Psoriatic Arthritis ICYMI

A new study in The Lancet Rheumatology examines the strength and duration of SARS-CoV-2 vaccine–induced immunoglobulin-G antibody responses over time for patients with a variety of autoimmune diseases, compared with healthy controls.

The presence of humoral antibodies to SARS-CoV-2 has been shown to correlate with protection against COVID infection. But for patients with immune-mediated inflammatory diseases (IMIDs), host response to COVID infection or to vaccination is affected by the immune dysfunction imposed by the IMID and by the use of immune-modulating drugs to treat it.

This new study finds a weaker – as shown previously – and less sustained immune response to SARS-CoV-2 vaccines in patients with a variety of IMIDs, including rheumatoid arthritis, spondyloarthritis, psoriasis, inflammatory bowel diseases, and other systemic autoimmune diseases such as lupus. It also points toward the possibility of adjusting treatment and vaccination schedules and strategies for these patients based on their antibody levels, among other factors, to preserve best protection against severe COVID.

Kmatta/Moment/Getty Images

“It is important to assess immune response in these patients to see if they still have protection against severe COVID infection,” said lead author David Simon, MD, senior clinical scientist in clinical immunology and rheumatology at University Hospital Erlangen (Germany). “We know that antibody response is an immune correlate. Therefore, it is important to see how large and durable the immune response is to the coronavirus vaccine in these IMID patients, and whether specific drugs or therapies have negative effects on their immune response.”
 

What was studied?

For this large prospective cohort study, researchers registered 5076 coronavirus-vaccinated individuals. They analyzed serum samples obtained between December 15, 2020, and December 1, 2021, from 2,535 patients diagnosed with IMIDs and participating in a prospective coronavirus study program at the Deutsches Zentrum Immuntherapie in Erlangen. The IMID patients had a mean age of 55.0 years, and 58.9% were women.

A healthy control group of 1,198 individuals without IMID who had a mean age of 40.7 years, including 53.8% men, was also recruited for the analysis. All approved coronavirus vaccines were included, following standard vaccination schedules. Antibody response was measured over time by an enzyme-linked immunosorbent assay from 8 weeks after first vaccination to week 40.

Among the findings, the healthy controls had higher postvaccine antibody levels than did those with IMIDs. But the majority of vaccinated patients with IMID were able to build up a humoral immune response to SARS-CoV-2. Patients who were taking B-cell inhibitors like rituximab (Rituxan, Genentech; and biosimilars) and T-cell inhibitors like abatacept (Orencia, Bristol Myers Squibb) for IMIDs had significantly poorer antibody response.

Greater age and the use of combination therapies for IMIDs, compared with monotherapy, further reduced immune response to the vaccine. In terms of vaccination modality, messenger RNA–based vaccines induced higher antibody levels than did vector-based vaccines. The researchers noted that patients with IMID who were given a third vaccine dose could actually catch up well with the antibody responses observed in healthy controls.

“We looked at whether different IMIDs had a different humoral response, and we also assessed if there are effects from different therapeutic strategies,” Dr. Simon explained. “It doesn’t matter so much what kind of IMID patients have; much more important is the specific drug treatment and its impact on their antibody response.” Some participants were advised to briefly stop taking some immunosuppressive treatments before or after vaccination.

One of Dr. Simon’s coauthors, statistician and rheumatologist Koray Tascilar, MD, added, “This research is important because we looked not only at who responded less, which has been previously established, but who are at greater risk of losing their immune response, and how quickly.”
 

Need to take care

“Most treatments we as rheumatologists give to our patients don’t affect their SARS-CoV-2 humoral response,” Dr. Simon said. “However, there are specific drugs that are associated with lower antibody response. With respect to those drugs, we have to be more careful.”

It is important to be able to tell patients which drugs are safe and won’t have a negative impact on their immune response to vaccinations, Dr. Tascilar said. “But it would be too strong to say we’re ready to choose therapies based on their potential impact on protection against COVID. Yes, there is a risk from catching COVID, but we need to balance that risk with the risk of not giving patients the medications that are necessary to treat their rheumatologic condition.”

These diseases are serious, sometimes life-threatening. “We might think of strategies for how to mitigate the risk of underprotection from COVID that is brought about by these treatments,” he said. For example, offering boosters sooner or more frequently, or prophylactically treating with monoclonal antibodies.

“This study, along other recent studies, has found that antibody levels in patients with immune-mediated diseases wane more rapidly than in healthy controls, and this is especially true of those on medications that interfere with the B and T cells and anticytokine therapies,” Rebecca Haberman, MD, assistant professor, division of rheumatology, New York University Langone Health, noted in an email to this news organization.

“While there is no known antibody level that specifically correlates with clinical protection, and each patient needs to be thought of individually, these findings support the use of supplemental booster dosing in patients with immune-mediated inflammatory diseases,” Dr. Haberman said, adding that her own research in this area has shown similar results.

“As a rheumatologist, I would be more likely to encourage my patients – especially those on immunomodulatory medications – to get boosted.”

Dr. Tascilar said his study does not directly answer the question of whether an earlier booster shot would be an effective strategy for patients with IMID. “In our department, we have an early boosting strategy, based on level of immune response.” But the decision of revaccination or not, and when, is based on a number of factors, not only on the level of antibodies. “It’s just part of the instruments we are using.”

The study was supported by the Deutsche Forschungsgemeinschaft. Dr. Simon and Dr. Tascilar declared no relevant financial relationships.

A version of this article first appeared on Medscape.com.

A new study in The Lancet Rheumatology examines the strength and duration of SARS-CoV-2 vaccine–induced immunoglobulin-G antibody responses over time for patients with a variety of autoimmune diseases, compared with healthy controls.

The presence of humoral antibodies to SARS-CoV-2 has been shown to correlate with protection against COVID infection. But for patients with immune-mediated inflammatory diseases (IMIDs), host response to COVID infection or to vaccination is affected by the immune dysfunction imposed by the IMID and by the use of immune-modulating drugs to treat it.

This new study finds a weaker – as shown previously – and less sustained immune response to SARS-CoV-2 vaccines in patients with a variety of IMIDs, including rheumatoid arthritis, spondyloarthritis, psoriasis, inflammatory bowel diseases, and other systemic autoimmune diseases such as lupus. It also points toward the possibility of adjusting treatment and vaccination schedules and strategies for these patients based on their antibody levels, among other factors, to preserve best protection against severe COVID.

Kmatta/Moment/Getty Images

“It is important to assess immune response in these patients to see if they still have protection against severe COVID infection,” said lead author David Simon, MD, senior clinical scientist in clinical immunology and rheumatology at University Hospital Erlangen (Germany). “We know that antibody response is an immune correlate. Therefore, it is important to see how large and durable the immune response is to the coronavirus vaccine in these IMID patients, and whether specific drugs or therapies have negative effects on their immune response.”
 

What was studied?

For this large prospective cohort study, researchers registered 5076 coronavirus-vaccinated individuals. They analyzed serum samples obtained between December 15, 2020, and December 1, 2021, from 2,535 patients diagnosed with IMIDs and participating in a prospective coronavirus study program at the Deutsches Zentrum Immuntherapie in Erlangen. The IMID patients had a mean age of 55.0 years, and 58.9% were women.

A healthy control group of 1,198 individuals without IMID who had a mean age of 40.7 years, including 53.8% men, was also recruited for the analysis. All approved coronavirus vaccines were included, following standard vaccination schedules. Antibody response was measured over time by an enzyme-linked immunosorbent assay from 8 weeks after first vaccination to week 40.

