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Paradoxical Eczema Risk Low With Biologic Psoriasis Treatments
examined in a large observational analysis.
Using data from the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR) database, Ali Al-Janabi, MA, from the University of Manchester (England) and associates found that 273 (1%) of approximately 25,000 drug exposures in 13,699 biologic-treated patients with psoriasis were associated with paradoxical eczema.
The incidence of paradoxical eczema was found to vary by class. The highest rate was seen for IL-17 inhibitors, at 1.22 per 100,000 person-years, and the lowest rate was seen with IL-23 inhibitors, at 0.56 per 100,000 person-years. The respective incidence rates for tumor necrosis factor (TNF) inhibitors and IL-12/IL-23 inhibitors were a respective 0.94 and 0.80 per 100,000 person-years.
“Compared with TNF inhibitors, IL-23 inhibitor exposure was associated with significantly lower risk of paradoxical eczema,” the BADBIR Study Group reported in JAMA Dermatology. Indeed, patients treated with IL-23 inhibitors were 61% less likely than were those taking TNF-inhibitors to experience a paradoxical eczema event.
“These findings remained when restricting the analysis to first-line biologic exposures and were specific to this eczema phenotype” the group said.
Cautious Interpretation
As the corresponding author for the work, Mr. Al-Janabi observed in an email that the research needs to be replicated, and the findings need to be interpreted with caution.
“As well as usual clinical variables influencing biologic selection, clinicians could consider IL-23 inhibitors in patients with previous atopic dermatitis, hay fever, or paradoxical eczema episodes, as this class was associated with the lowest risk of paradoxical eczema,” he suggested.
A prior history of atopic dermatitis (AD) and hay fever appears to be particularly relevant, as both substantially upped the chances that paradoxical eczema would occur, with hazard ratios of 12.40 and 3.78, respectively. Increasing age also increased the risk, albeit slightly (hazard ratio [HR], 1.02 per year), and there was an apparent lower risk (HR, 0.60) comparing men and women.
The BADBIR Study Group authors believe that, to the best of their knowledge, this is the first study to compare paradoxical eczema risk by biologic class. “Based on clinical experience and prevalence of eczematous reactions reported in some IL-17 inhibitor clinical trials, we suspected an association between IL-17 inhibitor exposure and paradoxical eczema,” they wrote.
“While the incidence of paradoxical eczema was numerically highest among IL-17 inhibitor exposures, it was not significantly different from the incidence among TNF inhibitor exposures.” The low overall incidence of paradoxical eczema “may be reassuring for patients and clinicians,” they added, “but it is possible that the incidence was underestimated due to underreporting or exclusion of adverse events with insufficient detail.”
Details of the Analysis, Other Findings
To explore the risk of paradoxical eczema by biologic class and identify possible risk factors, the BADBIR Study Group performed a prospective cohort study using data held within the BADBIR database between September 2007 and December 2022.
Adults over the age of 18 year or older with plaque psoriasis and who had been treated with at least one of the following biologics were eligible for inclusion: the TNF inhibitors adalimumab, certolizumab pegol, etanercept, and infliximab; the IL-17 inhibitors bimekizumab, brodalumab, ixekizumab, and secukinumab; the IL-12/23 inhibitor ustekinumab; and the IL-23 inhibitors guselkumab, risankizumab, and tildrakizumab.
Patient records and adverse event data were reviewed to determine the incidence of paradoxical eczema events, using terms such as eczema, eczematized, eczematous, atopy, atopic, and dermatitis.
Of 24,952 drug exposures analyzed, the majority (11,819) were for TNF inhibitors, followed by IL-17 inhibitors (4,776), IL-12/23 inhibitors (6,423), and finally, IL-23 inhibitors (1,934).
Mr. Al-Janabi and coauthors reported that the median time to onset of paradoxical eczema events was 294 days — approximately 9.8 months. The earliest that these events were recorded was at 120 days (4 months), and the latest at 699 days (almost 2 years).
The face and neck were the most common sites affected (26% of exposures), with other sites including the limbs (23%), the trunk (13%), and hands or feet (12%). Itching (18%), redness (7%), and dryness (4%) were the most commonly reported symptoms.
The researchers noted that 21 patients had skin biopsies taken and “all showed spongiosis or a feature of eczema, with 1 having overlapping features of psoriasis.”
In the majority (92 %) of cases, patients experienced only one eczema event. Of the 20 patients who had more than one event, just over one-fifth of repeat events occurred after receiving the same biologic as for the index event. A quarter of events occurred after a different biologic of the same class had been used, and just over half of events occurred after a different class of biologic had been given.
Strengths and Limitations
The “large sample size and inclusion of multiple lines of exposure per participant” are strengths of the study, said the researchers. “We included data for all currently available biologics, originating from more than 160 dermatology centers in the UK and Ireland.”
They added, however, that the “main limitation is the small numbers of observations within certain subgroups, such as specific biologic exposures or participants in ethnic minority groups, restricting generalizability of our findings and the interpretation of some subgroup analyses.”
Moreover, the small number of paradoxical eczema events seen may have resulted in imprecise effect estimates, they observe, noting that the number of exposures to IL-23 inhibitors was low compared with other classes.
“Future studies with more exposures and paradoxical eczema events would enable a more robust analysis of individual drugs and patient subgroups,” the authors concluded.
The study was funded by the Medical Research Council. BADBIR is coordinated by The University of Manchester, and funded by the British Association of Dermatologists (BAD). The BAD receives income from AbbVie, Almirall, Amgen, Celgene, Janssen, LEO Pharma, Lilly, Novartis, Samsung Bioepis, Sandoz Hexal AG, and UCB Pharma for providing pharmacovigilance services. This income finances a separate contract between the BAD and The University of Manchester, which coordinates BADBIR. Mr. Al-Janabi reported receiving grants from the Medical Research Council during the conduct of the study; nonfinancial support from UCB, Almirall, and Janssen; and personal fees from UCB outside the submitted work.
examined in a large observational analysis.
Using data from the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR) database, Ali Al-Janabi, MA, from the University of Manchester (England) and associates found that 273 (1%) of approximately 25,000 drug exposures in 13,699 biologic-treated patients with psoriasis were associated with paradoxical eczema.
