Key clinical point: Patients with psoriatic arthritis (PsA), particularly women, have higher disease burden from the patient’s perspective than those with rheumatoid arthritis (RA).

Major finding: The mean Visual Analogue Scale scores for pain (34 vs 32; P < .001) and fatigue (35 vs 33; P = .001) were slightly higher in patients with PsA vs RA. Women with PsA vs RA across all age groups had significantly higher scores for pain (<50 years old: 28 vs 18; >70 years old: 48 vs 38) and fatigue (50-59 years old: 41 vs 31; >70 years old: 46 vs 36; all P < .05).

Study details: Findings are from a cross-sectional analysis including patients with PsA (n = 3598) and RA (n = 13,913).

Disclosures: This study was funded by State Research Funding, Kuopio University Hospital Catchment Area, Kuopio, Finland. The authors declared no conflicts of interest.

Source: Weman L et al. Disease burden measured by patient-reported outcomes: Does psoriatic arthritis feel worse than rheumatoid arthritis? A cross-sectional nationwide study. Clin Exp Rheumatol. 2023 (May 15). doi: 10.55563/clinexprheumatol/h9hn90

Key clinical point: Patients with psoriatic arthritis (PsA), particularly women, have higher disease burden from the patient’s perspective than those with rheumatoid arthritis (RA).

Major finding: The mean Visual Analogue Scale scores for pain (34 vs 32; P < .001) and fatigue (35 vs 33; P = .001) were slightly higher in patients with PsA vs RA. Women with PsA vs RA across all age groups had significantly higher scores for pain (<50 years old: 28 vs 18; >70 years old: 48 vs 38) and fatigue (50-59 years old: 41 vs 31; >70 years old: 46 vs 36; all P < .05).

Study details: Findings are from a cross-sectional analysis including patients with PsA (n = 3598) and RA (n = 13,913).

Disclosures: This study was funded by State Research Funding, Kuopio University Hospital Catchment Area, Kuopio, Finland. The authors declared no conflicts of interest.

Source: Weman L et al. Disease burden measured by patient-reported outcomes: Does psoriatic arthritis feel worse than rheumatoid arthritis? A cross-sectional nationwide study. Clin Exp Rheumatol. 2023 (May 15). doi: 10.55563/clinexprheumatol/h9hn90

Key clinical point: Patients with psoriatic arthritis (PsA), particularly women, have higher disease burden from the patient’s perspective than those with rheumatoid arthritis (RA).

Major finding: The mean Visual Analogue Scale scores for pain (34 vs 32; P < .001) and fatigue (35 vs 33; P = .001) were slightly higher in patients with PsA vs RA. Women with PsA vs RA across all age groups had significantly higher scores for pain (<50 years old: 28 vs 18; >70 years old: 48 vs 38) and fatigue (50-59 years old: 41 vs 31; >70 years old: 46 vs 36; all P < .05).

Study details: Findings are from a cross-sectional analysis including patients with PsA (n = 3598) and RA (n = 13,913).

Disclosures: This study was funded by State Research Funding, Kuopio University Hospital Catchment Area, Kuopio, Finland. The authors declared no conflicts of interest.

Source: Weman L et al. Disease burden measured by patient-reported outcomes: Does psoriatic arthritis feel worse than rheumatoid arthritis? A cross-sectional nationwide study. Clin Exp Rheumatol. 2023 (May 15). doi: 10.55563/clinexprheumatol/h9hn90

Key clinical point: Many patients with psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) have impaired sleep despite treatment, with female patients having worse sleep quality than male patients.

Major finding: Overall, 46.6% of patients in the entire cohort had abnormal sleep behavior, with sleep quality being worse in women vs men (P < .001). Depressive symptoms (P < .001), female sex (P = .014), and Disease Activity Score in 28 joints (P = .003) predicted insomnia in PsA.

Study details: The data come from a retrospective medical chart analysis of 330 patients with spondyloarthritis, including 168 patients with PsA and 162 patients with axSpA.

Disclosures: This study was partly funded by an unrestricted grant from Novartis Pharma GmbH, Germany. Several authors, including the lead author, reported receiving speaker honoraria or research or travel grants or serving on advisory boards for several sources, including Novartis.

Source: Frede N et al. Sleep behaviour differs in women and men with psoriatic arthritis and axial spondyloarthritis with impact on quality of life and depressive symptoms. RMD Open. 2023;9:e002912 (May 19). doi: 10.1136/rmdopen-2022-002912

Key clinical point: Many patients with psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) have impaired sleep despite treatment, with female patients having worse sleep quality than male patients.

Major finding: Overall, 46.6% of patients in the entire cohort had abnormal sleep behavior, with sleep quality being worse in women vs men (P < .001). Depressive symptoms (P < .001), female sex (P = .014), and Disease Activity Score in 28 joints (P = .003) predicted insomnia in PsA.

Study details: The data come from a retrospective medical chart analysis of 330 patients with spondyloarthritis, including 168 patients with PsA and 162 patients with axSpA.

Disclosures: This study was partly funded by an unrestricted grant from Novartis Pharma GmbH, Germany. Several authors, including the lead author, reported receiving speaker honoraria or research or travel grants or serving on advisory boards for several sources, including Novartis.

Source: Frede N et al. Sleep behaviour differs in women and men with psoriatic arthritis and axial spondyloarthritis with impact on quality of life and depressive symptoms. RMD Open. 2023;9:e002912 (May 19). doi: 10.1136/rmdopen-2022-002912

Key clinical point: Many patients with psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) have impaired sleep despite treatment, with female patients having worse sleep quality than male patients.

Major finding: Overall, 46.6% of patients in the entire cohort had abnormal sleep behavior, with sleep quality being worse in women vs men (P < .001). Depressive symptoms (P < .001), female sex (P = .014), and Disease Activity Score in 28 joints (P = .003) predicted insomnia in PsA.

Study details: The data come from a retrospective medical chart analysis of 330 patients with spondyloarthritis, including 168 patients with PsA and 162 patients with axSpA.

Disclosures: This study was partly funded by an unrestricted grant from Novartis Pharma GmbH, Germany. Several authors, including the lead author, reported receiving speaker honoraria or research or travel grants or serving on advisory boards for several sources, including Novartis.

Source: Frede N et al. Sleep behaviour differs in women and men with psoriatic arthritis and axial spondyloarthritis with impact on quality of life and depressive symptoms. RMD Open. 2023;9:e002912 (May 19). doi: 10.1136/rmdopen-2022-002912

Key clinical point: Patients with psoriatic arthritis (PsA) and those with Behçet’s syndrome (BS) had significantly elevated levels of serum interleukin-36 alpha (IL-36α), although the extent was lesser in BS, highlighting the potential role of the serum IL-36α level in differential diagnosis between PsA and BS.