Among the findings, the healthy controls had higher postvaccine antibody levels than did those with IMIDs. But the majority of vaccinated patients with IMID were able to build up a humoral immune response to SARS-CoV-2. Patients who were taking B-cell inhibitors like rituximab (Rituxan, Genentech; and biosimilars) and T-cell inhibitors like abatacept (Orencia, Bristol Myers Squibb) for IMIDs had significantly poorer antibody response.

Greater age and the use of combination therapies for IMIDs, compared with monotherapy, further reduced immune response to the vaccine. In terms of vaccination modality, messenger RNA–based vaccines induced higher antibody levels than did vector-based vaccines. The researchers noted that patients with IMID who were given a third vaccine dose could actually catch up well with the antibody responses observed in healthy controls.

“We looked at whether different IMIDs had a different humoral response, and we also assessed if there are effects from different therapeutic strategies,” Dr. Simon explained. “It doesn’t matter so much what kind of IMID patients have; much more important is the specific drug treatment and its impact on their antibody response.” Some participants were advised to briefly stop taking some immunosuppressive treatments before or after vaccination.

One of Dr. Simon’s coauthors, statistician and rheumatologist Koray Tascilar, MD, added, “This research is important because we looked not only at who responded less, which has been previously established, but who are at greater risk of losing their immune response, and how quickly.”
 

Need to take care

“Most treatments we as rheumatologists give to our patients don’t affect their SARS-CoV-2 humoral response,” Dr. Simon said. “However, there are specific drugs that are associated with lower antibody response. With respect to those drugs, we have to be more careful.”

It is important to be able to tell patients which drugs are safe and won’t have a negative impact on their immune response to vaccinations, Dr. Tascilar said. “But it would be too strong to say we’re ready to choose therapies based on their potential impact on protection against COVID. Yes, there is a risk from catching COVID, but we need to balance that risk with the risk of not giving patients the medications that are necessary to treat their rheumatologic condition.”

These diseases are serious, sometimes life-threatening. “We might think of strategies for how to mitigate the risk of underprotection from COVID that is brought about by these treatments,” he said. For example, offering boosters sooner or more frequently, or prophylactically treating with monoclonal antibodies.

“This study, along other recent studies, has found that antibody levels in patients with immune-mediated diseases wane more rapidly than in healthy controls, and this is especially true of those on medications that interfere with the B and T cells and anticytokine therapies,” Rebecca Haberman, MD, assistant professor, division of rheumatology, New York University Langone Health, noted in an email to this news organization.

“While there is no known antibody level that specifically correlates with clinical protection, and each patient needs to be thought of individually, these findings support the use of supplemental booster dosing in patients with immune-mediated inflammatory diseases,” Dr. Haberman said, adding that her own research in this area has shown similar results.

“As a rheumatologist, I would be more likely to encourage my patients – especially those on immunomodulatory medications – to get boosted.”

Dr. Tascilar said his study does not directly answer the question of whether an earlier booster shot would be an effective strategy for patients with IMID. “In our department, we have an early boosting strategy, based on level of immune response.” But the decision of revaccination or not, and when, is based on a number of factors, not only on the level of antibodies. “It’s just part of the instruments we are using.”

The study was supported by the Deutsche Forschungsgemeinschaft. Dr. Simon and Dr. Tascilar declared no relevant financial relationships.

A version of this article first appeared on Medscape.com.

A new study in The Lancet Rheumatology examines the strength and duration of SARS-CoV-2 vaccine–induced immunoglobulin-G antibody responses over time for patients with a variety of autoimmune diseases, compared with healthy controls.

The presence of humoral antibodies to SARS-CoV-2 has been shown to correlate with protection against COVID infection. But for patients with immune-mediated inflammatory diseases (IMIDs), host response to COVID infection or to vaccination is affected by the immune dysfunction imposed by the IMID and by the use of immune-modulating drugs to treat it.

This new study finds a weaker – as shown previously – and less sustained immune response to SARS-CoV-2 vaccines in patients with a variety of IMIDs, including rheumatoid arthritis, spondyloarthritis, psoriasis, inflammatory bowel diseases, and other systemic autoimmune diseases such as lupus. It also points toward the possibility of adjusting treatment and vaccination schedules and strategies for these patients based on their antibody levels, among other factors, to preserve best protection against severe COVID.

Kmatta/Moment/Getty Images

“It is important to assess immune response in these patients to see if they still have protection against severe COVID infection,” said lead author David Simon, MD, senior clinical scientist in clinical immunology and rheumatology at University Hospital Erlangen (Germany). “We know that antibody response is an immune correlate. Therefore, it is important to see how large and durable the immune response is to the coronavirus vaccine in these IMID patients, and whether specific drugs or therapies have negative effects on their immune response.”
 

What was studied?

For this large prospective cohort study, researchers registered 5076 coronavirus-vaccinated individuals. They analyzed serum samples obtained between December 15, 2020, and December 1, 2021, from 2,535 patients diagnosed with IMIDs and participating in a prospective coronavirus study program at the Deutsches Zentrum Immuntherapie in Erlangen. The IMID patients had a mean age of 55.0 years, and 58.9% were women.

A healthy control group of 1,198 individuals without IMID who had a mean age of 40.7 years, including 53.8% men, was also recruited for the analysis. All approved coronavirus vaccines were included, following standard vaccination schedules. Antibody response was measured over time by an enzyme-linked immunosorbent assay from 8 weeks after first vaccination to week 40.

Among the findings, the healthy controls had higher postvaccine antibody levels than did those with IMIDs. But the majority of vaccinated patients with IMID were able to build up a humoral immune response to SARS-CoV-2. Patients who were taking B-cell inhibitors like rituximab (Rituxan, Genentech; and biosimilars) and T-cell inhibitors like abatacept (Orencia, Bristol Myers Squibb) for IMIDs had significantly poorer antibody response.

Greater age and the use of combination therapies for IMIDs, compared with monotherapy, further reduced immune response to the vaccine. In terms of vaccination modality, messenger RNA–based vaccines induced higher antibody levels than did vector-based vaccines. The researchers noted that patients with IMID who were given a third vaccine dose could actually catch up well with the antibody responses observed in healthy controls.

“We looked at whether different IMIDs had a different humoral response, and we also assessed if there are effects from different therapeutic strategies,” Dr. Simon explained. “It doesn’t matter so much what kind of IMID patients have; much more important is the specific drug treatment and its impact on their antibody response.” Some participants were advised to briefly stop taking some immunosuppressive treatments before or after vaccination.

One of Dr. Simon’s coauthors, statistician and rheumatologist Koray Tascilar, MD, added, “This research is important because we looked not only at who responded less, which has been previously established, but who are at greater risk of losing their immune response, and how quickly.”
 

Need to take care

“Most treatments we as rheumatologists give to our patients don’t affect their SARS-CoV-2 humoral response,” Dr. Simon said. “However, there are specific drugs that are associated with lower antibody response. With respect to those drugs, we have to be more careful.”

It is important to be able to tell patients which drugs are safe and won’t have a negative impact on their immune response to vaccinations, Dr. Tascilar said. “But it would be too strong to say we’re ready to choose therapies based on their potential impact on protection against COVID. Yes, there is a risk from catching COVID, but we need to balance that risk with the risk of not giving patients the medications that are necessary to treat their rheumatologic condition.”