The incidence of paradoxical eczema was found to vary by class. The highest rate was seen for IL-17 inhibitors, at 1.22 per 100,000 person-years, and the lowest rate was seen with IL-23 inhibitors, at 0.56 per 100,000 person-years. The respective incidence rates for tumor necrosis factor (TNF) inhibitors and IL-12/IL-23 inhibitors were a respective 0.94 and 0.80 per 100,000 person-years.
“Compared with TNF inhibitors, IL-23 inhibitor exposure was associated with significantly lower risk of paradoxical eczema,” the BADBIR Study Group reported in JAMA Dermatology. Indeed, patients treated with IL-23 inhibitors were 61% less likely than were those taking TNF-inhibitors to experience a paradoxical eczema event.
“These findings remained when restricting the analysis to first-line biologic exposures and were specific to this eczema phenotype” the group said.
Cautious Interpretation
As the corresponding author for the work, Mr. Al-Janabi observed in an email that the research needs to be replicated, and the findings need to be interpreted with caution.
“As well as usual clinical variables influencing biologic selection, clinicians could consider IL-23 inhibitors in patients with previous atopic dermatitis, hay fever, or paradoxical eczema episodes, as this class was associated with the lowest risk of paradoxical eczema,” he suggested.
A prior history of atopic dermatitis (AD) and hay fever appears to be particularly relevant, as both substantially upped the chances that paradoxical eczema would occur, with hazard ratios of 12.40 and 3.78, respectively. Increasing age also increased the risk, albeit slightly (hazard ratio [HR], 1.02 per year), and there was an apparent lower risk (HR, 0.60) comparing men and women.
The BADBIR Study Group authors believe that, to the best of their knowledge, this is the first study to compare paradoxical eczema risk by biologic class. “Based on clinical experience and prevalence of eczematous reactions reported in some IL-17 inhibitor clinical trials, we suspected an association between IL-17 inhibitor exposure and paradoxical eczema,” they wrote.
“While the incidence of paradoxical eczema was numerically highest among IL-17 inhibitor exposures, it was not significantly different from the incidence among TNF inhibitor exposures.” The low overall incidence of paradoxical eczema “may be reassuring for patients and clinicians,” they added, “but it is possible that the incidence was underestimated due to underreporting or exclusion of adverse events with insufficient detail.”
Details of the Analysis, Other Findings
To explore the risk of paradoxical eczema by biologic class and identify possible risk factors, the BADBIR Study Group performed a prospective cohort study using data held within the BADBIR database between September 2007 and December 2022.
Adults over the age of 18 year or older with plaque psoriasis and who had been treated with at least one of the following biologics were eligible for inclusion: the TNF inhibitors adalimumab, certolizumab pegol, etanercept, and infliximab; the IL-17 inhibitors bimekizumab, brodalumab, ixekizumab, and secukinumab; the IL-12/23 inhibitor ustekinumab; and the IL-23 inhibitors guselkumab, risankizumab, and tildrakizumab.
Patient records and adverse event data were reviewed to determine the incidence of paradoxical eczema events, using terms such as eczema, eczematized, eczematous, atopy, atopic, and dermatitis.
Of 24,952 drug exposures analyzed, the majority (11,819) were for TNF inhibitors, followed by IL-17 inhibitors (4,776), IL-12/23 inhibitors (6,423), and finally, IL-23 inhibitors (1,934).
Mr. Al-Janabi and coauthors reported that the median time to onset of paradoxical eczema events was 294 days — approximately 9.8 months. The earliest that these events were recorded was at 120 days (4 months), and the latest at 699 days (almost 2 years).
The face and neck were the most common sites affected (26% of exposures), with other sites including the limbs (23%), the trunk (13%), and hands or feet (12%). Itching (18%), redness (7%), and dryness (4%) were the most commonly reported symptoms.
The researchers noted that 21 patients had skin biopsies taken and “all showed spongiosis or a feature of eczema, with 1 having overlapping features of psoriasis.”
In the majority (92 %) of cases, patients experienced only one eczema event. Of the 20 patients who had more than one event, just over one-fifth of repeat events occurred after receiving the same biologic as for the index event. A quarter of events occurred after a different biologic of the same class had been used, and just over half of events occurred after a different class of biologic had been given.
Strengths and Limitations
The “large sample size and inclusion of multiple lines of exposure per participant” are strengths of the study, said the researchers. “We included data for all currently available biologics, originating from more than 160 dermatology centers in the UK and Ireland.”
They added, however, that the “main limitation is the small numbers of observations within certain subgroups, such as specific biologic exposures or participants in ethnic minority groups, restricting generalizability of our findings and the interpretation of some subgroup analyses.”
Moreover, the small number of paradoxical eczema events seen may have resulted in imprecise effect estimates, they observe, noting that the number of exposures to IL-23 inhibitors was low compared with other classes.
“Future studies with more exposures and paradoxical eczema events would enable a more robust analysis of individual drugs and patient subgroups,” the authors concluded.
The study was funded by the Medical Research Council. BADBIR is coordinated by The University of Manchester, and funded by the British Association of Dermatologists (BAD). The BAD receives income from AbbVie, Almirall, Amgen, Celgene, Janssen, LEO Pharma, Lilly, Novartis, Samsung Bioepis, Sandoz Hexal AG, and UCB Pharma for providing pharmacovigilance services. This income finances a separate contract between the BAD and The University of Manchester, which coordinates BADBIR. Mr. Al-Janabi reported receiving grants from the Medical Research Council during the conduct of the study; nonfinancial support from UCB, Almirall, and Janssen; and personal fees from UCB outside the submitted work.
examined in a large observational analysis.
Using data from the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR) database, Ali Al-Janabi, MA, from the University of Manchester (England) and associates found that 273 (1%) of approximately 25,000 drug exposures in 13,699 biologic-treated patients with psoriasis were associated with paradoxical eczema.
The incidence of paradoxical eczema was found to vary by class. The highest rate was seen for IL-17 inhibitors, at 1.22 per 100,000 person-years, and the lowest rate was seen with IL-23 inhibitors, at 0.56 per 100,000 person-years. The respective incidence rates for tumor necrosis factor (TNF) inhibitors and IL-12/IL-23 inhibitors were a respective 0.94 and 0.80 per 100,000 person-years.