Major finding: The median serum IL-36α level in patients with BS (201.7 pg/mL) was significantly higher than that in control individuals (16.9 pg/mL; P < .001) but lower than that in patients with PsA (544 pg/mL; P < .001). An empirical cut-off level of 420.6 pg/mL for IL-36α showed a specificity of 0.93 and sensitivity of 0.70 to distinguish patients with PsA from those with BS.

Study details: The data come from a cross-sectional study including patients with PsA (n = 80) and BS (n = 90) and control individuals without immune-mediated inflammatory disease (n = 80) who were assessed for serum IL-36α levels.

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

Source: Bettiol A et al. Serum interleukin-36 α as a candidate biomarker to distinguish Behçet’s syndrome and psoriatic arthritis. Int J Mol Sci. 2023;24:8817 (May 16). doi: 10.3390/ijms24108817

Key clinical point: Patients with psoriatic arthritis (PsA) and those with Behçet’s syndrome (BS) had significantly elevated levels of serum interleukin-36 alpha (IL-36α), although the extent was lesser in BS, highlighting the potential role of the serum IL-36α level in differential diagnosis between PsA and BS.

Major finding: The median serum IL-36α level in patients with BS (201.7 pg/mL) was significantly higher than that in control individuals (16.9 pg/mL; P < .001) but lower than that in patients with PsA (544 pg/mL; P < .001). An empirical cut-off level of 420.6 pg/mL for IL-36α showed a specificity of 0.93 and sensitivity of 0.70 to distinguish patients with PsA from those with BS.

Study details: The data come from a cross-sectional study including patients with PsA (n = 80) and BS (n = 90) and control individuals without immune-mediated inflammatory disease (n = 80) who were assessed for serum IL-36α levels.

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

Source: Bettiol A et al. Serum interleukin-36 α as a candidate biomarker to distinguish Behçet’s syndrome and psoriatic arthritis. Int J Mol Sci. 2023;24:8817 (May 16). doi: 10.3390/ijms24108817

Key clinical point: Patients with psoriatic arthritis (PsA) and those with Behçet’s syndrome (BS) had significantly elevated levels of serum interleukin-36 alpha (IL-36α), although the extent was lesser in BS, highlighting the potential role of the serum IL-36α level in differential diagnosis between PsA and BS.

Major finding: The median serum IL-36α level in patients with BS (201.7 pg/mL) was significantly higher than that in control individuals (16.9 pg/mL; P < .001) but lower than that in patients with PsA (544 pg/mL; P < .001). An empirical cut-off level of 420.6 pg/mL for IL-36α showed a specificity of 0.93 and sensitivity of 0.70 to distinguish patients with PsA from those with BS.

Study details: The data come from a cross-sectional study including patients with PsA (n = 80) and BS (n = 90) and control individuals without immune-mediated inflammatory disease (n = 80) who were assessed for serum IL-36α levels.

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

Source: Bettiol A et al. Serum interleukin-36 α as a candidate biomarker to distinguish Behçet’s syndrome and psoriatic arthritis. Int J Mol Sci. 2023;24:8817 (May 16). doi: 10.3390/ijms24108817

Key clinical point: No clinically meaningful treatment-related differences were observed in the efficacy, safety, and treatment persistence of ustekinumab over 3 years in younger (<60 years) and older (≥60 years) patients with psoriatic arthritis (PsA).

Major finding: At 6 months, 51.7% and 43.8% of patients aged <60 and ≥60 years achieved clinical Disease Activity Index for Psoriatic Arthritis low disease activity, respectively, with the efficacy being maintained through 36 months. The proportions of patients reporting at least one (32.7% vs 40.9%) and serious (5.3% vs 9.6%) adverse events and treatment persistence were not significantly different among patients age < 60 vs ≥ 60 years.

Study details: This post hoc analysis of the PsABio trial included patients with PsA who received ustekinumab and were subgrouped into those age < 60 years (n = 336) and ≥ 60 years (n = 103).

Disclosures: This study was sponsored by Janssen. Six authors declared being current or former employees of Janssen or shareholders of Johnson & Johnson. Three authors reported ties with various sources, including Janssen.

Source: Gossec L et al. Response to treatment in psoriatic arthritis, the effect of age: analysis of patients receiving ustekinumab in the PsABio real-world study. Arthritis Res Ther. 2023;25:100 (Jun 9). doi: 10.1186/s13075-023-03078-8

Key clinical point: No clinically meaningful treatment-related differences were observed in the efficacy, safety, and treatment persistence of ustekinumab over 3 years in younger (<60 years) and older (≥60 years) patients with psoriatic arthritis (PsA).

Major finding: At 6 months, 51.7% and 43.8% of patients aged <60 and ≥60 years achieved clinical Disease Activity Index for Psoriatic Arthritis low disease activity, respectively, with the efficacy being maintained through 36 months. The proportions of patients reporting at least one (32.7% vs 40.9%) and serious (5.3% vs 9.6%) adverse events and treatment persistence were not significantly different among patients age < 60 vs ≥ 60 years.

Study details: This post hoc analysis of the PsABio trial included patients with PsA who received ustekinumab and were subgrouped into those age < 60 years (n = 336) and ≥ 60 years (n = 103).

Disclosures: This study was sponsored by Janssen. Six authors declared being current or former employees of Janssen or shareholders of Johnson & Johnson. Three authors reported ties with various sources, including Janssen.

Source: Gossec L et al. Response to treatment in psoriatic arthritis, the effect of age: analysis of patients receiving ustekinumab in the PsABio real-world study. Arthritis Res Ther. 2023;25:100 (Jun 9). doi: 10.1186/s13075-023-03078-8

Key clinical point: No clinically meaningful treatment-related differences were observed in the efficacy, safety, and treatment persistence of ustekinumab over 3 years in younger (<60 years) and older (≥60 years) patients with psoriatic arthritis (PsA).

Major finding: At 6 months, 51.7% and 43.8% of patients aged <60 and ≥60 years achieved clinical Disease Activity Index for Psoriatic Arthritis low disease activity, respectively, with the efficacy being maintained through 36 months. The proportions of patients reporting at least one (32.7% vs 40.9%) and serious (5.3% vs 9.6%) adverse events and treatment persistence were not significantly different among patients age < 60 vs ≥ 60 years.

Study details: This post hoc analysis of the PsABio trial included patients with PsA who received ustekinumab and were subgrouped into those age < 60 years (n = 336) and ≥ 60 years (n = 103).

Disclosures: This study was sponsored by Janssen. Six authors declared being current or former employees of Janssen or shareholders of Johnson & Johnson. Three authors reported ties with various sources, including Janssen.