These diseases are serious, sometimes life-threatening. “We might think of strategies for how to mitigate the risk of underprotection from COVID that is brought about by these treatments,” he said. For example, offering boosters sooner or more frequently, or prophylactically treating with monoclonal antibodies.

“This study, along other recent studies, has found that antibody levels in patients with immune-mediated diseases wane more rapidly than in healthy controls, and this is especially true of those on medications that interfere with the B and T cells and anticytokine therapies,” Rebecca Haberman, MD, assistant professor, division of rheumatology, New York University Langone Health, noted in an email to this news organization.

“While there is no known antibody level that specifically correlates with clinical protection, and each patient needs to be thought of individually, these findings support the use of supplemental booster dosing in patients with immune-mediated inflammatory diseases,” Dr. Haberman said, adding that her own research in this area has shown similar results.

“As a rheumatologist, I would be more likely to encourage my patients – especially those on immunomodulatory medications – to get boosted.”

Dr. Tascilar said his study does not directly answer the question of whether an earlier booster shot would be an effective strategy for patients with IMID. “In our department, we have an early boosting strategy, based on level of immune response.” But the decision of revaccination or not, and when, is based on a number of factors, not only on the level of antibodies. “It’s just part of the instruments we are using.”

The study was supported by the Deutsche Forschungsgemeinschaft. Dr. Simon and Dr. Tascilar declared no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Dermatologists spent less time with Asian patients with psoriasis than patients of other races and ethnicities in a cross-sectional study using data from the National Ambulatory Medical Care Survey (NAMCS) from 2010 to 2016.

Yet the reasons for the difference are unclear and in need of further research, said the investigators and dermatologists who were asked to comment on the research.

The study covered over 4 million visits for psoriasis and found that the mean duration of visits for Asian patients was 9.2 minutes, compared with 15.7 minutes for Hispanic or Latino patients, 20.7 minutes for non-Hispanic Black patients, and 15.4 minutes for non-Hispanic White patients.

The mean duration of visits with Asian patients was 39.9% shorter, compared with visits with White patients (beta coefficient, –5,747; 95% confidence interval, –11.026 to –0.469; P = .03), and 40.6% shorter, compared with visits with non-Asian patients combined (beta coefficient, –5.908; 95% CI, –11.147 to –0.669, P = .03), April W. Armstrong, MD, MPH, professor of dermatology and director of the psoriasis program at the University of Southern California, Los Angeles, and Kevin K. Wu, MD, a dermatology resident at USC, said in a research letter published in JAMA Dermatology.

“The etiology of these differences is unclear,” they wrote. “It is possible that factors such as unconscious bias, cultural differences in communication, or residual confounding may be responsible for the observed findings.”

Their findings came from multivariable linear regression analyses that adjusted for age, sex, type of visit (new or follow-up), visit complexity based on the number of reasons for the visit, insurance status (such as private insurance or Medicaid), psoriasis severity on the basis of systemic psoriasis treatment or phototherapy, and complex topical regimens (three or more topical agents).

Commenting on the results, Deborah A. Scott, MD, codirector of the skin of color dermatology program at Brigham and Women’s Hospital and assistant professor at Harvard Medical School, both in Boston, said in an interview that visit length “is a reasonable parameter to look at among many others” when investigating potential disparities in care.

“They’re equating [shorter visit times] with lack of time spent counseling patients,” said Dr. Scott, who was not involved in the research. But there are “many variables” that can affect visit time, such as language differences, time spent with interpreters, and differences in patient educational levels.

Clarissa Yang, MD, dermatologist-in-chief at Tufts Medical Center, Boston, agreed. “We’re worried about there being a quality of care issue. However, there could also be differences culturally in how [the patients] interact with their physicians – their styles and the questions they ask,” she said in an interview. “The study is a good first step to noting that there may be a disparity,” and there is a need to break down the differences “into more granularity.”

Previous research, the authors wrote, has found that Asian patients were less likely to receive counseling from physicians, compared with White patients. And “paradoxically,” they noted, Asian individuals tend to present with more severe psoriasis than patients of other races and ethnicities.

Dr. Scott said the tendency to present with more severe psoriasis has been documented in patients with skin of color broadly – likely because of delays in recognition and treatment.

Race and ethnicity in the study were self-reported by patients, and missing data were imputed by NAMCS researchers using a sequential regression method. Patients who did not report race and ethnicity may have different characteristics affecting visit duration than those who did report the information, Dr. Armstrong and Dr. Wu said in describing their study’s limitations.

Other differences found

In addition to visit length, they found significant differences in mean age and in the use of complex topical regimens. The mean ages of Asian, Hispanic or Latino, and non-Hispanic Black patients were 37.2, 44.7, and 33.3 years, respectively. Complex topical regimens were prescribed to 11.8% of Asian patients, compared with 1.5% of Black and 1.1% of White patients.

For practicing dermatologists, knowing for now that Asian patients have shorter visits “may bring to light some consciousness to how we practice,” Dr. Yang noted. “We may counsel differently, we may spend differing amounts of time – for reasons still unknown. But being generally aware can help us to shift any unconscious bias that may be there.”

Dermatologists, Dr. Armstrong and Dr. Wu wrote, “need to allow sufficient time to develop strong physician-patient communication regardless of patient background.”

The NAMCS – administered by the Center for Disease Control and Prevention’s National Center for Health Statistics – collects data on a sample of visits provided by non–federally employed office-based physicians.

Dr. Armstrong disclosed receiving personal fees from AbbVie and Regeneron for research funding and serving as a scientific adviser and speaker for additional pharmaceutical and therapeutic companies. Dr. Wu, Dr. Scott, and Dr. Yang did not report any disclosures.
 

Dermatologists spent less time with Asian patients with psoriasis than patients of other races and ethnicities in a cross-sectional study using data from the National Ambulatory Medical Care Survey (NAMCS) from 2010 to 2016.

Yet the reasons for the difference are unclear and in need of further research, said the investigators and dermatologists who were asked to comment on the research.

The study covered over 4 million visits for psoriasis and found that the mean duration of visits for Asian patients was 9.2 minutes, compared with 15.7 minutes for Hispanic or Latino patients, 20.7 minutes for non-Hispanic Black patients, and 15.4 minutes for non-Hispanic White patients.

The mean duration of visits with Asian patients was 39.9% shorter, compared with visits with White patients (beta coefficient, –5,747; 95% confidence interval, –11.026 to –0.469; P = .03), and 40.6% shorter, compared with visits with non-Asian patients combined (beta coefficient, –5.908; 95% CI, –11.147 to –0.669, P = .03), April W. Armstrong, MD, MPH, professor of dermatology and director of the psoriasis program at the University of Southern California, Los Angeles, and Kevin K. Wu, MD, a dermatology resident at USC, said in a research letter published in JAMA Dermatology.

“The etiology of these differences is unclear,” they wrote. “It is possible that factors such as unconscious bias, cultural differences in communication, or residual confounding may be responsible for the observed findings.”

Their findings came from multivariable linear regression analyses that adjusted for age, sex, type of visit (new or follow-up), visit complexity based on the number of reasons for the visit, insurance status (such as private insurance or Medicaid), psoriasis severity on the basis of systemic psoriasis treatment or phototherapy, and complex topical regimens (three or more topical agents).