“Compared with TNF inhibitors, IL-23 inhibitor exposure was associated with significantly lower risk of paradoxical eczema,” the BADBIR Study Group reported in JAMA Dermatology. Indeed, patients treated with IL-23 inhibitors were 61% less likely than were those taking TNF-inhibitors to experience a paradoxical eczema event.
“These findings remained when restricting the analysis to first-line biologic exposures and were specific to this eczema phenotype” the group said.
Cautious Interpretation
As the corresponding author for the work, Mr. Al-Janabi observed in an email that the research needs to be replicated, and the findings need to be interpreted with caution.
“As well as usual clinical variables influencing biologic selection, clinicians could consider IL-23 inhibitors in patients with previous atopic dermatitis, hay fever, or paradoxical eczema episodes, as this class was associated with the lowest risk of paradoxical eczema,” he suggested.
A prior history of atopic dermatitis (AD) and hay fever appears to be particularly relevant, as both substantially upped the chances that paradoxical eczema would occur, with hazard ratios of 12.40 and 3.78, respectively. Increasing age also increased the risk, albeit slightly (hazard ratio [HR], 1.02 per year), and there was an apparent lower risk (HR, 0.60) comparing men and women.
The BADBIR Study Group authors believe that, to the best of their knowledge, this is the first study to compare paradoxical eczema risk by biologic class. “Based on clinical experience and prevalence of eczematous reactions reported in some IL-17 inhibitor clinical trials, we suspected an association between IL-17 inhibitor exposure and paradoxical eczema,” they wrote.
“While the incidence of paradoxical eczema was numerically highest among IL-17 inhibitor exposures, it was not significantly different from the incidence among TNF inhibitor exposures.” The low overall incidence of paradoxical eczema “may be reassuring for patients and clinicians,” they added, “but it is possible that the incidence was underestimated due to underreporting or exclusion of adverse events with insufficient detail.”
Details of the Analysis, Other Findings
To explore the risk of paradoxical eczema by biologic class and identify possible risk factors, the BADBIR Study Group performed a prospective cohort study using data held within the BADBIR database between September 2007 and December 2022.
Adults over the age of 18 year or older with plaque psoriasis and who had been treated with at least one of the following biologics were eligible for inclusion: the TNF inhibitors adalimumab, certolizumab pegol, etanercept, and infliximab; the IL-17 inhibitors bimekizumab, brodalumab, ixekizumab, and secukinumab; the IL-12/23 inhibitor ustekinumab; and the IL-23 inhibitors guselkumab, risankizumab, and tildrakizumab.
Patient records and adverse event data were reviewed to determine the incidence of paradoxical eczema events, using terms such as eczema, eczematized, eczematous, atopy, atopic, and dermatitis.
Of 24,952 drug exposures analyzed, the majority (11,819) were for TNF inhibitors, followed by IL-17 inhibitors (4,776), IL-12/23 inhibitors (6,423), and finally, IL-23 inhibitors (1,934).
Mr. Al-Janabi and coauthors reported that the median time to onset of paradoxical eczema events was 294 days — approximately 9.8 months. The earliest that these events were recorded was at 120 days (4 months), and the latest at 699 days (almost 2 years).
The face and neck were the most common sites affected (26% of exposures), with other sites including the limbs (23%), the trunk (13%), and hands or feet (12%). Itching (18%), redness (7%), and dryness (4%) were the most commonly reported symptoms.
The researchers noted that 21 patients had skin biopsies taken and “all showed spongiosis or a feature of eczema, with 1 having overlapping features of psoriasis.”
In the majority (92 %) of cases, patients experienced only one eczema event. Of the 20 patients who had more than one event, just over one-fifth of repeat events occurred after receiving the same biologic as for the index event. A quarter of events occurred after a different biologic of the same class had been used, and just over half of events occurred after a different class of biologic had been given.
Strengths and Limitations
The “large sample size and inclusion of multiple lines of exposure per participant” are strengths of the study, said the researchers. “We included data for all currently available biologics, originating from more than 160 dermatology centers in the UK and Ireland.”
They added, however, that the “main limitation is the small numbers of observations within certain subgroups, such as specific biologic exposures or participants in ethnic minority groups, restricting generalizability of our findings and the interpretation of some subgroup analyses.”
Moreover, the small number of paradoxical eczema events seen may have resulted in imprecise effect estimates, they observe, noting that the number of exposures to IL-23 inhibitors was low compared with other classes.
“Future studies with more exposures and paradoxical eczema events would enable a more robust analysis of individual drugs and patient subgroups,” the authors concluded.
The study was funded by the Medical Research Council. BADBIR is coordinated by The University of Manchester, and funded by the British Association of Dermatologists (BAD). The BAD receives income from AbbVie, Almirall, Amgen, Celgene, Janssen, LEO Pharma, Lilly, Novartis, Samsung Bioepis, Sandoz Hexal AG, and UCB Pharma for providing pharmacovigilance services. This income finances a separate contract between the BAD and The University of Manchester, which coordinates BADBIR. Mr. Al-Janabi reported receiving grants from the Medical Research Council during the conduct of the study; nonfinancial support from UCB, Almirall, and Janssen; and personal fees from UCB outside the submitted work.
FROM JAMA DERMATOLOGY
Common radiological alterations and their predictors in PsA
Key clinical point: Joint space narrowing, and bone proliferation were the most frequently observed radiological alterations in patients having psoriatic arthritis (PsA), with male sex, older age, higher disease activity, and initial polyarticular involvement being significant predictors of bone damage.
Major finding: At a mean follow-up period of ~12.9 years, patients presented with a significantly greater burden of joint space narrowing and bone proliferation in the hands (both P = .001) and joint space narrowing in the feet (P = .047). Male sex (P = .030), older age (P < .05), high initial scores of the Disease Activity Index for PsA (P = .032), and symmetrical polyarticular involvement (P = .025) were significant predictors of bone damage.
Study details: This retrospective cohort study included 50 patients with PsA who were assessed for radiological changes in bone structure and were followed up for ~10 years.
Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.
Source: Ozdemir Isik O et al. Radiological progression and predictive factors in psoriatic arthritis: Insights from a decade-long retrospective cohort study. Clin Rheumatol. 2023 (Dec 3). doi: 10.1007/s10067-023-06839-7
Key clinical point: Joint space narrowing, and bone proliferation were the most frequently observed radiological alterations in patients having psoriatic arthritis (PsA), with male sex, older age, higher disease activity, and initial polyarticular involvement being significant predictors of bone damage.