Source: Gossec L et al. Response to treatment in psoriatic arthritis, the effect of age: analysis of patients receiving ustekinumab in the PsABio real-world study. Arthritis Res Ther. 2023;25:100 (Jun 9). doi: 10.1186/s13075-023-03078-8

MADRID – Recent research has confirmed the impact of periodontitis on risk of neurologic diseases, especially the increased risks for stroke and Alzheimer’s disease.

The Spanish Society of Dentistry and Osseointegration (SEPA) and the Spanish Society of Neurology (SEN) recently released a report with the latest data on this topic. The report reviews, updates, and presents the most recent scientific evidence regarding this link. It also provides practical recommendations that, on the basis of the evidence, should be applied in dental clinics and neurology centers.

As Yago Leira, DDS, PhD, periodontist and coordinator of the SEPA-SEN working group, told this news organization, “The main takeaway from this scientific report is that patients with periodontitis are at nearly twice the risk of developing Alzheimer’s disease and at triple the risk of ischemic stroke.”

Data from the report show that individuals with periodontitis are at 2.8 times’ higher risk of ischemic stroke. The available evidence regarding hemorrhagic stroke, however, is conflicting.

How does this dental condition affect the course of cardiovascular disease? Observational studies have shown that those who have had an ischemic stroke and have a confirmed diagnosis of periodontitis are at greater risk of suffering a recurrent vascular event, worse neurologic deficit, and postictal depression than are patients without periodontitis.
 

Immune‐mediated inflammation

As far as its link to Alzheimer’s disease, meta-analyses of epidemiologic studies show that periodontitis is associated with a 1.7 times greater risk of this type of dementia and that the risk triples among patients with more serious forms of periodontitis.

Likewise, studies suggest that individuals with dementia or neurocognitive impairment are at a greater risk of suffering periodontitis. Other studies indicate that individuals with periodontitis have worse outcomes on various neuropsychological tests of cognitive function.

The current report presents the evidence from three clearly defined perspectives: The epidemiologic association between periodontitis and these neurologic diseases, the biological mechanisms that may explain this link, and interventional studies of dental treatment as a means of preventing stroke and Alzheimer’s disease.

“There is a possible biological explanation for these epidemiological findings. The report concludes that the low-grade chronic, systemic, immune-mediated inflammatory response induced by the bacteria and their endotoxins and the proinflammatory mediators circulating through the blood contributes to various biological processes that are involved in neurological impairment and cerebral ischemia,” said Dr. Leira, one of the report’s authors.

Ana Frank, MD, PhD, another author of this study, is head of the neurology department at the La Paz University Hospital in Madrid and a member of the SEPA-SEN group. She said in an interview that the main biological mechanism in stroke and Alzheimer’s disease is chronic exposure of the entire brain (vasculature, neurons, and astrocytes) to the harmful effects of periodontal infection. “Although low in intensity, this [exposure] is sufficient to set off a series of events that eventually lead to vascular endothelial injury, changes to neurons and astrocytes, and damage to the neuropil.”

As far as the evidence of an epidemiologic association between periodontitis and both neurologic diseases, Dr. Frank cited the exponential increase in risk brought on by periodontitis. She said that further epidemiologic studies are necessary to gain a better understanding of the magnitude of the problem.
 

A preventive alternative?

Dr. Leira cited evidence that periodontal treatment could provide a means of preventing stroke and dementia. He pointed out that numerous population studies have observed various oral health interventions (e.g., periodic dental prophylaxis or periodontal treatment) and regular dental visits to reduce the risk of developing dementia and stroke. “However, we don’t currently have randomized clinical trials that were designed to investigate whether periodontal treatment may be a primary or a secondary preventive measure against these neurological conditions.”

According to Dr. Leira, “There are currently several research groups in the United States and Europe, including ours, that are performing clinical trials to assess the impact of periodontal treatment on recurrent vascular events in patients with cerebrovascular disease.

“On the other hand, there are various interventional studies underway that are evaluating the potential effect of periodontal treatment on cognitive function in patients with dementia. Along these lines, there appear to be encouraging results from the 1-year follow-up in the GAIN study, which was a phase 2/3 clinical trial testing atuzaginstat. Atuzaginstat is an inhibitor of gingipain, the endotoxin produced by Porphyromonas gingivalis, which is one of the bacteria thought to be responsible for periodontitis. The drug reduces neurocognitive impairment in patients with high levels of antibodies against this periodontal pathogen.”
 

Toward clinical practice

The report has a practical focus. The intention is that this evidence will make its way into recommendations for dentists to implement in clinical practice, especially with elderly patients or patients with risk factors for stroke.

In this regard, Dr. Leira said, “On one hand, dentists have to know how to approach patients who have already suffered a stroke (most of whom have vascular risk factors like diabetes and hypertension), many of whom have polypharmacy and are [taking] certain drugs like blood thinners that could negatively impact various dental procedures. In such cases, it is important to maintain direct contact with a neurologist, since these patients ought to be treated with a multidisciplinary approach.

“On the other hand, each patient who comes to the dental office and has a diagnosis of periodontitis could be screened to identify potential vascular risk factors, even though the definitive diagnosis would need to be given by a specialist physician. To this end, SEPA is carrying out the Promosalud (“Health Promotion”) project, which will soon be applied in a large number of dental clinics in Spain,” added Dr. Leira.

“Lastly, specialists in odontology must understand the potential positive benefits surrounding systemic vascular inflammation that periodontal treatment could provide, including, for example, metabolic control and lowering blood pressure.”

For patients with cognitive impairment, the authors of the report recommended adhering to the following steps during dental visits: Inform the patient and the patient’s caregiver about the importance of good dental hygiene and monitor for any signs of infection or dental disease; address pain in every patient with cognitive impairment and dental problems, especially those with agitation, even if the patient isn’t specifically complaining of pain (also, try not to give opioids); finally, avoid sedation as much as possible and use the smallest effective dose if it becomes necessary.
 

Prescribe oral hygiene

Regarding recommendations that neurologists should follow during consultations in light of the link between these diseases and periodontitis, Dr. Frank said, “Regardless of how old our patients are, I believe it’s important to emphasize the importance of practicing good oral and dental hygiene. It’s a good strategy to put this in writing in medical reports, alongside the usual recommendations about healthy lifestyle habits and monitoring for diseases like high blood pressure, diabetes, or dyslipidemia. These, among other factors like smoking, a sedentary lifestyle, alcoholism, and other drug addictions, are vascular risk factors and are therefore risk factors for stroke and dementia.”

According to Dr. Frank, the public is largely unaware of the relationship between periodontitis and incident neurologic diseases. “We still have a long way to go before we can say that the public is aware of this potential link. And not just the public, either. I believe we must stress among our colleagues and among health care professionals in general the importance of promoting dental health to improve people’s overall health.”

