patients with PsA had a diagnostic delay of >2 years.

Major finding: The percentage of patients receiving a diagnosis of PsA by 2 years after symptom onset was 45%. Factors associated with a diagnostic delay of >2 years included earlier age at onset of symptoms, higher body mass index, and enthesitis.

Study details: The data come from a retrospective, population-based cohort of 164 incident adult PsA patients.

Disclosures: The study used resources of the Rochester Epidemiology Project, which is supported by various National Institutes of Health grants. P Karmacharya and A Duarte-García reported receiving individual research grants. A Ogdie and JM Davis reported ties with various pharmaceutical companies. The remaining authors declared no conflicts of interest.

Source: Karmacharya P et al. J Rheumatol. 2021 Feb 15. doi: 10.3899/jrheum.201199.

Key clinical point: There is favorable agreement between ultrasound (US) and magnetic resonance imaging (MRI) for detecting inflammatory changes in finger joints of patients with psoriatic arthritis (PsA). Additionally, there is a favorable agreement between US, radiography and MRI for detecting destructive changes.

Major finding: The absolute agreement between US and MRI was in the range of good-to-very good for detecting synovitis (85%-96%), flexor tenosynovitis (93%-98%), and extensor paratenonitis (95%-98%). Agreement between US, MRI and radiography was also good-to-very good for detecting erosions (96%-98%) and bone proliferations (71%-93%).

Study details: The data come from a study of 100 consecutive PsA patients who underwent clinical assessment and concomitant radiographic, US and MRI evaluations of the metacarpophalangeal, proximal interphalangeal and distal interphalangeal joints of one hand.

Disclosures: The study was supported by an investigator-initiated research grant sponsored by Johnson and Johnson. The authors declared no conflicts of interest.

Source: Polachek A et al. Rheumatology (Oxford). 2021 Mar 17. doi: 10.1093/rheumatology/keab272.

Key clinical point: There is favorable agreement between ultrasound (US) and magnetic resonance imaging (MRI) for detecting inflammatory changes in finger joints of patients with psoriatic arthritis (PsA). Additionally, there is a favorable agreement between US, radiography and MRI for detecting destructive changes.

Major finding: The absolute agreement between US and MRI was in the range of good-to-very good for detecting synovitis (85%-96%), flexor tenosynovitis (93%-98%), and extensor paratenonitis (95%-98%). Agreement between US, MRI and radiography was also good-to-very good for detecting erosions (96%-98%) and bone proliferations (71%-93%).

Study details: The data come from a study of 100 consecutive PsA patients who underwent clinical assessment and concomitant radiographic, US and MRI evaluations of the metacarpophalangeal, proximal interphalangeal and distal interphalangeal joints of one hand.

Disclosures: The study was supported by an investigator-initiated research grant sponsored by Johnson and Johnson. The authors declared no conflicts of interest.

Source: Polachek A et al. Rheumatology (Oxford). 2021 Mar 17. doi: 10.1093/rheumatology/keab272.

Key clinical point: There is favorable agreement between ultrasound (US) and magnetic resonance imaging (MRI) for detecting inflammatory changes in finger joints of patients with psoriatic arthritis (PsA). Additionally, there is a favorable agreement between US, radiography and MRI for detecting destructive changes.

Major finding: The absolute agreement between US and MRI was in the range of good-to-very good for detecting synovitis (85%-96%), flexor tenosynovitis (93%-98%), and extensor paratenonitis (95%-98%). Agreement between US, MRI and radiography was also good-to-very good for detecting erosions (96%-98%) and bone proliferations (71%-93%).

Study details: The data come from a study of 100 consecutive PsA patients who underwent clinical assessment and concomitant radiographic, US and MRI evaluations of the metacarpophalangeal, proximal interphalangeal and distal interphalangeal joints of one hand.

Disclosures: The study was supported by an investigator-initiated research grant sponsored by Johnson and Johnson. The authors declared no conflicts of interest.

Source: Polachek A et al. Rheumatology (Oxford). 2021 Mar 17. doi: 10.1093/rheumatology/keab272.

Key clinical point: Cognitive impairment may be one of the neurological manifestations of psoriatic arthritis (PsA).

Major finding: Patients with PsA scored worse on the Montreal Cognitive Assessment (MoCA) vs. controls (P = .01). Additionally, the proportion of patients with cognitive impairment according to MoCA was significantly higher among cases vs. controls (91.9% vs. 58.3%, P = .002).

Study details: The data come from a cross-sectional case-control study involving 37 patients with PsA and 36 healthy controls.

Disclosures: The study did not receive any funding. The authors declared no conflicts of interest.

Source: Garcia LOKL et al. Acta Neurol Belg. 2021 Mar 13. doi: 10.1007/s13760-021-01644-y.

Key clinical point: Cognitive impairment may be one of the neurological manifestations of psoriatic arthritis (PsA).