Major finding: At a mean follow-up period of ~12.9 years, patients presented with a significantly greater burden of joint space narrowing and bone proliferation in the hands (both P = .001) and joint space narrowing in the feet (P = .047). Male sex (P = .030), older age (P < .05), high initial scores of the Disease Activity Index for PsA (P = .032), and symmetrical polyarticular involvement (P = .025) were significant predictors of bone damage.
Study details: This retrospective cohort study included 50 patients with PsA who were assessed for radiological changes in bone structure and were followed up for ~10 years.
Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.
Source: Ozdemir Isik O et al. Radiological progression and predictive factors in psoriatic arthritis: Insights from a decade-long retrospective cohort study. Clin Rheumatol. 2023 (Dec 3). doi: 10.1007/s10067-023-06839-7
Key clinical point: Joint space narrowing, and bone proliferation were the most frequently observed radiological alterations in patients having psoriatic arthritis (PsA), with male sex, older age, higher disease activity, and initial polyarticular involvement being significant predictors of bone damage.
Major finding: At a mean follow-up period of ~12.9 years, patients presented with a significantly greater burden of joint space narrowing and bone proliferation in the hands (both P = .001) and joint space narrowing in the feet (P = .047). Male sex (P = .030), older age (P < .05), high initial scores of the Disease Activity Index for PsA (P = .032), and symmetrical polyarticular involvement (P = .025) were significant predictors of bone damage.
Study details: This retrospective cohort study included 50 patients with PsA who were assessed for radiological changes in bone structure and were followed up for ~10 years.
Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.
Source: Ozdemir Isik O et al. Radiological progression and predictive factors in psoriatic arthritis: Insights from a decade-long retrospective cohort study. Clin Rheumatol. 2023 (Dec 3). doi: 10.1007/s10067-023-06839-7
Central sensitization associated with increased disease burden in PsA
Key clinical point: Patients with psoriatic arthritis (PsA) who did not have fibromyalgia but presented with prolonged and persistent pain due to central sensitization (CS) reported a greater impact of disease, higher disease activity, and worsened physical and mental function.
Major finding: CS Inventory scores were positively associated with disease activity (Disease Activity in Psoriatic Arthritis: correlation coefficient [ρ] 0.587; P < .0001) and the impact of disease (PsA Impact of Disease 12 items: ρ 0.670; P < .0001) but were negatively associated with the quality of life (Short Form Survey 36 items [SF-36]-physical component summary: ρ −0.405; and SF-36-mental component summary: ρ −0.483; both P < .0001).
Study details: Findings are from a cross-sectional analysis including 157 patients who had PsA without coexisting fibromyalgia, 45.2% of whom had CS Inventory scores ≥40.
Disclosures: This study did not disclose any funding source. The authors declared no conflicts of interest.
Source: Salaffi F et al. Central sensitization in psoriatic arthritis: Relationship with composite measures of disease activity, functional disability and health-related quality of life. J Rheumatol. 2023 (Nov 15). doi: 10.3899/jrheum.2023-0177
Key clinical point: Patients with psoriatic arthritis (PsA) who did not have fibromyalgia but presented with prolonged and persistent pain due to central sensitization (CS) reported a greater impact of disease, higher disease activity, and worsened physical and mental function.
Major finding: CS Inventory scores were positively associated with disease activity (Disease Activity in Psoriatic Arthritis: correlation coefficient [ρ] 0.587; P < .0001) and the impact of disease (PsA Impact of Disease 12 items: ρ 0.670; P < .0001) but were negatively associated with the quality of life (Short Form Survey 36 items [SF-36]-physical component summary: ρ −0.405; and SF-36-mental component summary: ρ −0.483; both P < .0001).
Study details: Findings are from a cross-sectional analysis including 157 patients who had PsA without coexisting fibromyalgia, 45.2% of whom had CS Inventory scores ≥40.
Disclosures: This study did not disclose any funding source. The authors declared no conflicts of interest.
Source: Salaffi F et al. Central sensitization in psoriatic arthritis: Relationship with composite measures of disease activity, functional disability and health-related quality of life. J Rheumatol. 2023 (Nov 15). doi: 10.3899/jrheum.2023-0177
Key clinical point: Patients with psoriatic arthritis (PsA) who did not have fibromyalgia but presented with prolonged and persistent pain due to central sensitization (CS) reported a greater impact of disease, higher disease activity, and worsened physical and mental function.
Major finding: CS Inventory scores were positively associated with disease activity (Disease Activity in Psoriatic Arthritis: correlation coefficient [ρ] 0.587; P < .0001) and the impact of disease (PsA Impact of Disease 12 items: ρ 0.670; P < .0001) but were negatively associated with the quality of life (Short Form Survey 36 items [SF-36]-physical component summary: ρ −0.405; and SF-36-mental component summary: ρ −0.483; both P < .0001).
Study details: Findings are from a cross-sectional analysis including 157 patients who had PsA without coexisting fibromyalgia, 45.2% of whom had CS Inventory scores ≥40.
Disclosures: This study did not disclose any funding source. The authors declared no conflicts of interest.
Source: Salaffi F et al. Central sensitization in psoriatic arthritis: Relationship with composite measures of disease activity, functional disability and health-related quality of life. J Rheumatol. 2023 (Nov 15). doi: 10.3899/jrheum.2023-0177
Anti-TNF therapy may not be enough against non-inflammatory pain in bio-naive PsA patients
Key clinical point: The burden of inflammation-independent persistent refractory pain was substantially high in bio-naive patients with psoriatic arthritis (PsA) who received anti-tumor necrosis factor (TNF) therapy.
Major finding: At 12 months of anti-TNF therapy, 39% of patients reported unacceptable pain, the majority (63%) of which was non-inflammatory refractory pain. Higher pain intensity, higher disease activity, and worse health-related quality of life were associated with a higher risk for refractory pain at 12 months (all P < .05) whereas more swollen joints were associated with a lower risk for the same (P = .03).
Study details: This study included 351 bio-naive patients with PsA from the South Swedish Arthritis Treatment Group register who initiated anti-TNF therapy.
