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Evaluation of Bimekizumab in PsA
Bimekizumab (BKZ) is a monoclonal IgG1 antibody that selectively inhibits interleukin (IL)‑17A and F. There have been more updates on the 2 year data on BKZ at #ACR24, and this is a summary of four studies being presented this year at ACR24.
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#0585 🔬PsA/axSpA: TNFi Cycling v IL-17Ai Switch
➡️470 pts: Switchers to IL-17Ai had similar/better outcomes v TNFi cyclers @ 6 mo
➡️PsA: Switchers had improved arthritis/psoriasis(-5.0, p=0.02)
➡️axSpA: Switchers had improved fatigue(-9.4, p=0.01)
#ACR24 @RheumNow
Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)
PRO-SPIRIT trial data on 1192 PsA pts showed IL-17Ai seemed better than IL-12/23i and IL-23i improving cDAPSA at 3m and as effective as TNFi and JAKi. No much differences seen at 12m. Abst#0076 #ACR24 @RheumNow https://t.co/dScwsmkDOe
Adela Castro AdelaCastro222 ( View Tweet)
#0584🔬Real-World PsA Study:Tofacitinib
➡️141 pts:47% mono,53% combo;~70% on Rx @ 6mo
➡️Similar ⬆️in disease outcomes (cDAPSA LDA: 31% mono vs 21% combo; MDA ~16%).
➡️No significant differences mono v combo outcomes
🩺Tofa effective in diverse PsA population
#ACR24 @RheumNow
Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)
With many treatments for #PsA and #PsO, what are the prescribing trends?
Abstract 0604: TNF inhibitors remain the most common (~60%), but over the past 10 years, IL-17i use rose from 0.2% to 19%, and IL-23i from 0.1% to 39.7%! #ACR24 @RheumNow https://t.co/4TnCAkHfuY
Akhil Sood MD AkhilSoodMD ( View Tweet)
Can multidisciplinary clinics improve quality of care for PsA?
Abstract 0596: Multidisciplinary care in PsA associated with ↓ time to first biologic, ↑ dermatology & nurse visits, and better CV risk assessment. #ACR24 @RheumNow https://t.co/2OnUR6te63
Akhil Sood MD AkhilSoodMD ( View Tweet)
The METEOR study reveals distinct clinical features in spondyloarthritis (SpA) patients with vs. without IBD.
Key features of those with IBD:
- Lower male prevalence
- Higher uveitis rates
- Lower psoriasis rates
- More structural damage in SI joints
Mirroring gut… https://t.co/EyBZQ91DDn
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
🚨Therapeutic target in PsO?
Abst#0067 from Cleveland Clinic evaluated pts w/ PsO at high risk for PsA (HR-PsO).
- HR-PsO: ⬆️percentage in migratory dendritic cells with elevated expression of CXCR4.
- Migratory effect ⬇️ after selective CXCR4 inhibitor. #ACR24 @ElaineHusniMD… https://t.co/nVoAThUxi1 https://t.co/8d1K3nkttI
Links:
Adela Castro AdelaCastro222 ( View Tweet)
🤨To cycle or not to cycle TNFi. Abst#0585 studied pts with PsA and axSpA with primary TNFi failure:
-Switching to IL17Ai may benefit phGA for arthritis and psoriasis in PsA pts and fatigue in axSpA pts. @AlexisOgdie
#ACR24 @RheumNow https://t.co/Jc0cdmrVhI
Adela Castro AdelaCastro222 ( View Tweet)
Abstract 0587: Among PsA patients (bDMARD-naive & TNF non-responders) treated with Bimekizumab, better disease control was linked to improved work productivity, including ↓ work impairment, ↓ presenteeism, and ↓ activity impairment. #ACR24 @RheumNow https://t.co/sZBjJ9lk39
Akhil Sood MD AkhilSoodMD ( View Tweet)
High PBO effect in PsA studies
Abst#0772 from U. of Vienna analyzed PBO arms of PsA trials for bDMARDs and tsDMARDs on ACR response rates at week 12:
💡PBO rates significantly increased over time.
💡Recruitment patterns increasing in geographic areas with less affluent health… https://t.co/wAJnwjYkVe
Adela Castro AdelaCastro222 ( View Tweet)
#0582🔬Challenges in Achieving PsA Disease Control
➡️n=2,093; 18% and 8% achieved minimal, very low disease activity respectively
🔑Higher QoL & monotherapy⬆️success; female sex, fatigue, spine pain⬇️outcomes.
🩺Unmet needs remain in PsA; tailored Rx needed
#ACR24 @RheumNow
Caoilfhionn Connolly CaoilfhionnMD ( View Tweet)
The rising placebo response rates in PsA trials are linked to global recruiting patterns, with more studies in less affluent countries. Limited access to healthcare may drive this trend, highlighting the need for awareness among stakeholders. Plenary Abstr#0722… https://t.co/FplpSlIamR https://t.co/NIp76IS6TZ
Links:
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Kerschbaumer et al. Rising placebo rates in PsA RCTs appear linked to changes in global recruitment patterns. Dramatic relationship between GNI and placebo response rate. Crucial information for properly planning future trials @RheumNow #ACR24 Abstr#0772 https://t.co/PtHs2RXe0f https://t.co/OKG6czQrYD
Links:
Richard Conway RichardPAConway ( View Tweet)
Location of research matters Ab#0772
Global recruiting patterns impact PBO in PsA
PBO results improve w time - 0.9%/year
More globalization of trials w time
Gross nation index (GNI) neg ass w ACR20 - inclusion of less affluent controls affects higher PBO response
@RheumNow #ACR24
Eric Dein ericdeinmd ( View Tweet)
TNFi cycling vs. switching to IL-17Ai?
Dr @AlexisOgdie et al from CorEvitas registry:
PsA & axSpA cohort - switchers (TNFi to IL17i) had greater improvements in cDAPSA & BASDAI vs. cyclers (2nd TNF)
Not stat significant but offers alternative Tx options
@RheumNow #ACR24 abs585 https://t.co/8m347BRM75
sheila RHEUMarampa ( View Tweet)
Dr. Catherine Bakewell @CatherineB27 shares the preliminary ACR guidelines on ultrasound imaging in psoriatic arthritis covering 4 domains, detailed PICOs covering the early phase, diagnosis, assessment covering the domains of PsA @RheumNow #ACR24 https://t.co/DoHE1rsSGf
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Dactylitis management in PsA:
Acute: pain and swelling
Chronic: painless swelling
Broad ddx
No role for LEF or SSZ
#ReviewCourse #ACR24 @RheumNow https://t.co/KZXv1UvhXn
Links:
Adela Castro AdelaCastro222 ( View Tweet)
Great summary of treatment choices in PsA:
1. Identify domain involved
2. Identify comorbidities/pt preferences
3. Still unmet needs for ttx in inflammatory eye disease
#ACR24 @rheumnow https://t.co/1WMnkDYvip
Links:
Adela Castro AdelaCastro222 ( View Tweet)
Amazing review @NamrataRheum on the important role the rheumatologist can play to improve the care of our older patients!
Don’t forget the 5Ms!
🧠Mind (cog/mood)
💊Medication (PIM)
🏃♀️Mobility
👉Multi-complexity
💪🏻Matters most (pt priority)
@RheumNow #ACR24 #gerirheum https://t.co/0Iv4TdS8AX
Links:
Patricia Harkins DrTrishHarkins ( View Tweet)