In this regard, Dr. Leira emphasized the authors’ intention to make this report available not only to oral health and neurologic health care professionals but also to primary care physicians and nurses so that patients with cerebrovascular disease or Alzheimer’s disease and their caregivers can develop a greater awareness and thereby improve prevention.

“This study will also provide the scientific basis to support the SEPA-SEN working group as they implement their future activities and projects,” Dr. Leira concluded.

Dr. Leira and Dr. Frank have disclosed no relevant financial relationships.
 

This article was translated from the Medscape Spanish Edition. A version of this article appeared on Medscape.com.

MADRID – Recent research has confirmed the impact of periodontitis on risk of neurologic diseases, especially the increased risks for stroke and Alzheimer’s disease.

The Spanish Society of Dentistry and Osseointegration (SEPA) and the Spanish Society of Neurology (SEN) recently released a report with the latest data on this topic. The report reviews, updates, and presents the most recent scientific evidence regarding this link. It also provides practical recommendations that, on the basis of the evidence, should be applied in dental clinics and neurology centers.

As Yago Leira, DDS, PhD, periodontist and coordinator of the SEPA-SEN working group, told this news organization, “The main takeaway from this scientific report is that patients with periodontitis are at nearly twice the risk of developing Alzheimer’s disease and at triple the risk of ischemic stroke.”

Data from the report show that individuals with periodontitis are at 2.8 times’ higher risk of ischemic stroke. The available evidence regarding hemorrhagic stroke, however, is conflicting.

How does this dental condition affect the course of cardiovascular disease? Observational studies have shown that those who have had an ischemic stroke and have a confirmed diagnosis of periodontitis are at greater risk of suffering a recurrent vascular event, worse neurologic deficit, and postictal depression than are patients without periodontitis.
 

Immune‐mediated inflammation

As far as its link to Alzheimer’s disease, meta-analyses of epidemiologic studies show that periodontitis is associated with a 1.7 times greater risk of this type of dementia and that the risk triples among patients with more serious forms of periodontitis.

Likewise, studies suggest that individuals with dementia or neurocognitive impairment are at a greater risk of suffering periodontitis. Other studies indicate that individuals with periodontitis have worse outcomes on various neuropsychological tests of cognitive function.

The current report presents the evidence from three clearly defined perspectives: The epidemiologic association between periodontitis and these neurologic diseases, the biological mechanisms that may explain this link, and interventional studies of dental treatment as a means of preventing stroke and Alzheimer’s disease.

“There is a possible biological explanation for these epidemiological findings. The report concludes that the low-grade chronic, systemic, immune-mediated inflammatory response induced by the bacteria and their endotoxins and the proinflammatory mediators circulating through the blood contributes to various biological processes that are involved in neurological impairment and cerebral ischemia,” said Dr. Leira, one of the report’s authors.

Ana Frank, MD, PhD, another author of this study, is head of the neurology department at the La Paz University Hospital in Madrid and a member of the SEPA-SEN group. She said in an interview that the main biological mechanism in stroke and Alzheimer’s disease is chronic exposure of the entire brain (vasculature, neurons, and astrocytes) to the harmful effects of periodontal infection. “Although low in intensity, this [exposure] is sufficient to set off a series of events that eventually lead to vascular endothelial injury, changes to neurons and astrocytes, and damage to the neuropil.”

As far as the evidence of an epidemiologic association between periodontitis and both neurologic diseases, Dr. Frank cited the exponential increase in risk brought on by periodontitis. She said that further epidemiologic studies are necessary to gain a better understanding of the magnitude of the problem.
 

A preventive alternative?

Dr. Leira cited evidence that periodontal treatment could provide a means of preventing stroke and dementia. He pointed out that numerous population studies have observed various oral health interventions (e.g., periodic dental prophylaxis or periodontal treatment) and regular dental visits to reduce the risk of developing dementia and stroke. “However, we don’t currently have randomized clinical trials that were designed to investigate whether periodontal treatment may be a primary or a secondary preventive measure against these neurological conditions.”

According to Dr. Leira, “There are currently several research groups in the United States and Europe, including ours, that are performing clinical trials to assess the impact of periodontal treatment on recurrent vascular events in patients with cerebrovascular disease.

“On the other hand, there are various interventional studies underway that are evaluating the potential effect of periodontal treatment on cognitive function in patients with dementia. Along these lines, there appear to be encouraging results from the 1-year follow-up in the GAIN study, which was a phase 2/3 clinical trial testing atuzaginstat. Atuzaginstat is an inhibitor of gingipain, the endotoxin produced by Porphyromonas gingivalis, which is one of the bacteria thought to be responsible for periodontitis. The drug reduces neurocognitive impairment in patients with high levels of antibodies against this periodontal pathogen.”
 

Toward clinical practice

The report has a practical focus. The intention is that this evidence will make its way into recommendations for dentists to implement in clinical practice, especially with elderly patients or patients with risk factors for stroke.

In this regard, Dr. Leira said, “On one hand, dentists have to know how to approach patients who have already suffered a stroke (most of whom have vascular risk factors like diabetes and hypertension), many of whom have polypharmacy and are [taking] certain drugs like blood thinners that could negatively impact various dental procedures. In such cases, it is important to maintain direct contact with a neurologist, since these patients ought to be treated with a multidisciplinary approach.

“On the other hand, each patient who comes to the dental office and has a diagnosis of periodontitis could be screened to identify potential vascular risk factors, even though the definitive diagnosis would need to be given by a specialist physician. To this end, SEPA is carrying out the Promosalud (“Health Promotion”) project, which will soon be applied in a large number of dental clinics in Spain,” added Dr. Leira.

“Lastly, specialists in odontology must understand the potential positive benefits surrounding systemic vascular inflammation that periodontal treatment could provide, including, for example, metabolic control and lowering blood pressure.”

For patients with cognitive impairment, the authors of the report recommended adhering to the following steps during dental visits: Inform the patient and the patient’s caregiver about the importance of good dental hygiene and monitor for any signs of infection or dental disease; address pain in every patient with cognitive impairment and dental problems, especially those with agitation, even if the patient isn’t specifically complaining of pain (also, try not to give opioids); finally, avoid sedation as much as possible and use the smallest effective dose if it becomes necessary.
 

Prescribe oral hygiene

Regarding recommendations that neurologists should follow during consultations in light of the link between these diseases and periodontitis, Dr. Frank said, “Regardless of how old our patients are, I believe it’s important to emphasize the importance of practicing good oral and dental hygiene. It’s a good strategy to put this in writing in medical reports, alongside the usual recommendations about healthy lifestyle habits and monitoring for diseases like high blood pressure, diabetes, or dyslipidemia. These, among other factors like smoking, a sedentary lifestyle, alcoholism, and other drug addictions, are vascular risk factors and are therefore risk factors for stroke and dementia.”