Disclosures: This study was funded by grants from Greta och Johan Kocks stiftelser, ALF Region Skåne, and others. Two authors declared receiving research support from or performing consultation tasks for various sources. The other authors declared no conflicts of interest.
Source: Roseman C et al. Persistent pain and its predictors after starting anti-tumour necrosis factor therapy in psoriatic arthritis: What is the role of inflammation control? Scand J Rheumatol. 2023 (Nov 30). doi: 10.1080/03009742.2023.2258644
Key clinical point: The burden of inflammation-independent persistent refractory pain was substantially high in bio-naive patients with psoriatic arthritis (PsA) who received anti-tumor necrosis factor (TNF) therapy.
Major finding: At 12 months of anti-TNF therapy, 39% of patients reported unacceptable pain, the majority (63%) of which was non-inflammatory refractory pain. Higher pain intensity, higher disease activity, and worse health-related quality of life were associated with a higher risk for refractory pain at 12 months (all P < .05) whereas more swollen joints were associated with a lower risk for the same (P = .03).
Study details: This study included 351 bio-naive patients with PsA from the South Swedish Arthritis Treatment Group register who initiated anti-TNF therapy.
Disclosures: This study was funded by grants from Greta och Johan Kocks stiftelser, ALF Region Skåne, and others. Two authors declared receiving research support from or performing consultation tasks for various sources. The other authors declared no conflicts of interest.
Source: Roseman C et al. Persistent pain and its predictors after starting anti-tumour necrosis factor therapy in psoriatic arthritis: What is the role of inflammation control? Scand J Rheumatol. 2023 (Nov 30). doi: 10.1080/03009742.2023.2258644
Key clinical point: The burden of inflammation-independent persistent refractory pain was substantially high in bio-naive patients with psoriatic arthritis (PsA) who received anti-tumor necrosis factor (TNF) therapy.
Major finding: At 12 months of anti-TNF therapy, 39% of patients reported unacceptable pain, the majority (63%) of which was non-inflammatory refractory pain. Higher pain intensity, higher disease activity, and worse health-related quality of life were associated with a higher risk for refractory pain at 12 months (all P < .05) whereas more swollen joints were associated with a lower risk for the same (P = .03).
Study details: This study included 351 bio-naive patients with PsA from the South Swedish Arthritis Treatment Group register who initiated anti-TNF therapy.
Disclosures: This study was funded by grants from Greta och Johan Kocks stiftelser, ALF Region Skåne, and others. Two authors declared receiving research support from or performing consultation tasks for various sources. The other authors declared no conflicts of interest.
Source: Roseman C et al. Persistent pain and its predictors after starting anti-tumour necrosis factor therapy in psoriatic arthritis: What is the role of inflammation control? Scand J Rheumatol. 2023 (Nov 30). doi: 10.1080/03009742.2023.2258644
Worsened psychosocial factors in PsA patients with non-inflammatory persistent joint pain
Key clinical point: Patients with psoriatic arthritis (PsA) who had no evidence of active swelling or inflammation but reported persistent joint pain presented with higher levels of fatigue, depression, and anxiety along with increased sleep disturbances than those in remission.
Major finding: Higher levels of fatigue, depression, and anxiety, as well as increased sleep disturbances were observed in patients with PsA who had persistent joint pain vs those who achieved remission (all P ≤ .01). Patients with persistent pain vs those in remission also had lower global mental health scores, which indicated worsened mental health (45.2 vs 49.9, P = 0.02).
Study details: This study included 95 patients having PsA without swollen joints, of whom 25 patients had persistent joint pain.
Disclosures: This study was funded by the US National Institutes of Health and other sources. Three authors declared serving as consultants for or receiving clinical research support or funding from various sources. The other authors declared no conflicts of interest.
Source: Haberman RH et al. Psychosocial factors significantly contribute to joint pain persistence in psoriatic arthritis. J Rheumatol. 2023 (Dec 1). doi: 10.3899/jrheum.2023-0909
Key clinical point: Patients with psoriatic arthritis (PsA) who had no evidence of active swelling or inflammation but reported persistent joint pain presented with higher levels of fatigue, depression, and anxiety along with increased sleep disturbances than those in remission.
Major finding: Higher levels of fatigue, depression, and anxiety, as well as increased sleep disturbances were observed in patients with PsA who had persistent joint pain vs those who achieved remission (all P ≤ .01). Patients with persistent pain vs those in remission also had lower global mental health scores, which indicated worsened mental health (45.2 vs 49.9, P = 0.02).
Study details: This study included 95 patients having PsA without swollen joints, of whom 25 patients had persistent joint pain.
Disclosures: This study was funded by the US National Institutes of Health and other sources. Three authors declared serving as consultants for or receiving clinical research support or funding from various sources. The other authors declared no conflicts of interest.
Source: Haberman RH et al. Psychosocial factors significantly contribute to joint pain persistence in psoriatic arthritis. J Rheumatol. 2023 (Dec 1). doi: 10.3899/jrheum.2023-0909
Key clinical point: Patients with psoriatic arthritis (PsA) who had no evidence of active swelling or inflammation but reported persistent joint pain presented with higher levels of fatigue, depression, and anxiety along with increased sleep disturbances than those in remission.
Major finding: Higher levels of fatigue, depression, and anxiety, as well as increased sleep disturbances were observed in patients with PsA who had persistent joint pain vs those who achieved remission (all P ≤ .01). Patients with persistent pain vs those in remission also had lower global mental health scores, which indicated worsened mental health (45.2 vs 49.9, P = 0.02).
Study details: This study included 95 patients having PsA without swollen joints, of whom 25 patients had persistent joint pain.
Disclosures: This study was funded by the US National Institutes of Health and other sources. Three authors declared serving as consultants for or receiving clinical research support or funding from various sources. The other authors declared no conflicts of interest.
Source: Haberman RH et al. Psychosocial factors significantly contribute to joint pain persistence in psoriatic arthritis. J Rheumatol. 2023 (Dec 1). doi: 10.3899/jrheum.2023-0909
First-line TNFi seem to be less effective for PsA in women than in men
Key clinical point: Female patients with psoriatic arthritis (PsA) who initiated treatment with first-line tumor necrosis factor inhibitors (TNFi) experienced less reduction in disease activity scores and showed higher discontinuation rates than male patients.