Commenting on the results, Deborah A. Scott, MD, codirector of the skin of color dermatology program at Brigham and Women’s Hospital and assistant professor at Harvard Medical School, both in Boston, said in an interview that visit length “is a reasonable parameter to look at among many others” when investigating potential disparities in care.

“They’re equating [shorter visit times] with lack of time spent counseling patients,” said Dr. Scott, who was not involved in the research. But there are “many variables” that can affect visit time, such as language differences, time spent with interpreters, and differences in patient educational levels.

Clarissa Yang, MD, dermatologist-in-chief at Tufts Medical Center, Boston, agreed. “We’re worried about there being a quality of care issue. However, there could also be differences culturally in how [the patients] interact with their physicians – their styles and the questions they ask,” she said in an interview. “The study is a good first step to noting that there may be a disparity,” and there is a need to break down the differences “into more granularity.”

Previous research, the authors wrote, has found that Asian patients were less likely to receive counseling from physicians, compared with White patients. And “paradoxically,” they noted, Asian individuals tend to present with more severe psoriasis than patients of other races and ethnicities.

Dr. Scott said the tendency to present with more severe psoriasis has been documented in patients with skin of color broadly – likely because of delays in recognition and treatment.

Race and ethnicity in the study were self-reported by patients, and missing data were imputed by NAMCS researchers using a sequential regression method. Patients who did not report race and ethnicity may have different characteristics affecting visit duration than those who did report the information, Dr. Armstrong and Dr. Wu said in describing their study’s limitations.

Other differences found

In addition to visit length, they found significant differences in mean age and in the use of complex topical regimens. The mean ages of Asian, Hispanic or Latino, and non-Hispanic Black patients were 37.2, 44.7, and 33.3 years, respectively. Complex topical regimens were prescribed to 11.8% of Asian patients, compared with 1.5% of Black and 1.1% of White patients.

For practicing dermatologists, knowing for now that Asian patients have shorter visits “may bring to light some consciousness to how we practice,” Dr. Yang noted. “We may counsel differently, we may spend differing amounts of time – for reasons still unknown. But being generally aware can help us to shift any unconscious bias that may be there.”

Dermatologists, Dr. Armstrong and Dr. Wu wrote, “need to allow sufficient time to develop strong physician-patient communication regardless of patient background.”

The NAMCS – administered by the Center for Disease Control and Prevention’s National Center for Health Statistics – collects data on a sample of visits provided by non–federally employed office-based physicians.

Dr. Armstrong disclosed receiving personal fees from AbbVie and Regeneron for research funding and serving as a scientific adviser and speaker for additional pharmaceutical and therapeutic companies. Dr. Wu, Dr. Scott, and Dr. Yang did not report any disclosures.
 

Dermatologists spent less time with Asian patients with psoriasis than patients of other races and ethnicities in a cross-sectional study using data from the National Ambulatory Medical Care Survey (NAMCS) from 2010 to 2016.

Yet the reasons for the difference are unclear and in need of further research, said the investigators and dermatologists who were asked to comment on the research.

The study covered over 4 million visits for psoriasis and found that the mean duration of visits for Asian patients was 9.2 minutes, compared with 15.7 minutes for Hispanic or Latino patients, 20.7 minutes for non-Hispanic Black patients, and 15.4 minutes for non-Hispanic White patients.

The mean duration of visits with Asian patients was 39.9% shorter, compared with visits with White patients (beta coefficient, –5,747; 95% confidence interval, –11.026 to –0.469; P = .03), and 40.6% shorter, compared with visits with non-Asian patients combined (beta coefficient, –5.908; 95% CI, –11.147 to –0.669, P = .03), April W. Armstrong, MD, MPH, professor of dermatology and director of the psoriasis program at the University of Southern California, Los Angeles, and Kevin K. Wu, MD, a dermatology resident at USC, said in a research letter published in JAMA Dermatology.

“The etiology of these differences is unclear,” they wrote. “It is possible that factors such as unconscious bias, cultural differences in communication, or residual confounding may be responsible for the observed findings.”

Their findings came from multivariable linear regression analyses that adjusted for age, sex, type of visit (new or follow-up), visit complexity based on the number of reasons for the visit, insurance status (such as private insurance or Medicaid), psoriasis severity on the basis of systemic psoriasis treatment or phototherapy, and complex topical regimens (three or more topical agents).

Commenting on the results, Deborah A. Scott, MD, codirector of the skin of color dermatology program at Brigham and Women’s Hospital and assistant professor at Harvard Medical School, both in Boston, said in an interview that visit length “is a reasonable parameter to look at among many others” when investigating potential disparities in care.

“They’re equating [shorter visit times] with lack of time spent counseling patients,” said Dr. Scott, who was not involved in the research. But there are “many variables” that can affect visit time, such as language differences, time spent with interpreters, and differences in patient educational levels.

Clarissa Yang, MD, dermatologist-in-chief at Tufts Medical Center, Boston, agreed. “We’re worried about there being a quality of care issue. However, there could also be differences culturally in how [the patients] interact with their physicians – their styles and the questions they ask,” she said in an interview. “The study is a good first step to noting that there may be a disparity,” and there is a need to break down the differences “into more granularity.”

Previous research, the authors wrote, has found that Asian patients were less likely to receive counseling from physicians, compared with White patients. And “paradoxically,” they noted, Asian individuals tend to present with more severe psoriasis than patients of other races and ethnicities.

Dr. Scott said the tendency to present with more severe psoriasis has been documented in patients with skin of color broadly – likely because of delays in recognition and treatment.

Race and ethnicity in the study were self-reported by patients, and missing data were imputed by NAMCS researchers using a sequential regression method. Patients who did not report race and ethnicity may have different characteristics affecting visit duration than those who did report the information, Dr. Armstrong and Dr. Wu said in describing their study’s limitations.

Other differences found

In addition to visit length, they found significant differences in mean age and in the use of complex topical regimens. The mean ages of Asian, Hispanic or Latino, and non-Hispanic Black patients were 37.2, 44.7, and 33.3 years, respectively. Complex topical regimens were prescribed to 11.8% of Asian patients, compared with 1.5% of Black and 1.1% of White patients.

For practicing dermatologists, knowing for now that Asian patients have shorter visits “may bring to light some consciousness to how we practice,” Dr. Yang noted. “We may counsel differently, we may spend differing amounts of time – for reasons still unknown. But being generally aware can help us to shift any unconscious bias that may be there.”

Dermatologists, Dr. Armstrong and Dr. Wu wrote, “need to allow sufficient time to develop strong physician-patient communication regardless of patient background.”

The NAMCS – administered by the Center for Disease Control and Prevention’s National Center for Health Statistics – collects data on a sample of visits provided by non–federally employed office-based physicians.

Dr. Armstrong disclosed receiving personal fees from AbbVie and Regeneron for research funding and serving as a scientific adviser and speaker for additional pharmaceutical and therapeutic companies. Dr. Wu, Dr. Scott, and Dr. Yang did not report any disclosures.
 

Key clinical point: A substantial proportion of patients with psoriatic arthritis (PsA) reported fatigue, and the degree of fatigue had a significant impact on their disease severity and physical functionality.

Major finding: The majority of patients with PsA (78.3%) reported fatigue. Patients with higher fatigue scores reported more severe disease, greater pain levels, and higher tender/swollen joint count (all P < .001). Higher fatigue scores were associated with worse physical functioning and higher overall work impairment (both P < .001).

Study details: Findings are from an analysis of an independent, cross-sectional, multinational, real-world survey, Adelphi Real World Spondyloarthritis (SpA) IV Disease Specific Programme, including 831 patients with PsA.

