Ustekinumab and other options in psoriatic arthritis

F. van den Bosch discussed „how to treat psoriatic arthritis?” Upon failure of methotrexate as a “therapeutic option, approved anti-TNF agents, such as etanercept, adalimumab, infliximab and golimumab, have been shown to improve dramatically the outcomes for patients, often tackling both the rheumatological and the dermatological aspects of the disease.” He didn'd mention leflunomide and cyclosporin A, though. But new agents have been studied or are in development for psoriatic arthritis: abatacept, ustekinumab, and secukinumab as well as small oral molecules (protein kinase inhibitors) such as apremilast or tofacitinib.


D. Wallis and colleagues presented an observational stuy on biologics in psoriatic arthritis. They looked at treatment response, drug survival, and outcome after switching. As switching means switching in the class of TNF inhibitors, the study also shows that we are in desperate need for other modes of action in psoriatic arthritis. Persistance with the first TNF inhibitor has been 70% at 36 months with 87% at 12 months. But persistence with the second biologic agent has only been 53% at 12 months. So it is worth while to switch, but we end up with a resonable number of patients we have to look for new therapeutic options. If the reason for switching has been an adverse event, the chances are higher that the second TNF inhibitor persists.


[AB0928] PSORIATIC ARTHRITIS AND BIOLOGIC THERAPY: TREATMENT RESPONSE, DRUG SURVIVAL AND OUTCOME AFTER SWITCHING – AN OBSERVATIONAL STUDY
D. Wallis1, D. Jadon1, W. Tillett1, N. Waldron1, C. Cavill2, N. McHugh1, E. Korendowych1. 1Royal National Hospital for Rheumatic Diseases; 2Bath Institute for Rheumatic Diseases, Bath, United Kingdom
Conclusions: Persistence with the first biologic agent in this cohort was 87% at 12 months, 74% at 24 months and 70% at 36 months. The response to the first biologic agent was sustained at 24 months across joint, skin, nail and quality of life measures. Persistence with the second biologic agent was 53% at 12 months. Patients who switched to a second biologic agent because of adverse event were more likely to continue with the second agent than those who switched because of secondary inefficacy.


Out of the new drugs let's have a closer look at ustekinumab. There has been a discussion on adverse events, but the study didn't find a significant difference between ustekinumab and placebo. I.B. McInnes and colleagues presented a study of ustekinumab in patients with active psoriatic arthritis. It has been a phase 3, multicenter, double-blind, placebo-controlled study. The results showed an ACR20 response of 49.5% for ustekinumab (22.8 for placebo) and a DAS28-CRP response of 67.6% with 34.5% for placebo. PASI75 response has been 62.4% with 11.0% for placebo. Safety profiles have been similar in all groups.


[OP0158] USTEKINUMAB IN PATIENTS WITH ACTIVE PSORIATIC ARTHRITIS: RESULTS OF THE PHASE 3, MULTICENTER, DOUBLE-BLIND, PLACEBO-CONTROLLED PSUMMIT I STUDY
I.B. McInnes1, A. Kavanaugh2, A.B. Gottlieb3, L. Puig4, P. Rahman5, C. Ritchlin6, S. Li7, Y. Wang7, A.M. Mendelsohn7, M.K. Doyle7,8, on behalf of the PSUMMIT I Study Group. 1U Glasgow, Scotland, United Kingdom; 2U California, San Diego, CA; 3Tufts Med Cntr, Boston, MA, United States; 4Universitat Autònoma de Barcelona, Barcelona, Spain; 5Memorial U, NL, Canada; 6U Rochester, Rochester, NY; 7Janssen R&D, Spring House, PA; 8U Penn, Philadelphia, PA, United States
Conclusions: In pts w/ active PsA,UST sig reduced the signs and symptoms of arthritis, improved physical function, enthesitis and dactylitis and improved plaque psoriasis vs PBO-treated pts at wk24. Safety profiles were similar between UST-and PBO-treated pts.


All in all ustekinumab will be a real option, but still there will be lots of patients waiting for other therapeutic options. None the less, I'll be looking forward for approval of the drug. And I'll be looking for developments concerning abatacept, secukinumab, apremilast, and tofacitinib.