Major finding: At 6 months, women were 17% less likely than men to achieve low disease activity according to Disease Activity Score-28 C-reactive protein measurements (adjusted relative risk 0.83; 95% CI 0.81-0.85), and the risk for TNFi treatment discontinuation at 2 years was nearly 60% higher in women vs in men (adjusted hazard ratio 1.57; 95% CI 1.49-1.66).
Study details: Findings are from a retrospective study including 18,599 patients with PsA who received their first TNFi, of whom 7679 and 17,842 women were analyzed for treatment response and retention rates, respectively.
Disclosures: This study did not disclose any funding source. Several authors declared receiving honoraria, unrestricted grants, speaker’s fees, or consultancy fees from or having other ties with various sources.
Source: Hellamand P et al. Sex differences in the effectiveness of first-line tumor necrosis factor inhibitors in psoriatic arthritis; results from the EuroSpA Research Collaboration Network. Arthritis Rheumatol. 2023 (Nov 16). doi: 10.1002/art.42758
Key clinical point: Female patients with psoriatic arthritis (PsA) who initiated treatment with first-line tumor necrosis factor inhibitors (TNFi) experienced less reduction in disease activity scores and showed higher discontinuation rates than male patients.
Major finding: At 6 months, women were 17% less likely than men to achieve low disease activity according to Disease Activity Score-28 C-reactive protein measurements (adjusted relative risk 0.83; 95% CI 0.81-0.85), and the risk for TNFi treatment discontinuation at 2 years was nearly 60% higher in women vs in men (adjusted hazard ratio 1.57; 95% CI 1.49-1.66).
Study details: Findings are from a retrospective study including 18,599 patients with PsA who received their first TNFi, of whom 7679 and 17,842 women were analyzed for treatment response and retention rates, respectively.
Disclosures: This study did not disclose any funding source. Several authors declared receiving honoraria, unrestricted grants, speaker’s fees, or consultancy fees from or having other ties with various sources.
Source: Hellamand P et al. Sex differences in the effectiveness of first-line tumor necrosis factor inhibitors in psoriatic arthritis; results from the EuroSpA Research Collaboration Network. Arthritis Rheumatol. 2023 (Nov 16). doi: 10.1002/art.42758
Key clinical point: Female patients with psoriatic arthritis (PsA) who initiated treatment with first-line tumor necrosis factor inhibitors (TNFi) experienced less reduction in disease activity scores and showed higher discontinuation rates than male patients.
Major finding: At 6 months, women were 17% less likely than men to achieve low disease activity according to Disease Activity Score-28 C-reactive protein measurements (adjusted relative risk 0.83; 95% CI 0.81-0.85), and the risk for TNFi treatment discontinuation at 2 years was nearly 60% higher in women vs in men (adjusted hazard ratio 1.57; 95% CI 1.49-1.66).
Study details: Findings are from a retrospective study including 18,599 patients with PsA who received their first TNFi, of whom 7679 and 17,842 women were analyzed for treatment response and retention rates, respectively.
Disclosures: This study did not disclose any funding source. Several authors declared receiving honoraria, unrestricted grants, speaker’s fees, or consultancy fees from or having other ties with various sources.
Source: Hellamand P et al. Sex differences in the effectiveness of first-line tumor necrosis factor inhibitors in psoriatic arthritis; results from the EuroSpA Research Collaboration Network. Arthritis Rheumatol. 2023 (Nov 16). doi: 10.1002/art.42758
TNFi may improve ultrasound-confirmed active enthesitis more effectively than secukinumab
Key clinical point: In patients with psoriatic arthritis (PsA), a 16-week treatment with either a tumor necrosis factor inhibitor (TNFi) or secukinumab improved both active and chronic ultrasound-confirmed enthesitis to a similar extent; however, a TNFi was more effective in reducing active entheseal lesions.
Major finding: The mean reduction in MAdrid Sonographic Enthesitis Index (MASEI) score that assesses both active and chronic entheseal disease was not significantly different with TNFi vs secukinumab treatment (3.42 vs 1.74; P = .097). However, TNFi was significantly more effective than secukinumab when only active entheseal lesions were considered (MASEIActive score 4.37 vs 2.26; P = .030).
Study details: Findings are from an open-label observational study including 80 patients with PsA who received either secukinumab (n = 24) or TNFi (n = 56), of whom 75 patients completed the treatment.
Disclosures: This study was supported by the UK Psoriasis and Psoriatic Arthritis Alliance and other sources. The authors reported receiving honoraria from Novartis.
Source: Elliott A et al. Effects of TNF-α inhibition versus secukinumab on active ultrasound-confirmed enthesitis in psoriatic arthritis. Ther Adv Musculoskelet Dis. 2023; 15:1759720X231179524. (Nov 16). doi: 10.1177/1759720X231179524
Key clinical point: In patients with psoriatic arthritis (PsA), a 16-week treatment with either a tumor necrosis factor inhibitor (TNFi) or secukinumab improved both active and chronic ultrasound-confirmed enthesitis to a similar extent; however, a TNFi was more effective in reducing active entheseal lesions.
Major finding: The mean reduction in MAdrid Sonographic Enthesitis Index (MASEI) score that assesses both active and chronic entheseal disease was not significantly different with TNFi vs secukinumab treatment (3.42 vs 1.74; P = .097). However, TNFi was significantly more effective than secukinumab when only active entheseal lesions were considered (MASEIActive score 4.37 vs 2.26; P = .030).
Study details: Findings are from an open-label observational study including 80 patients with PsA who received either secukinumab (n = 24) or TNFi (n = 56), of whom 75 patients completed the treatment.
Disclosures: This study was supported by the UK Psoriasis and Psoriatic Arthritis Alliance and other sources. The authors reported receiving honoraria from Novartis.
Source: Elliott A et al. Effects of TNF-α inhibition versus secukinumab on active ultrasound-confirmed enthesitis in psoriatic arthritis. Ther Adv Musculoskelet Dis. 2023; 15:1759720X231179524. (Nov 16). doi: 10.1177/1759720X231179524
Key clinical point: In patients with psoriatic arthritis (PsA), a 16-week treatment with either a tumor necrosis factor inhibitor (TNFi) or secukinumab improved both active and chronic ultrasound-confirmed enthesitis to a similar extent; however, a TNFi was more effective in reducing active entheseal lesions.