According to Dr. Frank, the public is largely unaware of the relationship between periodontitis and incident neurologic diseases. “We still have a long way to go before we can say that the public is aware of this potential link. And not just the public, either. I believe we must stress among our colleagues and among health care professionals in general the importance of promoting dental health to improve people’s overall health.”

In this regard, Dr. Leira emphasized the authors’ intention to make this report available not only to oral health and neurologic health care professionals but also to primary care physicians and nurses so that patients with cerebrovascular disease or Alzheimer’s disease and their caregivers can develop a greater awareness and thereby improve prevention.

“This study will also provide the scientific basis to support the SEPA-SEN working group as they implement their future activities and projects,” Dr. Leira concluded.

Dr. Leira and Dr. Frank have disclosed no relevant financial relationships.
 

This article was translated from the Medscape Spanish Edition. A version of this article appeared on Medscape.com.

MADRID – Recent research has confirmed the impact of periodontitis on risk of neurologic diseases, especially the increased risks for stroke and Alzheimer’s disease.

The Spanish Society of Dentistry and Osseointegration (SEPA) and the Spanish Society of Neurology (SEN) recently released a report with the latest data on this topic. The report reviews, updates, and presents the most recent scientific evidence regarding this link. It also provides practical recommendations that, on the basis of the evidence, should be applied in dental clinics and neurology centers.

As Yago Leira, DDS, PhD, periodontist and coordinator of the SEPA-SEN working group, told this news organization, “The main takeaway from this scientific report is that patients with periodontitis are at nearly twice the risk of developing Alzheimer’s disease and at triple the risk of ischemic stroke.”

Data from the report show that individuals with periodontitis are at 2.8 times’ higher risk of ischemic stroke. The available evidence regarding hemorrhagic stroke, however, is conflicting.

How does this dental condition affect the course of cardiovascular disease? Observational studies have shown that those who have had an ischemic stroke and have a confirmed diagnosis of periodontitis are at greater risk of suffering a recurrent vascular event, worse neurologic deficit, and postictal depression than are patients without periodontitis.
 

Immune‐mediated inflammation

As far as its link to Alzheimer’s disease, meta-analyses of epidemiologic studies show that periodontitis is associated with a 1.7 times greater risk of this type of dementia and that the risk triples among patients with more serious forms of periodontitis.

Likewise, studies suggest that individuals with dementia or neurocognitive impairment are at a greater risk of suffering periodontitis. Other studies indicate that individuals with periodontitis have worse outcomes on various neuropsychological tests of cognitive function.

The current report presents the evidence from three clearly defined perspectives: The epidemiologic association between periodontitis and these neurologic diseases, the biological mechanisms that may explain this link, and interventional studies of dental treatment as a means of preventing stroke and Alzheimer’s disease.

“There is a possible biological explanation for these epidemiological findings. The report concludes that the low-grade chronic, systemic, immune-mediated inflammatory response induced by the bacteria and their endotoxins and the proinflammatory mediators circulating through the blood contributes to various biological processes that are involved in neurological impairment and cerebral ischemia,” said Dr. Leira, one of the report’s authors.

Ana Frank, MD, PhD, another author of this study, is head of the neurology department at the La Paz University Hospital in Madrid and a member of the SEPA-SEN group. She said in an interview that the main biological mechanism in stroke and Alzheimer’s disease is chronic exposure of the entire brain (vasculature, neurons, and astrocytes) to the harmful effects of periodontal infection. “Although low in intensity, this [exposure] is sufficient to set off a series of events that eventually lead to vascular endothelial injury, changes to neurons and astrocytes, and damage to the neuropil.”

As far as the evidence of an epidemiologic association between periodontitis and both neurologic diseases, Dr. Frank cited the exponential increase in risk brought on by periodontitis. She said that further epidemiologic studies are necessary to gain a better understanding of the magnitude of the problem.
 

A preventive alternative?

Dr. Leira cited evidence that periodontal treatment could provide a means of preventing stroke and dementia. He pointed out that numerous population studies have observed various oral health interventions (e.g., periodic dental prophylaxis or periodontal treatment) and regular dental visits to reduce the risk of developing dementia and stroke. “However, we don’t currently have randomized clinical trials that were designed to investigate whether periodontal treatment may be a primary or a secondary preventive measure against these neurological conditions.”

According to Dr. Leira, “There are currently several research groups in the United States and Europe, including ours, that are performing clinical trials to assess the impact of periodontal treatment on recurrent vascular events in patients with cerebrovascular disease.

“On the other hand, there are various interventional studies underway that are evaluating the potential effect of periodontal treatment on cognitive function in patients with dementia. Along these lines, there appear to be encouraging results from the 1-year follow-up in the GAIN study, which was a phase 2/3 clinical trial testing atuzaginstat. Atuzaginstat is an inhibitor of gingipain, the endotoxin produced by Porphyromonas gingivalis, which is one of the bacteria thought to be responsible for periodontitis. The drug reduces neurocognitive impairment in patients with high levels of antibodies against this periodontal pathogen.”
 

Toward clinical practice

The report has a practical focus. The intention is that this evidence will make its way into recommendations for dentists to implement in clinical practice, especially with elderly patients or patients with risk factors for stroke.

In this regard, Dr. Leira said, “On one hand, dentists have to know how to approach patients who have already suffered a stroke (most of whom have vascular risk factors like diabetes and hypertension), many of whom have polypharmacy and are [taking] certain drugs like blood thinners that could negatively impact various dental procedures. In such cases, it is important to maintain direct contact with a neurologist, since these patients ought to be treated with a multidisciplinary approach.

“On the other hand, each patient who comes to the dental office and has a diagnosis of periodontitis could be screened to identify potential vascular risk factors, even though the definitive diagnosis would need to be given by a specialist physician. To this end, SEPA is carrying out the Promosalud (“Health Promotion”) project, which will soon be applied in a large number of dental clinics in Spain,” added Dr. Leira.

“Lastly, specialists in odontology must understand the potential positive benefits surrounding systemic vascular inflammation that periodontal treatment could provide, including, for example, metabolic control and lowering blood pressure.”

For patients with cognitive impairment, the authors of the report recommended adhering to the following steps during dental visits: Inform the patient and the patient’s caregiver about the importance of good dental hygiene and monitor for any signs of infection or dental disease; address pain in every patient with cognitive impairment and dental problems, especially those with agitation, even if the patient isn’t specifically complaining of pain (also, try not to give opioids); finally, avoid sedation as much as possible and use the smallest effective dose if it becomes necessary.
 