Disclosures: The Adelphi SpA IV Disease Specific Programme was funded by Janssen. Three authors declared being employees of Janssen and shareholders of Janssen/Johnson & Johnson. Four authors declared being employees of Adelphi Real World. Other authors declared receiving grants of serving as consultants for several sources, including Janssen.

Source: Gossec L et al. Impact of fatigue on health-related quality of life and work productivity in psoriatic arthritis: Findings from a real-world survey. J Rheumatol. 2022 (Jul 15). Doi: 10.3899/jrheum.211288

Key clinical point: A substantial proportion of patients with psoriatic arthritis (PsA) reported fatigue, and the degree of fatigue had a significant impact on their disease severity and physical functionality.

Major finding: The majority of patients with PsA (78.3%) reported fatigue. Patients with higher fatigue scores reported more severe disease, greater pain levels, and higher tender/swollen joint count (all P < .001). Higher fatigue scores were associated with worse physical functioning and higher overall work impairment (both P < .001).

Study details: Findings are from an analysis of an independent, cross-sectional, multinational, real-world survey, Adelphi Real World Spondyloarthritis (SpA) IV Disease Specific Programme, including 831 patients with PsA.

Disclosures: The Adelphi SpA IV Disease Specific Programme was funded by Janssen. Three authors declared being employees of Janssen and shareholders of Janssen/Johnson & Johnson. Four authors declared being employees of Adelphi Real World. Other authors declared receiving grants of serving as consultants for several sources, including Janssen.

Source: Gossec L et al. Impact of fatigue on health-related quality of life and work productivity in psoriatic arthritis: Findings from a real-world survey. J Rheumatol. 2022 (Jul 15). Doi: 10.3899/jrheum.211288

Key clinical point: A substantial proportion of patients with psoriatic arthritis (PsA) reported fatigue, and the degree of fatigue had a significant impact on their disease severity and physical functionality.

Major finding: The majority of patients with PsA (78.3%) reported fatigue. Patients with higher fatigue scores reported more severe disease, greater pain levels, and higher tender/swollen joint count (all P < .001). Higher fatigue scores were associated with worse physical functioning and higher overall work impairment (both P < .001).

Study details: Findings are from an analysis of an independent, cross-sectional, multinational, real-world survey, Adelphi Real World Spondyloarthritis (SpA) IV Disease Specific Programme, including 831 patients with PsA.

Disclosures: The Adelphi SpA IV Disease Specific Programme was funded by Janssen. Three authors declared being employees of Janssen and shareholders of Janssen/Johnson & Johnson. Four authors declared being employees of Adelphi Real World. Other authors declared receiving grants of serving as consultants for several sources, including Janssen.

Source: Gossec L et al. Impact of fatigue on health-related quality of life and work productivity in psoriatic arthritis: Findings from a real-world survey. J Rheumatol. 2022 (Jul 15). Doi: 10.3899/jrheum.211288

Key clinical point: In patients with psoriatic arthritis (PsA), serum interleukin-23 (IL-23) levels were elevated and significantly correlated with disease activity (DA), depression, and anxiety.

Major finding: Serum IL-23 levels were higher in patients with PsA vs healthy volunteers without PsA (225.19 vs 118.12 pg/mL; P < .0001), and a significantly higher proportion of patients vs volunteers reported anxiety (45% vs 20%) and depression (35% vs 15%; both P < .0001). Serum IL-23 levels were positively correlated with Disease Activity Index for Psoriatic Arthritis (correlation coefficient [r] 0.959), Hospital Anxiety and Depression Scale (HADS) anxiety (r 0.932), and HADS depression (r 0.934; all P  =  .0001) scores.

Study details: Findings are from an observational case-control study including 80 patients with PsA and 80 matched healthy volunteers.

Disclosures: This study was funded by The Science, Technology & Innovation Funding Authority, Egypt, in cooperation with The Egyptian Knowledge Bank. The authors declared no conflicts of interest.

Source: Tabra SA et al. Serum interleukin-23 levels: Relation to depression, anxiety, and disease activity in psoriatic arthritis patients. Clin Rheumatol. 2022 (Jul 21). Doi: 10.1007/s10067-022-06300-1

Key clinical point: In patients with psoriatic arthritis (PsA), serum interleukin-23 (IL-23) levels were elevated and significantly correlated with disease activity (DA), depression, and anxiety.

Major finding: Serum IL-23 levels were higher in patients with PsA vs healthy volunteers without PsA (225.19 vs 118.12 pg/mL; P < .0001), and a significantly higher proportion of patients vs volunteers reported anxiety (45% vs 20%) and depression (35% vs 15%; both P < .0001). Serum IL-23 levels were positively correlated with Disease Activity Index for Psoriatic Arthritis (correlation coefficient [r] 0.959), Hospital Anxiety and Depression Scale (HADS) anxiety (r 0.932), and HADS depression (r 0.934; all P  =  .0001) scores.

Study details: Findings are from an observational case-control study including 80 patients with PsA and 80 matched healthy volunteers.

Disclosures: This study was funded by The Science, Technology & Innovation Funding Authority, Egypt, in cooperation with The Egyptian Knowledge Bank. The authors declared no conflicts of interest.

Source: Tabra SA et al. Serum interleukin-23 levels: Relation to depression, anxiety, and disease activity in psoriatic arthritis patients. Clin Rheumatol. 2022 (Jul 21). Doi: 10.1007/s10067-022-06300-1

Key clinical point: In patients with psoriatic arthritis (PsA), serum interleukin-23 (IL-23) levels were elevated and significantly correlated with disease activity (DA), depression, and anxiety.

Major finding: Serum IL-23 levels were higher in patients with PsA vs healthy volunteers without PsA (225.19 vs 118.12 pg/mL; P < .0001), and a significantly higher proportion of patients vs volunteers reported anxiety (45% vs 20%) and depression (35% vs 15%; both P < .0001). Serum IL-23 levels were positively correlated with Disease Activity Index for Psoriatic Arthritis (correlation coefficient [r] 0.959), Hospital Anxiety and Depression Scale (HADS) anxiety (r 0.932), and HADS depression (r 0.934; all P  =  .0001) scores.

Study details: Findings are from an observational case-control study including 80 patients with PsA and 80 matched healthy volunteers.

Disclosures: This study was funded by The Science, Technology & Innovation Funding Authority, Egypt, in cooperation with The Egyptian Knowledge Bank. The authors declared no conflicts of interest.

Source: Tabra SA et al. Serum interleukin-23 levels: Relation to depression, anxiety, and disease activity in psoriatic arthritis patients. Clin Rheumatol. 2022 (Jul 21). Doi: 10.1007/s10067-022-06300-1

Key clinical point: Patients with psoriatic arthritis (PsA) were more likely to report remission if they perceived an acceptable disease state, psoriasis remission, and a lower impact of PsA on global quality of life.

Major finding: Patient-reported PsA remission was associated with the achievement of 9-question Psoriatic Arthritis Impact of Disease score of ≤4 (odds ratio [OR] 4.58; P < .05), perception of psoriasis remission (OR 4.51; P < .05), and global quality of life score (OR 0.55; P < .001).

Study details: Findings are from a cross-sectional survey by the National Psoriasis Foundation including 834 patients with psoriasis or PsA.

Disclosures: This study did not receive any funding. Several authors declared serving as research or principal investigators, advisors, or consultants for several sources.