Major finding: The mean reduction in MAdrid Sonographic Enthesitis Index (MASEI) score that assesses both active and chronic entheseal disease was not significantly different with TNFi vs secukinumab treatment (3.42 vs 1.74; P = .097). However, TNFi was significantly more effective than secukinumab when only active entheseal lesions were considered (MASEIActive score 4.37 vs 2.26; P = .030).
Study details: Findings are from an open-label observational study including 80 patients with PsA who received either secukinumab (n = 24) or TNFi (n = 56), of whom 75 patients completed the treatment.
Disclosures: This study was supported by the UK Psoriasis and Psoriatic Arthritis Alliance and other sources. The authors reported receiving honoraria from Novartis.
Source: Elliott A et al. Effects of TNF-α inhibition versus secukinumab on active ultrasound-confirmed enthesitis in psoriatic arthritis. Ther Adv Musculoskelet Dis. 2023; 15:1759720X231179524. (Nov 16). doi: 10.1177/1759720X231179524
Non-trough serum drug levels can identify TNFi treatment responders in PsA
Key clinical point: Patients with psoriatic arthritis (PsA) who responded to tumor necrosis factor inhibitors (TNFi), such as adalimumab and etanercept, had higher serum drug levels (SDL), with non-trough SDL being able to differentiate responders from non-responders with substantial efficacy.
Major finding: At 3 months, patients with higher etanercept SDL (odds ratio [OR] 1.24; P = .018) or higher adalimumab SDL (OR 1.08; P = .047) were significantly more likely to be responders according to the European Alliance of Associations for Rheumatology criteria. A non-trough etanercept SDL of 2.0 µg/mL and adalimumab SDL of 3.6 µg/mL could differentiate between responders and non-responders with ~50% specificity and >60% sensitivity.
Study details: This study included patients with PsA who initiated treatment with adalimumab (n = 104) or etanercept (n = 97).
Disclosures: This study was supported by the UK National Institute for Health and Care Research Manchester Biomedical Research Centre and Versus Arthritis. Two authors declared receiving grant support, consulting fees, or travel fees from various sources, including the sponsors.
Source: Curry PDK et al. Non-trough serum drug levels of adalimumab and etanercept are associated with response in patients with psoriatic arthritis. Rheumatology (Oxford). 2023 (Dec 09) doi: 10.1093/rheumatology/kead666
Key clinical point: Patients with psoriatic arthritis (PsA) who responded to tumor necrosis factor inhibitors (TNFi), such as adalimumab and etanercept, had higher serum drug levels (SDL), with non-trough SDL being able to differentiate responders from non-responders with substantial efficacy.
Major finding: At 3 months, patients with higher etanercept SDL (odds ratio [OR] 1.24; P = .018) or higher adalimumab SDL (OR 1.08; P = .047) were significantly more likely to be responders according to the European Alliance of Associations for Rheumatology criteria. A non-trough etanercept SDL of 2.0 µg/mL and adalimumab SDL of 3.6 µg/mL could differentiate between responders and non-responders with ~50% specificity and >60% sensitivity.
Study details: This study included patients with PsA who initiated treatment with adalimumab (n = 104) or etanercept (n = 97).
Disclosures: This study was supported by the UK National Institute for Health and Care Research Manchester Biomedical Research Centre and Versus Arthritis. Two authors declared receiving grant support, consulting fees, or travel fees from various sources, including the sponsors.
Source: Curry PDK et al. Non-trough serum drug levels of adalimumab and etanercept are associated with response in patients with psoriatic arthritis. Rheumatology (Oxford). 2023 (Dec 09) doi: 10.1093/rheumatology/kead666
Key clinical point: Patients with psoriatic arthritis (PsA) who responded to tumor necrosis factor inhibitors (TNFi), such as adalimumab and etanercept, had higher serum drug levels (SDL), with non-trough SDL being able to differentiate responders from non-responders with substantial efficacy.
Major finding: At 3 months, patients with higher etanercept SDL (odds ratio [OR] 1.24; P = .018) or higher adalimumab SDL (OR 1.08; P = .047) were significantly more likely to be responders according to the European Alliance of Associations for Rheumatology criteria. A non-trough etanercept SDL of 2.0 µg/mL and adalimumab SDL of 3.6 µg/mL could differentiate between responders and non-responders with ~50% specificity and >60% sensitivity.
Study details: This study included patients with PsA who initiated treatment with adalimumab (n = 104) or etanercept (n = 97).
Disclosures: This study was supported by the UK National Institute for Health and Care Research Manchester Biomedical Research Centre and Versus Arthritis. Two authors declared receiving grant support, consulting fees, or travel fees from various sources, including the sponsors.
Source: Curry PDK et al. Non-trough serum drug levels of adalimumab and etanercept are associated with response in patients with psoriatic arthritis. Rheumatology (Oxford). 2023 (Dec 09) doi: 10.1093/rheumatology/kead666
Hyperuricemia associated with more comorbidities in PsA
Key clinical point: Patients with psoriatic arthritis (PsA) who had hyperuricemia (baseline serum uric acid level ≥ 360 µmol/L) presented with worsened clinical characteristics than those with normouricemia; however, secukinumab was equally effective in patients with and without hyperuricemia.
Major finding: Patients with hyperuricemia vs normouricemia presented with higher mean body mass index values (30.90 kg/m2 vs 28.33 kg/m2), more frequent hypertension (43.8% vs 31.3%), diabetes mellitus (10.3% vs 8.6%), and dactylitis (34.5% vs 25.9%). More than 40% of patients achieved ≥ 50% improvement in the American College of Rheumatology scores with secukinumab, irrespective of the presence of hyperuricemia.
Study details: This post hoc analysis of the pooled data from five phase 3 clinical trials included 2504 patients with active PsA who received secukinumab, 32.8% of whom had hyperuricemia.
Disclosures: This study was funded by Novartis Pharma AG, Basel, Switzerland. Four authors declared being employees, shareholders, or advisory board members of or receiving consulting fees from Novartis.