Prescribe oral hygiene

Regarding recommendations that neurologists should follow during consultations in light of the link between these diseases and periodontitis, Dr. Frank said, “Regardless of how old our patients are, I believe it’s important to emphasize the importance of practicing good oral and dental hygiene. It’s a good strategy to put this in writing in medical reports, alongside the usual recommendations about healthy lifestyle habits and monitoring for diseases like high blood pressure, diabetes, or dyslipidemia. These, among other factors like smoking, a sedentary lifestyle, alcoholism, and other drug addictions, are vascular risk factors and are therefore risk factors for stroke and dementia.”

According to Dr. Frank, the public is largely unaware of the relationship between periodontitis and incident neurologic diseases. “We still have a long way to go before we can say that the public is aware of this potential link. And not just the public, either. I believe we must stress among our colleagues and among health care professionals in general the importance of promoting dental health to improve people’s overall health.”

In this regard, Dr. Leira emphasized the authors’ intention to make this report available not only to oral health and neurologic health care professionals but also to primary care physicians and nurses so that patients with cerebrovascular disease or Alzheimer’s disease and their caregivers can develop a greater awareness and thereby improve prevention.

“This study will also provide the scientific basis to support the SEPA-SEN working group as they implement their future activities and projects,” Dr. Leira concluded.

Dr. Leira and Dr. Frank have disclosed no relevant financial relationships.
 

This article was translated from the Medscape Spanish Edition. A version of this article appeared on Medscape.com.

Key clinical point: Apremilast led to a significant improvement in enthesitis and dactylitis activity among patients with psoriatic arthritis (PsA) presenting with enthesitis and dactylitis phenotypes, with more than one-third of patients achieving remission after 1 year of treatment.

Major finding: After 6 and 12 months of apremilast treatment, remission was achieved by 25% and 34% of patients with enthesitis and 47% and 44% of patients with dactylitis, respectively, with significant improvements in the Leeds Enthesitis and Dactylitis Indexes (P < .001).

Study details: Findings are from a retrospective study including patients with PsA who presented with either enthesitis (n = 118) or dactylitis (n = 96) phenotype and received apremilast.

Disclosures: This study received no external funding. The authors declared no conflicts of interest.

Source: Lo Gullo A et al. Therapeutic effects of apremilast on enthesitis and dactylitis in real clinical setting: An Italian multicenter study. J Clin Med. 2023;12:3892 (Jun 7). doi: 10.3390/jcm12123892

Key clinical point: Apremilast led to a significant improvement in enthesitis and dactylitis activity among patients with psoriatic arthritis (PsA) presenting with enthesitis and dactylitis phenotypes, with more than one-third of patients achieving remission after 1 year of treatment.

Major finding: After 6 and 12 months of apremilast treatment, remission was achieved by 25% and 34% of patients with enthesitis and 47% and 44% of patients with dactylitis, respectively, with significant improvements in the Leeds Enthesitis and Dactylitis Indexes (P < .001).

Study details: Findings are from a retrospective study including patients with PsA who presented with either enthesitis (n = 118) or dactylitis (n = 96) phenotype and received apremilast.

Disclosures: This study received no external funding. The authors declared no conflicts of interest.

Source: Lo Gullo A et al. Therapeutic effects of apremilast on enthesitis and dactylitis in real clinical setting: An Italian multicenter study. J Clin Med. 2023;12:3892 (Jun 7). doi: 10.3390/jcm12123892

Key clinical point: Apremilast led to a significant improvement in enthesitis and dactylitis activity among patients with psoriatic arthritis (PsA) presenting with enthesitis and dactylitis phenotypes, with more than one-third of patients achieving remission after 1 year of treatment.

Major finding: After 6 and 12 months of apremilast treatment, remission was achieved by 25% and 34% of patients with enthesitis and 47% and 44% of patients with dactylitis, respectively, with significant improvements in the Leeds Enthesitis and Dactylitis Indexes (P < .001).

Study details: Findings are from a retrospective study including patients with PsA who presented with either enthesitis (n = 118) or dactylitis (n = 96) phenotype and received apremilast.

Disclosures: This study received no external funding. The authors declared no conflicts of interest.

Source: Lo Gullo A et al. Therapeutic effects of apremilast on enthesitis and dactylitis in real clinical setting: An Italian multicenter study. J Clin Med. 2023;12:3892 (Jun 7). doi: 10.3390/jcm12123892

Key clinical point: Axial spondyloarthritis (axSpA) with or without concomitant psoriasis and axial psoriatic arthritis (PsA) appear distinct entities based on marked demographic, clinical, and genetic differences.

Major finding: Patients with axial PsA vs axSpA with or without psoriasis were older at symptom onset (48.6 vs 44.7 or 41.4 years, respectively; P < .001), had a higher prevalence of dactylitis (43.2% vs 18.3% or 8.4%, respectively; P < .001) and peripheral arthritis (86.7% vs 58.1% or 44.3%, respectively; P < .001), and were less frequently HLA-B27 positive (22.3% vs 55.4% or 65.5%, respectively; P < .001).

Study details: This study included 5208 patients with axSpA (with or without psoriasis) and 2771 with PsA (axial or peripheral arthritis) from the Swiss Clinical Quality Management (SCQM) registry.

Disclosures: This study was funded by Eli Lilly. Two authors declared being employees of SCQM with salary partly financed by Eli Lilly. Several authors declared receiving honoraria, speaking or consulting fees, research grants, or other financial support from various sources, including Lilly and other SCQM supporters. Two authors declared no conflicts of interest.

Source: Ciurea A et al. Characterisation of patients with axial psoriatic arthritis and patients with axial spondyloarthritis and concomitant psoriasis in the SCQM registry. RMD Open. 2023;9:e002956 (Jun 5). doi: 10.1136/rmdopen-2022-002956

Key clinical point: Axial spondyloarthritis (axSpA) with or without concomitant psoriasis and axial psoriatic arthritis (PsA) appear distinct entities based on marked demographic, clinical, and genetic differences.

Major finding: Patients with axial PsA vs axSpA with or without psoriasis were older at symptom onset (48.6 vs 44.7 or 41.4 years, respectively; P < .001), had a higher prevalence of dactylitis (43.2% vs 18.3% or 8.4%, respectively; P < .001) and peripheral arthritis (86.7% vs 58.1% or 44.3%, respectively; P < .001), and were less frequently HLA-B27 positive (22.3% vs 55.4% or 65.5%, respectively; P < .001).

Study details: This study included 5208 patients with axSpA (with or without psoriasis) and 2771 with PsA (axial or peripheral arthritis) from the Swiss Clinical Quality Management (SCQM) registry.

Disclosures: This study was funded by Eli Lilly. Two authors declared being employees of SCQM with salary partly financed by Eli Lilly. Several authors declared receiving honoraria, speaking or consulting fees, research grants, or other financial support from various sources, including Lilly and other SCQM supporters. Two authors declared no conflicts of interest.