Major finding: Patients with PsA scored worse on the Montreal Cognitive Assessment (MoCA) vs. controls (P = .01). Additionally, the proportion of patients with cognitive impairment according to MoCA was significantly higher among cases vs. controls (91.9% vs. 58.3%, P = .002).

Study details: The data come from a cross-sectional case-control study involving 37 patients with PsA and 36 healthy controls.

Disclosures: The study did not receive any funding. The authors declared no conflicts of interest.

Source: Garcia LOKL et al. Acta Neurol Belg. 2021 Mar 13. doi: 10.1007/s13760-021-01644-y.

Key clinical point: Cognitive impairment may be one of the neurological manifestations of psoriatic arthritis (PsA).

Major finding: Patients with PsA scored worse on the Montreal Cognitive Assessment (MoCA) vs. controls (P = .01). Additionally, the proportion of patients with cognitive impairment according to MoCA was significantly higher among cases vs. controls (91.9% vs. 58.3%, P = .002).

Study details: The data come from a cross-sectional case-control study involving 37 patients with PsA and 36 healthy controls.

Disclosures: The study did not receive any funding. The authors declared no conflicts of interest.

Source: Garcia LOKL et al. Acta Neurol Belg. 2021 Mar 13. doi: 10.1007/s13760-021-01644-y.

Key clinical point: In patients with active psoriatic arthritis (PsA), intravenous (IV) golimumab improved health-related quality of life (HRQoL) and productivity as early as 8 weeks and maintained improvement through 1 year; and these improvements were associated with improvements in disease activity and patient functional capability outcomes.

Major finding: At week 8, patients receiving IV golimumab vs. placebo had greater improvements in EuroQol-5 dimension-5 level index (0.14 vs. 0.04) and visual analog scale (VAS; 17.16 vs. 3.69), daily productivity VAS (−2.91 vs. −0.71), and Work Limitations Questionnaire productivity loss score (−2.92 vs. −0.78). At week 52, improvements were similar in the golimumab and placebo-crossover groups. HRQoL and productivity correlated with disease activity and functional capability, with continued association from week 8 through week 52.

Study details: In this phase 3 GO-VIBRANT trial, 480 patients with PsA were randomly assigned to receive IV golimumab 2 mg/kg (n=241) at weeks 0, 4, and then every 8 weeks (q8w) through week 52 or placebo (n=239) at weeks 0, 4, and then q8w, with crossover to IV golimumab 2 mg/kg at weeks 24, 28, and then q8w through week 52.

Disclosures: This study was supported by Janssen Research & Development, LLC, Spring House, PA. Some study investigators are employees of Janssen Global Services, LLC and own stock in Johnson & Johnson, of which Janssen Global Services, LLC is a wholly owned subsidiary. Some study authors reported receiving support from and consulting for Janssen.

Source: Ogdie A et al. Clin Rheumatol. 2021 Mar 2. doi: 10.1007/s10067-021-05639-1.

Key clinical point: In patients with active psoriatic arthritis (PsA), intravenous (IV) golimumab improved health-related quality of life (HRQoL) and productivity as early as 8 weeks and maintained improvement through 1 year; and these improvements were associated with improvements in disease activity and patient functional capability outcomes.

Major finding: At week 8, patients receiving IV golimumab vs. placebo had greater improvements in EuroQol-5 dimension-5 level index (0.14 vs. 0.04) and visual analog scale (VAS; 17.16 vs. 3.69), daily productivity VAS (−2.91 vs. −0.71), and Work Limitations Questionnaire productivity loss score (−2.92 vs. −0.78). At week 52, improvements were similar in the golimumab and placebo-crossover groups. HRQoL and productivity correlated with disease activity and functional capability, with continued association from week 8 through week 52.

Study details: In this phase 3 GO-VIBRANT trial, 480 patients with PsA were randomly assigned to receive IV golimumab 2 mg/kg (n=241) at weeks 0, 4, and then every 8 weeks (q8w) through week 52 or placebo (n=239) at weeks 0, 4, and then q8w, with crossover to IV golimumab 2 mg/kg at weeks 24, 28, and then q8w through week 52.

Disclosures: This study was supported by Janssen Research & Development, LLC, Spring House, PA. Some study investigators are employees of Janssen Global Services, LLC and own stock in Johnson & Johnson, of which Janssen Global Services, LLC is a wholly owned subsidiary. Some study authors reported receiving support from and consulting for Janssen.

Source: Ogdie A et al. Clin Rheumatol. 2021 Mar 2. doi: 10.1007/s10067-021-05639-1.

Key clinical point: In patients with active psoriatic arthritis (PsA), intravenous (IV) golimumab improved health-related quality of life (HRQoL) and productivity as early as 8 weeks and maintained improvement through 1 year; and these improvements were associated with improvements in disease activity and patient functional capability outcomes.