Source: Gondo G et al. Demographic and clinical factors associated with patient-reported remission in psoriatic arthritis. Dermatol Ther (Heidelb). 2022;12(8):1885-1895 (Jul 21). Doi: 10.1007/s13555-022-00770-6

Key clinical point: Patients with psoriatic arthritis (PsA) were more likely to report remission if they perceived an acceptable disease state, psoriasis remission, and a lower impact of PsA on global quality of life.

Major finding: Patient-reported PsA remission was associated with the achievement of 9-question Psoriatic Arthritis Impact of Disease score of ≤4 (odds ratio [OR] 4.58; P < .05), perception of psoriasis remission (OR 4.51; P < .05), and global quality of life score (OR 0.55; P < .001).

Study details: Findings are from a cross-sectional survey by the National Psoriasis Foundation including 834 patients with psoriasis or PsA.

Disclosures: This study did not receive any funding. Several authors declared serving as research or principal investigators, advisors, or consultants for several sources.

Source: Gondo G et al. Demographic and clinical factors associated with patient-reported remission in psoriatic arthritis. Dermatol Ther (Heidelb). 2022;12(8):1885-1895 (Jul 21). Doi: 10.1007/s13555-022-00770-6

Key clinical point: Patients with psoriatic arthritis (PsA) were more likely to report remission if they perceived an acceptable disease state, psoriasis remission, and a lower impact of PsA on global quality of life.

Major finding: Patient-reported PsA remission was associated with the achievement of 9-question Psoriatic Arthritis Impact of Disease score of ≤4 (odds ratio [OR] 4.58; P < .05), perception of psoriasis remission (OR 4.51; P < .05), and global quality of life score (OR 0.55; P < .001).

Study details: Findings are from a cross-sectional survey by the National Psoriasis Foundation including 834 patients with psoriasis or PsA.

Disclosures: This study did not receive any funding. Several authors declared serving as research or principal investigators, advisors, or consultants for several sources.

Source: Gondo G et al. Demographic and clinical factors associated with patient-reported remission in psoriatic arthritis. Dermatol Ther (Heidelb). 2022;12(8):1885-1895 (Jul 21). Doi: 10.1007/s13555-022-00770-6

Key clinical point: In patients with psoriatic arthritis (PsA), risankizumab demonstrated long-term (76 weeks) effectiveness in reducing joint symptoms with a favorable safety profile.

Major finding: At week 16, the American College of Rheumatology 20 criteria response rate was significantly higher with 150 mg risankizumab at weeks 0, 4, 8, 12, and 16 (arm 1) or 150 mg risankizumab at weeks 0, 4, and 16 (arm 2) vs placebo (59.5% [pooled arms 1 and 2] vs 35.7%; P  =  .007), which further improved (75.2%) at week 52. Both risankizumab and placebo had a similar safety profile.

Study details: Findings are from a phase 2 study including 185 patients with active PsA and inadequate response or intolerance to standard therapies who were randomly assigned to receive risankizumab or placebo, of which 145 patients entered the 52-week open-label extension study and received 150 mg risankizumab for 36 weeks.

Disclosures: This study was funded by AbbVie and Boehringer Ingelheim. Some authors declared being current or former employees of Boehringer Ingelheim or AbbVie or owning stocks in AbbVie. The other authors reported ties with several sources, including AbbVie and Boehringer Ingelheim.

Source: Mease PJ et al. Long-term efficacy and safety of risankizumab in patients with active psoriatic arthritis: Results from a 76-week phase 2 randomized trial. Rheumatol Ther. 2022 (Aug 5). Doi: 10.1007/s40744-022-00474-5

Key clinical point: In patients with psoriatic arthritis (PsA), risankizumab demonstrated long-term (76 weeks) effectiveness in reducing joint symptoms with a favorable safety profile.

Major finding: At week 16, the American College of Rheumatology 20 criteria response rate was significantly higher with 150 mg risankizumab at weeks 0, 4, 8, 12, and 16 (arm 1) or 150 mg risankizumab at weeks 0, 4, and 16 (arm 2) vs placebo (59.5% [pooled arms 1 and 2] vs 35.7%; P  =  .007), which further improved (75.2%) at week 52. Both risankizumab and placebo had a similar safety profile.

Study details: Findings are from a phase 2 study including 185 patients with active PsA and inadequate response or intolerance to standard therapies who were randomly assigned to receive risankizumab or placebo, of which 145 patients entered the 52-week open-label extension study and received 150 mg risankizumab for 36 weeks.

Disclosures: This study was funded by AbbVie and Boehringer Ingelheim. Some authors declared being current or former employees of Boehringer Ingelheim or AbbVie or owning stocks in AbbVie. The other authors reported ties with several sources, including AbbVie and Boehringer Ingelheim.

Source: Mease PJ et al. Long-term efficacy and safety of risankizumab in patients with active psoriatic arthritis: Results from a 76-week phase 2 randomized trial. Rheumatol Ther. 2022 (Aug 5). Doi: 10.1007/s40744-022-00474-5

Key clinical point: In patients with psoriatic arthritis (PsA), risankizumab demonstrated long-term (76 weeks) effectiveness in reducing joint symptoms with a favorable safety profile.

Major finding: At week 16, the American College of Rheumatology 20 criteria response rate was significantly higher with 150 mg risankizumab at weeks 0, 4, 8, 12, and 16 (arm 1) or 150 mg risankizumab at weeks 0, 4, and 16 (arm 2) vs placebo (59.5% [pooled arms 1 and 2] vs 35.7%; P  =  .007), which further improved (75.2%) at week 52. Both risankizumab and placebo had a similar safety profile.

Study details: Findings are from a phase 2 study including 185 patients with active PsA and inadequate response or intolerance to standard therapies who were randomly assigned to receive risankizumab or placebo, of which 145 patients entered the 52-week open-label extension study and received 150 mg risankizumab for 36 weeks.

Disclosures: This study was funded by AbbVie and Boehringer Ingelheim. Some authors declared being current or former employees of Boehringer Ingelheim or AbbVie or owning stocks in AbbVie. The other authors reported ties with several sources, including AbbVie and Boehringer Ingelheim.

Source: Mease PJ et al. Long-term efficacy and safety of risankizumab in patients with active psoriatic arthritis: Results from a 76-week phase 2 randomized trial. Rheumatol Ther. 2022 (Aug 5). Doi: 10.1007/s40744-022-00474-5

Key clinical point: A dose of 100 mg guselkumab every 4/8 weeks (Q4W/Q8W) improved health-related quality of life (HRQoL) through 52 weeks in patients with psoriatic arthritis (PsA).

Major finding: A significantly higher proportion of patients receiving guselkumab Q4W/Q8W vs placebo reported minimally important differences in the EuroQol 5-Dimension 5-Level (EQ-5D-5L) Index (56.0%/56.0% vs 43.4%; P < .006) and Visual Analog Scale (EQ-VAS) score (62.8%/63.5% vs 44.4%; P < .0001) at week 24, with >60% of patients reporting improvements at week 52.

Study details: Findings are from an analysis of the phase 3 DISCOVER 2 trial including 738 biologic-naive patients with active PsA and an inadequate response to standard treatments who were randomly assigned to receive 100 mg guselkumab (Q4W/Q8W) or placebo.

Disclosures: This study was supported by Janssen, a subsidiary of Johnson and Johnson. Eight authors declared being employees of one of the subsidiaries of or owning stocks in Johnson and Johnson. The other authors reported ties with several sources.

