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Guselkumab in Psoriatic Arthritis

Pedro Castillo

D1 and D2 trials compared guselkumab vs placebo in patients with active PsA, with the major difference between the two being that only biologic-naïve patients were enrolled in the D2 trial. Today, we discuss three abstracts presented at ACR 2021 that expand on that work with an additional year of data.

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ACR Best

ACR21 Best Abstracts - Day 1

Jack Cush, MD

The RheumNow faculty have been glued to their monitors all day, watching video, and running down abstract presentations to find the best – several of these stood out as #ACRBests. Here is a listing of “Best” they saw on Day 1.

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Risankizumab for Active Psoriatic Arthritis

Robert Chao, MD

The arsenal of therapeutics for psoriatic arthritis continues to increase. Risankizumab is an IL-23 inhibitor to the p19 subunit, currently being investigated for treatment of psoriatic arthritis.

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Opening Day Report

Jack Cush, MD

The opening of ACR2 Convergence was a hit for all who signed up and viewed in. The day included the presidential address by outgoing president Dr. David Karp (UT Southwestern) and a keynote talk and interview with Dr. Seema Yasmin (Stanford).

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Pipeline

Emerging Therapies in Spondyloarthritis: A Promising Pipeline

Olga Petryna, MD

Growing awareness of spondyloarthropathies over the last two decades has led to a better understanding of the pathophysiology of spondyloarthritis, and subsequently increased interest in more distinct, disease state specific treatment options.

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Do you use RAPID3 in PsA? Abst#0633 at #ACR21 shows a strong agreement between RAPID3 remission score w/ DAPSA + cDAPSA, esp when redefining RAPID3 categories. Is this practice △ing? With more studies to validate, yes, since RAPID3 is simpler! @RheumNow https://t.co/2q0FLeBSkC https://t.co/M3WDTGzEOT

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Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
Monozygotic twin study in PsO patients showed a gut and skin microbiome difference compared to their "normal" twin ⭐️Ruminococcus decreased/absent in gut flora of PsO ⭐️microbiome differences even in healthy PsO skin Abs#944 #ACR21 @RheumNow #ACRBest https://t.co/VlfVh5Kt3Y https://t.co/W0eSqi77lx

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Robert B Chao, MD doctorRBC ( View Tweet)
Abst0944 #ACR21 #ACRBest @RheumNow microbiom evaluation of MZ twins discordant for PSO reveals Ruminococcus bromii species significantly reduced & two pathways related to tetrahydrofolate biosynthesis upregulated in PSO twins compared to their unaffected siblings (p< 0.05) https://t.co/67ao0l23sI
Olga Petryna DrPetryna ( View Tweet)
Dr Exarchou presents incidence of PsA in Sweden. 22/100000. 75% received DMARDs within 2 years, which seems high, so perhaps this is tip of iceberg with milder cases undiagnosed. Abstr#0571 #ACR21 @RheumNow https://t.co/kANG6KBnOd
Richard Conway RichardPAConway ( View Tweet)
Novel study exploring microbial differences in MZ twins discordant for psoriatic disease ⭐️Ruminococcus 🔽/❎ Gut of Ps pts and maybe associated with Ps Dis ⭐️NL skin scalp of Psoriatic pts 🔽 microbial diversity compared to unaffected twins Abst#0944 #ACR21 #ACRBest @RheumNow

swethaann23 swethaann23 ( View Tweet)

Dr Manasson presents on microbiome differences between monozygotic twins discordant for psoriatic disease. Differences seen in gut (Ruminococcus virtually absent in psoriatic) and scalp non-lesional skin microbiomes Abstr#0944 #ACR21 @RheumNow https://t.co/8Ch0M4dwUH
Richard Conway RichardPAConway ( View Tweet)
#ACR21 Abst#0786. Fibroscan screening for liver injury in pts on MTX: ▶️No significant correlation between cumulative MTX dose and liver stiffness by fibroscan, even at high dose MTX. ⭐️Age, sex, waist circumference, BMI are risks @Rheumnow https://t.co/IhcNr9fhEh https://t.co/c7TUoGrNZ7

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Eric Dein ericdeinmd ( View Tweet)
#ACR21 Abst#0449: Ever wish you had a tool to help you predict which PsA pts will progress to radiographic damage? ➡️Proteomic approaches identified 103 candidate biomarker peptides related to 69 proteins that can potentially do so! @Rheumnow @uptoTate https://t.co/uUsZlBLTWC

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Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)

#ACR21 Abst#0452 ⭐️Total Body PET/CT (TB-PET/CT) as a tool to identify subclinical PsA at the point of transition from psoriasis (PsO). ➡️Should all pts w/ new dx of PsO have a baseline TB-PET/CT to identify early PsA? #ACRBest @Rheumnow @uptoTate https://t.co/IuxVuJgFSd https://t.co/AIuH9CIucy

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Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
#ACR21 Abst#0182 Does tenderness in non-swollen joints of PsA or RA pts portend inflammation & radiographic damage? ⭐️NO, except in early PsA! ➡️Abnormal PDUS associated w/ radiographic progression vs tenderness otherwise #ACRBest @Rheumnow @uptoTate https://t.co/iB1E0SL45e https://t.co/3Q30LeCMH4

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Meral K. El Ramahi, MD MeralElRamahiMD ( View Tweet)
⁦@JointMD⁩ shares his thoughts on IL23, IL17, TNF inh- where/when/how we might use them. ⁦@RheumNow⁩ #acr21 https://t.co/mVw05iFPhF

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TheDaoIndex KDAO2011 ( View Tweet)

👉Get contrast if ordering an MRI to eval for inflamm. arthritis 👉Heel spur vs. enthesitis? Look for erosions at dorsum of calcaneus & other signs of inflamm 👉DISH vs. axial PsA? DISH➡️contiguous bony ossific'n up anterior margin of the vertebral bodies; PsA not cont.

TheDaoIndex KDAO2011 ( View Tweet)

KEEPsAKE trial 1 (DMARD-IR) and 2 (DMARD/biologic-IR) on risankizumab (IL23i) for PsA: 👉some benefits of risankizumab for axial disease 👉no data regarding bowel disease 👉pts did remain on background DMARDS, steroids. (2/2)

TheDaoIndex KDAO2011 ( View Tweet)

Excellent talk by Dr. Anna Molto. Characteristics of spondyloarthritis, noting some patients with PsA have radiographic and non-radiographic axial SpA. #ACR21 6S403 @RheumNow https://t.co/ycftOMrWO9
Pedro Castillo _Castillo_Pedro ( View Tweet)
Are we getting closer to personalised medicine in #psoriaticarthritis Predicting progressors vs non-progressors using proteomics identified 103 candidate biomarker peptides that will discriminate the two groups @RheumNow #ACR21 #ACRBest Abst#0449 https://t.co/obDXTz3i5N

Links:

Dr. Antoni Chan synovialjoints ( View Tweet)

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