Major finding: At week 8, patients receiving IV golimumab vs. placebo had greater improvements in EuroQol-5 dimension-5 level index (0.14 vs. 0.04) and visual analog scale (VAS; 17.16 vs. 3.69), daily productivity VAS (−2.91 vs. −0.71), and Work Limitations Questionnaire productivity loss score (−2.92 vs. −0.78). At week 52, improvements were similar in the golimumab and placebo-crossover groups. HRQoL and productivity correlated with disease activity and functional capability, with continued association from week 8 through week 52.

Study details: In this phase 3 GO-VIBRANT trial, 480 patients with PsA were randomly assigned to receive IV golimumab 2 mg/kg (n=241) at weeks 0, 4, and then every 8 weeks (q8w) through week 52 or placebo (n=239) at weeks 0, 4, and then q8w, with crossover to IV golimumab 2 mg/kg at weeks 24, 28, and then q8w through week 52.

Disclosures: This study was supported by Janssen Research & Development, LLC, Spring House, PA. Some study investigators are employees of Janssen Global Services, LLC and own stock in Johnson & Johnson, of which Janssen Global Services, LLC is a wholly owned subsidiary. Some study authors reported receiving support from and consulting for Janssen.

Source: Ogdie A et al. Clin Rheumatol. 2021 Mar 2. doi: 10.1007/s10067-021-05639-1.

Key clinical point: The presence of depression/anxiety symptoms reduces the probability of achieving sustained minimal disease activity (MDA) in patients with psoriatic arthritis (PsA), regardless of the method used to define depression/anxiety.

Major finding: When depression/anxiety was defined as a score of 38 or lower on the Mental Component Summary of the Short Form-36 questionnaire (definition 1), the odds ratio (OR) for reaching sustained MDA was 0.30 (P less than .0001). The OR values were 0.34 (P less than .0001) and 0.47 (P less than .0001) for a score of 56 or lower on the Mental Health sub-scale (definition 2) and for rheumatologist’s report of a diagnosis or treatment for depression/anxiety (definition 3), respectively.

Study details: The data come from a study of 743 patients with PsA.

Disclosures: No study sponsor was identified. Several of the authors are affiliated with the Psoriatic Disease Program of the Krembil Research Institute of University Health Network in Toronto, which is supported by the Krembil Foundation. Dr. A Wong was supported by a Krembil Psoriatic Arthritis Fellowship and Dr. V Chandran was supported by a Pfizer Chair Rheumatology Research Award from the Department of Medicine, University of Toronto.

Source: Wong A et al. Arthritis Care Res (Hoboken). 2021 Mar 4. doi: 10.1002/acr.24593.

Key clinical point: The presence of depression/anxiety symptoms reduces the probability of achieving sustained minimal disease activity (MDA) in patients with psoriatic arthritis (PsA), regardless of the method used to define depression/anxiety.

Major finding: When depression/anxiety was defined as a score of 38 or lower on the Mental Component Summary of the Short Form-36 questionnaire (definition 1), the odds ratio (OR) for reaching sustained MDA was 0.30 (P less than .0001). The OR values were 0.34 (P less than .0001) and 0.47 (P less than .0001) for a score of 56 or lower on the Mental Health sub-scale (definition 2) and for rheumatologist’s report of a diagnosis or treatment for depression/anxiety (definition 3), respectively.

Study details: The data come from a study of 743 patients with PsA.

Disclosures: No study sponsor was identified. Several of the authors are affiliated with the Psoriatic Disease Program of the Krembil Research Institute of University Health Network in Toronto, which is supported by the Krembil Foundation. Dr. A Wong was supported by a Krembil Psoriatic Arthritis Fellowship and Dr. V Chandran was supported by a Pfizer Chair Rheumatology Research Award from the Department of Medicine, University of Toronto.

Source: Wong A et al. Arthritis Care Res (Hoboken). 2021 Mar 4. doi: 10.1002/acr.24593.

Key clinical point: The presence of depression/anxiety symptoms reduces the probability of achieving sustained minimal disease activity (MDA) in patients with psoriatic arthritis (PsA), regardless of the method used to define depression/anxiety.

Major finding: When depression/anxiety was defined as a score of 38 or lower on the Mental Component Summary of the Short Form-36 questionnaire (definition 1), the odds ratio (OR) for reaching sustained MDA was 0.30 (P less than .0001). The OR values were 0.34 (P less than .0001) and 0.47 (P less than .0001) for a score of 56 or lower on the Mental Health sub-scale (definition 2) and for rheumatologist’s report of a diagnosis or treatment for depression/anxiety (definition 3), respectively.

Study details: The data come from a study of 743 patients with PsA.

Disclosures: No study sponsor was identified. Several of the authors are affiliated with the Psoriatic Disease Program of the Krembil Research Institute of University Health Network in Toronto, which is supported by the Krembil Foundation. Dr. A Wong was supported by a Krembil Psoriatic Arthritis Fellowship and Dr. V Chandran was supported by a Pfizer Chair Rheumatology Research Award from the Department of Medicine, University of Toronto.

Source: Wong A et al. Arthritis Care Res (Hoboken). 2021 Mar 4. doi: 10.1002/acr.24593.