Source: Curtis JR et al. The effect of guselkumab on general health state in biologic-naïve patients with active psoriatic arthritis through week 52 of the phase 3, randomized, placebo-controlled DISCOVER-2 trial. Adv Ther. 2022 (Aug 10). Doi: 10.1007/s12325-022-02269-0

Key clinical point: A dose of 100 mg guselkumab every 4/8 weeks (Q4W/Q8W) improved health-related quality of life (HRQoL) through 52 weeks in patients with psoriatic arthritis (PsA).

Major finding: A significantly higher proportion of patients receiving guselkumab Q4W/Q8W vs placebo reported minimally important differences in the EuroQol 5-Dimension 5-Level (EQ-5D-5L) Index (56.0%/56.0% vs 43.4%; P < .006) and Visual Analog Scale (EQ-VAS) score (62.8%/63.5% vs 44.4%; P < .0001) at week 24, with >60% of patients reporting improvements at week 52.

Study details: Findings are from an analysis of the phase 3 DISCOVER 2 trial including 738 biologic-naive patients with active PsA and an inadequate response to standard treatments who were randomly assigned to receive 100 mg guselkumab (Q4W/Q8W) or placebo.

Disclosures: This study was supported by Janssen, a subsidiary of Johnson and Johnson. Eight authors declared being employees of one of the subsidiaries of or owning stocks in Johnson and Johnson. The other authors reported ties with several sources.

Source: Curtis JR et al. The effect of guselkumab on general health state in biologic-naïve patients with active psoriatic arthritis through week 52 of the phase 3, randomized, placebo-controlled DISCOVER-2 trial. Adv Ther. 2022 (Aug 10). Doi: 10.1007/s12325-022-02269-0

Key clinical point: A dose of 100 mg guselkumab every 4/8 weeks (Q4W/Q8W) improved health-related quality of life (HRQoL) through 52 weeks in patients with psoriatic arthritis (PsA).

Major finding: A significantly higher proportion of patients receiving guselkumab Q4W/Q8W vs placebo reported minimally important differences in the EuroQol 5-Dimension 5-Level (EQ-5D-5L) Index (56.0%/56.0% vs 43.4%; P < .006) and Visual Analog Scale (EQ-VAS) score (62.8%/63.5% vs 44.4%; P < .0001) at week 24, with >60% of patients reporting improvements at week 52.

Study details: Findings are from an analysis of the phase 3 DISCOVER 2 trial including 738 biologic-naive patients with active PsA and an inadequate response to standard treatments who were randomly assigned to receive 100 mg guselkumab (Q4W/Q8W) or placebo.

Disclosures: This study was supported by Janssen, a subsidiary of Johnson and Johnson. Eight authors declared being employees of one of the subsidiaries of or owning stocks in Johnson and Johnson. The other authors reported ties with several sources.

Source: Curtis JR et al. The effect of guselkumab on general health state in biologic-naïve patients with active psoriatic arthritis through week 52 of the phase 3, randomized, placebo-controlled DISCOVER-2 trial. Adv Ther. 2022 (Aug 10). Doi: 10.1007/s12325-022-02269-0

Key clinical point: Patients with psoriatic arthritis (PsA) who received risankizumab vs placebo were more likely to achieve clinically meaningful improvements in patient-reported outcomes (PRO).

Major finding: At week 24, patients receiving risankizumab vs placebo were significantly more likely to report minimal clinically important differences (MCID) in Patient’s Global Assessment of Disease Activity (PtGA) in both KEEPsAKE-1 (odds ratio [OR] 2.0; P < .001) and KEEPsAKE-2 (OR 1.9; P < .01) studies, with further improvement until week 52. Risankizumab significantly improved other PRO like pain, fatigue, quality of life, and physical functioning (P < .05).

Study details: The data come from an analysis of 2 phase 3 trials, KEEPsAKE-1 and KEEPsAKE-2, including adults with PsA and inadequate response or intolerance to disease-modifying antirheumatic drugs or biologics who were randomly assigned to receive risankizumab or placebo for 24 weeks and only risankizumab during weeks 24-52.

Disclosures: This study was funded by AbbVie. Three authors declared being employees or stockholders of AbbVie. The other authors reported ties with several sources, including AbbVie.

Source: Kristensen LE et al. The effect of risankizumab on achieving minimal clinically important differences in patient-reported outcomes in patients with psoriatic arthritis: Results from KEEPsAKE 1 and 2. J Eur Acad Dermatol Venereol. 2022 (Aug 3). Doi: 10.1111/jdv.18475

Key clinical point: Patients with psoriatic arthritis (PsA) who received risankizumab vs placebo were more likely to achieve clinically meaningful improvements in patient-reported outcomes (PRO).

Major finding: At week 24, patients receiving risankizumab vs placebo were significantly more likely to report minimal clinically important differences (MCID) in Patient’s Global Assessment of Disease Activity (PtGA) in both KEEPsAKE-1 (odds ratio [OR] 2.0; P < .001) and KEEPsAKE-2 (OR 1.9; P < .01) studies, with further improvement until week 52. Risankizumab significantly improved other PRO like pain, fatigue, quality of life, and physical functioning (P < .05).

Study details: The data come from an analysis of 2 phase 3 trials, KEEPsAKE-1 and KEEPsAKE-2, including adults with PsA and inadequate response or intolerance to disease-modifying antirheumatic drugs or biologics who were randomly assigned to receive risankizumab or placebo for 24 weeks and only risankizumab during weeks 24-52.

Disclosures: This study was funded by AbbVie. Three authors declared being employees or stockholders of AbbVie. The other authors reported ties with several sources, including AbbVie.

Source: Kristensen LE et al. The effect of risankizumab on achieving minimal clinically important differences in patient-reported outcomes in patients with psoriatic arthritis: Results from KEEPsAKE 1 and 2. J Eur Acad Dermatol Venereol. 2022 (Aug 3). Doi: 10.1111/jdv.18475

Key clinical point: Patients with psoriatic arthritis (PsA) who received risankizumab vs placebo were more likely to achieve clinically meaningful improvements in patient-reported outcomes (PRO).

Major finding: At week 24, patients receiving risankizumab vs placebo were significantly more likely to report minimal clinically important differences (MCID) in Patient’s Global Assessment of Disease Activity (PtGA) in both KEEPsAKE-1 (odds ratio [OR] 2.0; P < .001) and KEEPsAKE-2 (OR 1.9; P < .01) studies, with further improvement until week 52. Risankizumab significantly improved other PRO like pain, fatigue, quality of life, and physical functioning (P < .05).

Study details: The data come from an analysis of 2 phase 3 trials, KEEPsAKE-1 and KEEPsAKE-2, including adults with PsA and inadequate response or intolerance to disease-modifying antirheumatic drugs or biologics who were randomly assigned to receive risankizumab or placebo for 24 weeks and only risankizumab during weeks 24-52.

Disclosures: This study was funded by AbbVie. Three authors declared being employees or stockholders of AbbVie. The other authors reported ties with several sources, including AbbVie.

Source: Kristensen LE et al. The effect of risankizumab on achieving minimal clinically important differences in patient-reported outcomes in patients with psoriatic arthritis: Results from KEEPsAKE 1 and 2. J Eur Acad Dermatol Venereol. 2022 (Aug 3). Doi: 10.1111/jdv.18475

Key clinical point: The presence of nail dystrophy predicted a better treatment response to secukinumab in patients with psoriatic arthritis (PsA) and axial symptoms.