Source: Felten R et al. Impact of hyperuricaemia on patients with psoriatic arthritis treated with secukinumab in the FUTURE 2-5 and MAXIMISE studies. RMD Open. 2023;9(4):e003428. (Nov 9) doi: 10.1136/rmdopen-2023-003428
Key clinical point: Patients with psoriatic arthritis (PsA) who had hyperuricemia (baseline serum uric acid level ≥ 360 µmol/L) presented with worsened clinical characteristics than those with normouricemia; however, secukinumab was equally effective in patients with and without hyperuricemia.
Major finding: Patients with hyperuricemia vs normouricemia presented with higher mean body mass index values (30.90 kg/m2 vs 28.33 kg/m2), more frequent hypertension (43.8% vs 31.3%), diabetes mellitus (10.3% vs 8.6%), and dactylitis (34.5% vs 25.9%). More than 40% of patients achieved ≥ 50% improvement in the American College of Rheumatology scores with secukinumab, irrespective of the presence of hyperuricemia.
Study details: This post hoc analysis of the pooled data from five phase 3 clinical trials included 2504 patients with active PsA who received secukinumab, 32.8% of whom had hyperuricemia.
Disclosures: This study was funded by Novartis Pharma AG, Basel, Switzerland. Four authors declared being employees, shareholders, or advisory board members of or receiving consulting fees from Novartis.
Source: Felten R et al. Impact of hyperuricaemia on patients with psoriatic arthritis treated with secukinumab in the FUTURE 2-5 and MAXIMISE studies. RMD Open. 2023;9(4):e003428. (Nov 9) doi: 10.1136/rmdopen-2023-003428
Key clinical point: Patients with psoriatic arthritis (PsA) who had hyperuricemia (baseline serum uric acid level ≥ 360 µmol/L) presented with worsened clinical characteristics than those with normouricemia; however, secukinumab was equally effective in patients with and without hyperuricemia.
Major finding: Patients with hyperuricemia vs normouricemia presented with higher mean body mass index values (30.90 kg/m2 vs 28.33 kg/m2), more frequent hypertension (43.8% vs 31.3%), diabetes mellitus (10.3% vs 8.6%), and dactylitis (34.5% vs 25.9%). More than 40% of patients achieved ≥ 50% improvement in the American College of Rheumatology scores with secukinumab, irrespective of the presence of hyperuricemia.
Study details: This post hoc analysis of the pooled data from five phase 3 clinical trials included 2504 patients with active PsA who received secukinumab, 32.8% of whom had hyperuricemia.
Disclosures: This study was funded by Novartis Pharma AG, Basel, Switzerland. Four authors declared being employees, shareholders, or advisory board members of or receiving consulting fees from Novartis.
Source: Felten R et al. Impact of hyperuricaemia on patients with psoriatic arthritis treated with secukinumab in the FUTURE 2-5 and MAXIMISE studies. RMD Open. 2023;9(4):e003428. (Nov 9) doi: 10.1136/rmdopen-2023-003428
Real-world study demonstrates long-term efficacy of secukinumab in PsA
Key clinical point: In a real-world setting, secukinumab demonstrated substantial efficacy in improving disease activity scores, enthesitis, and dactylitis in patients with psoriatic arthritis (PsA).
Major finding: The proportion of patients who achieved low disease activity according to the Disease Activity Score-28 C-reactive protein measurements increased significantly from 25% at baseline to 66% after 6 months (P < .001), with the improvements maintained for up to 24 months (75%). After 6 months of secukinumab treatment, complete resolution of enthesitis and dactylitis was reported by the majority of patients (82% and 67%, respectively) along with an improvement in pain scores.
Study details: Findings are from an observational retrospective study including 178 patients with PsA who received secukinumab in the first-, second-, or third- or higher line setting.
Disclosures: This study was sponsored by Novartis Farmacéutica, S.A. Two authors declared financial and non-financial ties with various sources including Novartis. Other authors declared no conflicts of interest.
Source: Alegre-Sancho JJ et al. Real-world effectiveness and persistence of secukinumab in the treatment of patients with psoriatic arthritis. Front Med (Lausanne). 2023;10:1294247 (Nov 20). doi: 10.3389/fmed.2023.1294247
Key clinical point: In a real-world setting, secukinumab demonstrated substantial efficacy in improving disease activity scores, enthesitis, and dactylitis in patients with psoriatic arthritis (PsA).
Major finding: The proportion of patients who achieved low disease activity according to the Disease Activity Score-28 C-reactive protein measurements increased significantly from 25% at baseline to 66% after 6 months (P < .001), with the improvements maintained for up to 24 months (75%). After 6 months of secukinumab treatment, complete resolution of enthesitis and dactylitis was reported by the majority of patients (82% and 67%, respectively) along with an improvement in pain scores.
Study details: Findings are from an observational retrospective study including 178 patients with PsA who received secukinumab in the first-, second-, or third- or higher line setting.
Disclosures: This study was sponsored by Novartis Farmacéutica, S.A. Two authors declared financial and non-financial ties with various sources including Novartis. Other authors declared no conflicts of interest.
Source: Alegre-Sancho JJ et al. Real-world effectiveness and persistence of secukinumab in the treatment of patients with psoriatic arthritis. Front Med (Lausanne). 2023;10:1294247 (Nov 20). doi: 10.3389/fmed.2023.1294247
Key clinical point: In a real-world setting, secukinumab demonstrated substantial efficacy in improving disease activity scores, enthesitis, and dactylitis in patients with psoriatic arthritis (PsA).
Major finding: The proportion of patients who achieved low disease activity according to the Disease Activity Score-28 C-reactive protein measurements increased significantly from 25% at baseline to 66% after 6 months (P < .001), with the improvements maintained for up to 24 months (75%). After 6 months of secukinumab treatment, complete resolution of enthesitis and dactylitis was reported by the majority of patients (82% and 67%, respectively) along with an improvement in pain scores.
Study details: Findings are from an observational retrospective study including 178 patients with PsA who received secukinumab in the first-, second-, or third- or higher line setting.
Disclosures: This study was sponsored by Novartis Farmacéutica, S.A. Two authors declared financial and non-financial ties with various sources including Novartis. Other authors declared no conflicts of interest.
Source: Alegre-Sancho JJ et al. Real-world effectiveness and persistence of secukinumab in the treatment of patients with psoriatic arthritis. Front Med (Lausanne). 2023;10:1294247 (Nov 20). doi: 10.3389/fmed.2023.1294247