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Psoriatic Arthritis: Which biologic agent is the best first choice?
A growing arsenal of therapeutic targets in psoriatic arthritis (PsA) has enhanced the landscape of treatment in patients with this disease.
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In a 5-year EHR-based cohort, PsO patients initiating IL-17i had significantly lower incidence of PsA/IA vs IL-23i, IL-12/23i, or TNFi. IL-17i reduced time with PsA/IA by 45% vs IL-23i, 61% vs IL-12/23i, and 74% vs TNFi. Further research need investigate if IL-17i may delay https://t.co/0PTbXZpLbu
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
#ACR25 Clinical Review by Prof Coates @DrLauraCoates to be applied tomorrow!
Early Diagnosis/Tx
Abstr#2689 EHR study = IL-17i could prevent #PsA vs IL-23/TNFi
Abstr#576 Oligo → Polyarthritis progression in women, no DMARD, enthesitis, dactylitis, nail psoriasis @RheumNow https://t.co/e1hCERpCNW
Links:
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Do biologics prevent PsA?
Retro cohort analysis EHR through natural language processing
5 years trends
PsO treated w/ IL-17i had lower incidence of PsA/IA than pts treated w/ IL-23i, IL-12/23i, or TNFi therapies
Adjustment on several confounding
Prospective data heavily https://t.co/W9MFaWNbWC
Aurelie Najm AurelieRheumo ( View Tweet)
Secukinumab vs Ustekinumab in PsA https://t.co/EylYHtRWsj
@synovialjoints Elaborate more on head to head trial in PsA , in a population who failed TNF biologic.
@RheumNow
#ACR25
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
52wks data of IZOKIPEB affibody IL17Ai RCT 2b/3 PsA
Primary ACR 50 16wks
Crossover 52 wks IZO 160 Q2W, IZO 160 QW, PBO-> IZO 160 QW
ACR50 50% 57% 51%
ACR70 36% 42% 42%
PASI100 55% 64% 58%
MDA 47% 52% 47%
No specific enthesitis data presented
No new safety signal
Next https://t.co/J18rSTmyze
Aurelie Najm AurelieRheumo ( View Tweet)
#IL2 #Rx in active #SLE?
Maybe 🤔
IL2 is tricky - low dose May help #SLE but too much of a good thing may have a neg impact.
RCT of IL2i in #SLE gave a good dose response and improved TRegs.
#ACRBest #ACR25 @RheumNow @ACRheum #LB01 https://t.co/F61qz5x5We
Links:
Janet Pope Janetbirdope ( View Tweet)
ROC-SpA study assessed whether changing to an IL-17Ai was superior to rotating to a 2nd TNFi in axSpA pts who failed on a 1st TNFi
At wk 24, no significant diff in ASAS40 rates bet the 2 groups
IL-17Ai not superior to a 2nd TNFi
Rotate or change?
#ACR25 @Rheumnow AbsLB09 https://t.co/4EtNEFTSN9
sheila RHEUMarampa ( View Tweet)
Gladman et al. PsA patients treated with guselkumab in DISCOVER-2. Male patients had more radiographic progression. Males exhibit stronger relationship between early joint response and lower subsequent rates radiographic progression. @RheumNow #ACR25 Abstr#2345 https://t.co/TSNwesvPzj
Richard Conway RichardPAConway ( View Tweet)
Late breaking: secukinumab out-performs ustekinumab in PsA pt who have failed TNF therapy
RCT of 119 pt
57.1% response at wk 28 in SEC
27% response at wk 28 in UST
Numerically lower adverse events leading to d/c in SEC
@RheumNow #ACR25 #ACRBest Abst LB06 https://t.co/wDxtscP2ku
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
To be continued (or discontinued?): Abstract 2360: Compared to TNFi, IL-17i & JAKi users had 🔹 Higher odds of med switching <180 days 🔹 Shorter time to discontinuation @RheumNow #ACR25 #axSpA https://t.co/IOHaFSJqHn
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
Meta-analysis of 3 RCTs (n=1990) shows IL-17i offers comparable joint response but superior skin clearance vs adalimumab in biologic-naive PsA. IL-17i also had fewer discontinuations due to adverse events. Supports sequencing of biologics through different mechanisms of action in https://t.co/SJgFUMxWVb
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Heydari-Kamjani et al. TriNetX study. 28973 PsA patients. IL-17i and IL-23i lower rates stroke, MI, DVT/PE than TNFi. IL-12/23i higher rate of stroke vs TNFi. @RheumNow #ACR25 Abstr#2363 https://t.co/fNHaxyYPCP
Richard Conway RichardPAConway ( View Tweet)
Rotation or Change in Biologic post TNFi failure in axSpA. Switching biologic class after TNFi failure improved outcomes in axial SpA. In a randomized trial of axSpA patients with inadequate response to a first TNFi, switching to an IL-17Ai was not superior to cycling to a second https://t.co/MEsokWeT8e
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Late-Breaking Trials in axSpA and PsA https://t.co/Fw8wiAPLoN
The amazing @Janetbirdope discussing head to head trials in Axial SpA and PsA with primary failure to TNF.
To switch to another TNF or IL17?
IL17 for my PsA patient for sure.
@RheumNow
#ACR25
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
In the SERENA study (n=292), secukinumab reduced PsA incidence to 0.49/100 PY over 5 years in PsO patients with nail involvement, an ~82% drop vs historic non-biologic rates (2.7/100 PY). 98.3% remained PsA-free; PASI 90 achieved in 63%. Abstract#1463 @RheumNow #ACR25 https://t.co/ySOuFJiwge
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Fragoulis et al. Real world study of bimekizumab demonstrates equal efficacy in IL-17i naive and exposed. @RheumNow #ACR25 Abstr#1439 https://t.co/aCcLgnKvFJ
Richard Conway RichardPAConway ( View Tweet)
Gensler et al. Bimekizumab in male and female axSpA patients. Greater benefit in males at week 16, but similar responses at week 52 @RheumNow #ACR25 Abstr#1449 https://t.co/zDYI2zItqT
Richard Conway RichardPAConway ( View Tweet)
Bimekizumab showed sustained 1-year efficacy in axSpA across age, BMI, CRP, and HLA-B27 subgroups. ASAS40, ASDAS, BASDAI, ASQoL, and MRI scores improved in most groups—especially age ≤35, BMI 25–30, CRP >5, and HLA-B27+. Abstract 1451 @RheumNow #ACR25
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Abstract 0878: In PsA pts w/ lateral epicondyle enthesitis on secukinumab (n=11):
🔹 Improved DAPSA & SPARCC scores
🔹 entheseal tissue biopsy showing shift toward pro-resolving fibroblasts (↑DKK3/CD200⁺)
🔹 ↓ osteoblast-related pathways
@RheumNow #ACR25
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