Major finding: Presence vs absence of nail dystrophy was associated with the achievement of significantly better Assessment of SpondyloArthritis International Society 20 response in the 300 mg secukinumab (odds ratio 5.0; 95% CI 1.47-17.19) vs placebo group (interaction alone P  =  .029).

Study details: Findings are from a post hoc analysis of the phase 3b MAXIMISE trial including 473 adult patients with PsA and axial manifestations who were randomly assigned to receive secukinumab (150 or 300 mg) or placebo.

Disclosures: H Marzo-Ortega and LC Coates reported receiving grants from the UK National Institute for Health Research. The other authors reported ties with several sources outside this work.

Source: Baraliakos X et al. Predictors of response to secukinumab in patients with psoriatic arthritis and axial manifestations: A post-hoc analysis of the MAXIMISE trial. RMD Open. 2022;8(2):e002303 (Jul 18). Doi: 10.1136/rmdopen-2022-002303

Key clinical point: The presence of nail dystrophy predicted a better treatment response to secukinumab in patients with psoriatic arthritis (PsA) and axial symptoms.

Major finding: Presence vs absence of nail dystrophy was associated with the achievement of significantly better Assessment of SpondyloArthritis International Society 20 response in the 300 mg secukinumab (odds ratio 5.0; 95% CI 1.47-17.19) vs placebo group (interaction alone P  =  .029).

Study details: Findings are from a post hoc analysis of the phase 3b MAXIMISE trial including 473 adult patients with PsA and axial manifestations who were randomly assigned to receive secukinumab (150 or 300 mg) or placebo.

Disclosures: H Marzo-Ortega and LC Coates reported receiving grants from the UK National Institute for Health Research. The other authors reported ties with several sources outside this work.

Source: Baraliakos X et al. Predictors of response to secukinumab in patients with psoriatic arthritis and axial manifestations: A post-hoc analysis of the MAXIMISE trial. RMD Open. 2022;8(2):e002303 (Jul 18). Doi: 10.1136/rmdopen-2022-002303

Key clinical point: The presence of nail dystrophy predicted a better treatment response to secukinumab in patients with psoriatic arthritis (PsA) and axial symptoms.

Major finding: Presence vs absence of nail dystrophy was associated with the achievement of significantly better Assessment of SpondyloArthritis International Society 20 response in the 300 mg secukinumab (odds ratio 5.0; 95% CI 1.47-17.19) vs placebo group (interaction alone P  =  .029).

Study details: Findings are from a post hoc analysis of the phase 3b MAXIMISE trial including 473 adult patients with PsA and axial manifestations who were randomly assigned to receive secukinumab (150 or 300 mg) or placebo.

Disclosures: H Marzo-Ortega and LC Coates reported receiving grants from the UK National Institute for Health Research. The other authors reported ties with several sources outside this work.

Source: Baraliakos X et al. Predictors of response to secukinumab in patients with psoriatic arthritis and axial manifestations: A post-hoc analysis of the MAXIMISE trial. RMD Open. 2022;8(2):e002303 (Jul 18). Doi: 10.1136/rmdopen-2022-002303

Key clinical point: The presence of dactylitis and nail disease were associated with improved outcomes in patients with early psoriatic arthritis (PsA) who received etanercept or methotrexate.

Major finding: The presence of both dactylitis and nail disease at baseline were significantly associated with the achievement of minimal disease activity (DA; odds ratio [OR] 1.4; P  =  .0457, and OR 1.8; P  =  .0233, respectively), PsA DA Score (PASDAS) of  low DA (OR 1.8; P  =  .0014, and OR 1.8; P  =  .0168, respectively) responses, and greater reductions in PASDAS scores at week 24 (estimate –3.8; P  =  .0155, and estimate –0.7; P  =  .0005, respectively).

Study details: Findings are from a post hoc analysis of the phase 3 SEAM-PsA trial including 851 biologic/methotrexate-naive patients with active PsA who were randomly assigned to receive methotrexate monotherapy, etanercept monotherapy, or methotrexate+etanercept combination therapy.

Disclosures: This study was funded by Immunex, a wholly owned subsidiary of Amgen. Three authors declared being employees or owning stocks in Amgen, and the other authors reported ties with several sources, including Amgen.

Source: Helliwell PS et al. Impact of clinical domains other than arthritis on composite outcomes in psoriatic arthritis: Comparison of treatment effects in the SEAM-PsA trial. RMD Open. 2022;8(2):e002366 (Jul 21). Doi: 10.1136/rmdopen-2022-002366

Key clinical point: The presence of dactylitis and nail disease were associated with improved outcomes in patients with early psoriatic arthritis (PsA) who received etanercept or methotrexate.

Major finding: The presence of both dactylitis and nail disease at baseline were significantly associated with the achievement of minimal disease activity (DA; odds ratio [OR] 1.4; P  =  .0457, and OR 1.8; P  =  .0233, respectively), PsA DA Score (PASDAS) of  low DA (OR 1.8; P  =  .0014, and OR 1.8; P  =  .0168, respectively) responses, and greater reductions in PASDAS scores at week 24 (estimate –3.8; P  =  .0155, and estimate –0.7; P  =  .0005, respectively).

Study details: Findings are from a post hoc analysis of the phase 3 SEAM-PsA trial including 851 biologic/methotrexate-naive patients with active PsA who were randomly assigned to receive methotrexate monotherapy, etanercept monotherapy, or methotrexate+etanercept combination therapy.

Disclosures: This study was funded by Immunex, a wholly owned subsidiary of Amgen. Three authors declared being employees or owning stocks in Amgen, and the other authors reported ties with several sources, including Amgen.

Source: Helliwell PS et al. Impact of clinical domains other than arthritis on composite outcomes in psoriatic arthritis: Comparison of treatment effects in the SEAM-PsA trial. RMD Open. 2022;8(2):e002366 (Jul 21). Doi: 10.1136/rmdopen-2022-002366

Key clinical point: The presence of dactylitis and nail disease were associated with improved outcomes in patients with early psoriatic arthritis (PsA) who received etanercept or methotrexate.

Major finding: The presence of both dactylitis and nail disease at baseline were significantly associated with the achievement of minimal disease activity (DA; odds ratio [OR] 1.4; P  =  .0457, and OR 1.8; P  =  .0233, respectively), PsA DA Score (PASDAS) of  low DA (OR 1.8; P  =  .0014, and OR 1.8; P  =  .0168, respectively) responses, and greater reductions in PASDAS scores at week 24 (estimate –3.8; P  =  .0155, and estimate –0.7; P  =  .0005, respectively).

Study details: Findings are from a post hoc analysis of the phase 3 SEAM-PsA trial including 851 biologic/methotrexate-naive patients with active PsA who were randomly assigned to receive methotrexate monotherapy, etanercept monotherapy, or methotrexate+etanercept combination therapy.

Disclosures: This study was funded by Immunex, a wholly owned subsidiary of Amgen. Three authors declared being employees or owning stocks in Amgen, and the other authors reported ties with several sources, including Amgen.

Source: Helliwell PS et al. Impact of clinical domains other than arthritis on composite outcomes in psoriatic arthritis: Comparison of treatment effects in the SEAM-PsA trial. RMD Open. 2022;8(2):e002366 (Jul 21). Doi: 10.1136/rmdopen-2022-002366