Source: Ciurea A et al. Characterisation of patients with axial psoriatic arthritis and patients with axial spondyloarthritis and concomitant psoriasis in the SCQM registry. RMD Open. 2023;9:e002956 (Jun 5). doi: 10.1136/rmdopen-2022-002956

Key clinical point: Axial spondyloarthritis (axSpA) with or without concomitant psoriasis and axial psoriatic arthritis (PsA) appear distinct entities based on marked demographic, clinical, and genetic differences.

Major finding: Patients with axial PsA vs axSpA with or without psoriasis were older at symptom onset (48.6 vs 44.7 or 41.4 years, respectively; P < .001), had a higher prevalence of dactylitis (43.2% vs 18.3% or 8.4%, respectively; P < .001) and peripheral arthritis (86.7% vs 58.1% or 44.3%, respectively; P < .001), and were less frequently HLA-B27 positive (22.3% vs 55.4% or 65.5%, respectively; P < .001).

Study details: This study included 5208 patients with axSpA (with or without psoriasis) and 2771 with PsA (axial or peripheral arthritis) from the Swiss Clinical Quality Management (SCQM) registry.

Disclosures: This study was funded by Eli Lilly. Two authors declared being employees of SCQM with salary partly financed by Eli Lilly. Several authors declared receiving honoraria, speaking or consulting fees, research grants, or other financial support from various sources, including Lilly and other SCQM supporters. Two authors declared no conflicts of interest.

Source: Ciurea A et al. Characterisation of patients with axial psoriatic arthritis and patients with axial spondyloarthritis and concomitant psoriasis in the SCQM registry. RMD Open. 2023;9:e002956 (Jun 5). doi: 10.1136/rmdopen-2022-002956

Key clinical point: Etanercept was safe and effective with low rates of adverse events and led to better clinical outcomes in children with juvenile psoriatic arthritis (JPsA).

Major finding: The overall incidence of adverse events of special interest and serious adverse events were low and included 3 cases of uveitis (incidence rate [IR]/100 person-years 0.55; 95% CI 0.18-1.69), 1 of neuropathy (IR/100 person-years 0.18; 95% CI 0.03-1.29), and 1 of malignancy (IR/100 person-years 0.13; 95% CI 0.02-0.90). The American College of Rheumatology provisional criteria for inactive disease were achieved by 51.9% and 43.8% of patients at 6- and 12-month follow-ups.

Study details: This study included 226 patients with JPsA (aged ≥2 to <18 years) who received etanercept.

Disclosures: This study was sponsored by Immunex, a wholly owned subsidiary of Amgen Inc. S Stryker and D Collier declared being employees of and owning stocks in Amgen. SJ Balevic and T Beukelman declared receiving grants or research support, honoraria, or consulting fees or participating in data safety monitoring boards for various sources. The other authors declared no conflicts of interest.

Source: Correll CK et al. Occurrence of adverse events and change in disease activity after initiation of etanercept in paediatric patients with juvenile psoriatic arthritis in the CARRA Registry. RMD Open. 2023;9:e002943 (May 25). doi: 10.1136/rmdopen-2022-002943

Key clinical point: Etanercept was safe and effective with low rates of adverse events and led to better clinical outcomes in children with juvenile psoriatic arthritis (JPsA).

Major finding: The overall incidence of adverse events of special interest and serious adverse events were low and included 3 cases of uveitis (incidence rate [IR]/100 person-years 0.55; 95% CI 0.18-1.69), 1 of neuropathy (IR/100 person-years 0.18; 95% CI 0.03-1.29), and 1 of malignancy (IR/100 person-years 0.13; 95% CI 0.02-0.90). The American College of Rheumatology provisional criteria for inactive disease were achieved by 51.9% and 43.8% of patients at 6- and 12-month follow-ups.

Study details: This study included 226 patients with JPsA (aged ≥2 to <18 years) who received etanercept.

Disclosures: This study was sponsored by Immunex, a wholly owned subsidiary of Amgen Inc. S Stryker and D Collier declared being employees of and owning stocks in Amgen. SJ Balevic and T Beukelman declared receiving grants or research support, honoraria, or consulting fees or participating in data safety monitoring boards for various sources. The other authors declared no conflicts of interest.

Source: Correll CK et al. Occurrence of adverse events and change in disease activity after initiation of etanercept in paediatric patients with juvenile psoriatic arthritis in the CARRA Registry. RMD Open. 2023;9:e002943 (May 25). doi: 10.1136/rmdopen-2022-002943

Key clinical point: Etanercept was safe and effective with low rates of adverse events and led to better clinical outcomes in children with juvenile psoriatic arthritis (JPsA).

Major finding: The overall incidence of adverse events of special interest and serious adverse events were low and included 3 cases of uveitis (incidence rate [IR]/100 person-years 0.55; 95% CI 0.18-1.69), 1 of neuropathy (IR/100 person-years 0.18; 95% CI 0.03-1.29), and 1 of malignancy (IR/100 person-years 0.13; 95% CI 0.02-0.90). The American College of Rheumatology provisional criteria for inactive disease were achieved by 51.9% and 43.8% of patients at 6- and 12-month follow-ups.

Study details: This study included 226 patients with JPsA (aged ≥2 to <18 years) who received etanercept.

Disclosures: This study was sponsored by Immunex, a wholly owned subsidiary of Amgen Inc. S Stryker and D Collier declared being employees of and owning stocks in Amgen. SJ Balevic and T Beukelman declared receiving grants or research support, honoraria, or consulting fees or participating in data safety monitoring boards for various sources. The other authors declared no conflicts of interest.

Source: Correll CK et al. Occurrence of adverse events and change in disease activity after initiation of etanercept in paediatric patients with juvenile psoriatic arthritis in the CARRA Registry. RMD Open. 2023;9:e002943 (May 25). doi: 10.1136/rmdopen-2022-002943

Key clinical point: Patients with newly diagnosed psoriatic arthritis (PsA) and rheumatoid arthritis (RA) who initiated methotrexate showed similar rates of methotrexate retention; however, the addition of any other disease-modifying antirheumatic drugs (DMARD) to the treatment regimen was more rapid in RA vs PsA.

Major finding: Overall, 71% of patients with PsA and 76% of patients with RA remained on methotrexate at 2 years after initiating methotrexate. The risk for adding any other DMARD to the treatment regimen was greater in the RA vs PsA group (adjusted hazard ratio 0.86; 95% CI 0.77-0.96), with methotrexate monotherapy improving disease activity in both the groups.

Study details: This observational study included DMARD-naive patients with newly diagnosed PsA (n = 3642) who initiated methotrexate and matched comparator patients with RA (n = 3642).

Disclosures: This study was funded by grants from the Swedish Rheumatism Association and others. Some authors declared serving as consultants or receiving lecture fees, speakers’ bureau fees, or research support from various sources.

Source: Lindström U et al. Methotrexate treatment in early psoriatic arthritis in comparison to rheumatoid arthritis: An observational nationwide study. RMD Open. 2023;9:e002883 (May 12). doi: 10.1136/rmdopen-2022-002883

Key clinical point: Patients with newly diagnosed psoriatic arthritis (PsA) and rheumatoid arthritis (RA) who initiated methotrexate showed similar rates of methotrexate retention; however, the addition of any other disease-modifying antirheumatic drugs (DMARD) to the treatment regimen was more rapid in RA vs PsA.

Major finding: Overall, 71% of patients with PsA and 76% of patients with RA remained on methotrexate at 2 years after initiating methotrexate. The risk for adding any other DMARD to the treatment regimen was greater in the RA vs PsA group (adjusted hazard ratio 0.86; 95% CI 0.77-0.96), with methotrexate monotherapy improving disease activity in both the groups.

Study details: This observational study included DMARD-naive patients with newly diagnosed PsA (n = 3642) who initiated methotrexate and matched comparator patients with RA (n = 3642).

Disclosures: This study was funded by grants from the Swedish Rheumatism Association and others. Some authors declared serving as consultants or receiving lecture fees, speakers’ bureau fees, or research support from various sources.

Source: Lindström U et al. Methotrexate treatment in early psoriatic arthritis in comparison to rheumatoid arthritis: An observational nationwide study. RMD Open. 2023;9:e002883 (May 12). doi: 10.1136/rmdopen-2022-002883

Key clinical point: Patients with newly diagnosed psoriatic arthritis (PsA) and rheumatoid arthritis (RA) who initiated methotrexate showed similar rates of methotrexate retention; however, the addition of any other disease-modifying antirheumatic drugs (DMARD) to the treatment regimen was more rapid in RA vs PsA.

Major finding: Overall, 71% of patients with PsA and 76% of patients with RA remained on methotrexate at 2 years after initiating methotrexate. The risk for adding any other DMARD to the treatment regimen was greater in the RA vs PsA group (adjusted hazard ratio 0.86; 95% CI 0.77-0.96), with methotrexate monotherapy improving disease activity in both the groups.

Study details: This observational study included DMARD-naive patients with newly diagnosed PsA (n = 3642) who initiated methotrexate and matched comparator patients with RA (n = 3642).

Disclosures: This study was funded by grants from the Swedish Rheumatism Association and others. Some authors declared serving as consultants or receiving lecture fees, speakers’ bureau fees, or research support from various sources.

Source: Lindström U et al. Methotrexate treatment in early psoriatic arthritis in comparison to rheumatoid arthritis: An observational nationwide study. RMD Open. 2023;9:e002883 (May 12). doi: 10.1136/rmdopen-2022-002883

Key clinical point: Brepocitinib, the tyrosine kinase 2/Janus kinase 1 inhibitor, was superior to placebo in reducing signs and symptoms of psoriatic arthritis (PsA) and was well-tolerated throughout the 52-week study period.

Major finding: At week 16, American College of Rheumatology 20 response was achieved by a significantly higher proportion of patients receiving brepocitinib at doses of 30 mg (66.7%; P = .0197) and 60 mg (74.6%; P = .0006) compared with placebo (43.3%), with the response being maintained through week 52. Overall, 12 serious adverse events were reported in the brepocitinib arms (30 and 60 mg) by week 52. No deaths were reported.

Study details: Findings are from a phase 2b, dose-ranging, parallel treatment group trial including 218 patients with active PsA who were randomly assigned to receive either brepocitinib (60, 30, or 10 mg once daily) or placebo.

Disclosures: This study was sponsored by Pfizer Inc. Several authors declared being current or former employees and shareholders of Pfizer. The other authors reported ties with various sources, including Pfizer.

Source: Mease P et al. Efficacy and safety of tyrosine kinase 2/Janus kinase 1 Inhibitor brepocitinib for active psoriatic arthritis: A phase IIb randomized controlled trial. Arthritis Rheumatol. 2023 (May 17). doi: 10.1002/art.42519

Key clinical point: Brepocitinib, the tyrosine kinase 2/Janus kinase 1 inhibitor, was superior to placebo in reducing signs and symptoms of psoriatic arthritis (PsA) and was well-tolerated throughout the 52-week study period.

Major finding: At week 16, American College of Rheumatology 20 response was achieved by a significantly higher proportion of patients receiving brepocitinib at doses of 30 mg (66.7%; P = .0197) and 60 mg (74.6%; P = .0006) compared with placebo (43.3%), with the response being maintained through week 52. Overall, 12 serious adverse events were reported in the brepocitinib arms (30 and 60 mg) by week 52. No deaths were reported.

Study details: Findings are from a phase 2b, dose-ranging, parallel treatment group trial including 218 patients with active PsA who were randomly assigned to receive either brepocitinib (60, 30, or 10 mg once daily) or placebo.

Disclosures: This study was sponsored by Pfizer Inc. Several authors declared being current or former employees and shareholders of Pfizer. The other authors reported ties with various sources, including Pfizer.

Source: Mease P et al. Efficacy and safety of tyrosine kinase 2/Janus kinase 1 Inhibitor brepocitinib for active psoriatic arthritis: A phase IIb randomized controlled trial. Arthritis Rheumatol. 2023 (May 17). doi: 10.1002/art.42519

Key clinical point: Brepocitinib, the tyrosine kinase 2/Janus kinase 1 inhibitor, was superior to placebo in reducing signs and symptoms of psoriatic arthritis (PsA) and was well-tolerated throughout the 52-week study period.

Major finding: At week 16, American College of Rheumatology 20 response was achieved by a significantly higher proportion of patients receiving brepocitinib at doses of 30 mg (66.7%; P = .0197) and 60 mg (74.6%; P = .0006) compared with placebo (43.3%), with the response being maintained through week 52. Overall, 12 serious adverse events were reported in the brepocitinib arms (30 and 60 mg) by week 52. No deaths were reported.

Study details: Findings are from a phase 2b, dose-ranging, parallel treatment group trial including 218 patients with active PsA who were randomly assigned to receive either brepocitinib (60, 30, or 10 mg once daily) or placebo.

Disclosures: This study was sponsored by Pfizer Inc. Several authors declared being current or former employees and shareholders of Pfizer. The other authors reported ties with various sources, including Pfizer.

Source: Mease P et al. Efficacy and safety of tyrosine kinase 2/Janus kinase 1 Inhibitor brepocitinib for active psoriatic arthritis: A phase IIb randomized controlled trial. Arthritis Rheumatol. 2023 (May 17). doi: 10.1002/art.42519