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Up-front Secukinumab in PsA?
We now have an absolute plethora of agents available for use in psoriatic arthritis (PsA). In contrast we have an almost complete lack of understanding of how best to optimise use of these agents – what is the right agent at the right time for the right patient. A study presented this week has given us some further information on the topic.
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#Poorer responses to #Rx in
#Females vs #males
Sex hormone and pathway differences
explained
👇
Biological differences
F start worse in disease activity
F May have ⬇️ response to #Rx
Yr in Preview C Ritchlin
@lihi_eder’s PsA work quoted
ACR24 @RheumNow @ACRheum @ACRBest https://t.co/EWoCvzOLiL
Janet Pope Janetbirdope ( View Tweet)
What is the effect of cs/bDMARDs on weight in #PsA?
⬇️Weight loss seen with:
IL17i
IL23i
csDMARDs
⬆️Weight gain seen with:
TNFi
IL12/23i
Important to consider #comorbidity & #BMI in management decisions in PsA
Ab2639 #ACR24 @RheumNow
Mrinalini Dey DrMiniDey ( View Tweet)
A#2582 McInnes
Sonelokimab - IL17A,F nanobody
Prior P2 in PsO, HS
ARGO: P2 W24 RCT
Significant improv in ACR response
High PASI90/100 data
Up to 60% achieved MDA by W24
Improved PsAID domains (PRO)
Safety no IBD, MACE, depr. 2% oral candida
IZAR-1,2 - P3 ongoing
#ACR24 @RheumNow https://t.co/O4fEhTC8jK
Links:
Eric Dein ericdeinmd ( View Tweet)
SEC demonstrated high retention rates after 5 years in pts with PsA and r-axSpA in this real-world study.
Reasons for stopping SEC:
lack of efficacy
pt decision
lost to ffup
AEs
Reassuring data on SECs position in the treatment of PsA/AS.
@Rheumnow #ACR24 abs2344 https://t.co/zECEsheQIi
sheila RHEUMarampa ( View Tweet)
A#2583
Apremilast for axial inflamm in PsA, assess by CANDEN MRI scoring
MOSAIC P4 open label trial
Reduction in inflammation seen in vertebral bodies & posteriolateral, not in facet joints
No changes in SPARCC SIJ, spine - though low baseline SIJ inflammation
@RheumNow #ACR24 https://t.co/3GKEGJbtdc
Eric Dein ericdeinmd ( View Tweet)
A#2584 Mease
Zasocitinib TAK-279 - potent, selective TYK2i
P2b, 12w PsA RCT
15/30 mg - similar response, better than PBO for ACR20/50/70, MDA, DAPSA, PASDAS
29% MDA v 13% PBO
Safety no signal for MACE, cancer, serious ifn, death. Mild acne signal noted
@RheumNow #ACR24 https://t.co/1eqD9R5fLe
Links:
Eric Dein ericdeinmd ( View Tweet)
Selective TYK2i zasocitinib, results of Phase 2 DBRCT Dose dependent improvements in various PsA outcomes; NNT~5 for DAS28 remission, NNT~20 for PASDAS Hard to compare to current agents, somewhere between JAKs (woot!) & "apremlist zone" 🫣 #ACR24 @RheumNow Abstr#2584 #ACRbest https://t.co/t0y6C618ll
Mike Putman EBRheum ( View Tweet)
A#2585
PsABIOnd observ cohort study of IL23 (GUS) or IL17i
6 mo interim results of 686 pts
PROs: PsAID-12
High Rx persistence at 6mo -94% on both Rx
Comparable improvement in PsAID-12 - best results skin, discomfort
1/2 with clinically meaningful improvement
#ACR24 @RheumNow https://t.co/TM1jwTRR7C
Links:
Eric Dein ericdeinmd ( View Tweet)
A#2586
EBIO study - secukinumab on entheseal bx in PsA. Compare b/l to 3+ mo on SEC
Biopsy: change of entheseal cell composition on IL-17A Rx
- decr Il-17A producing cells in responding pts
Spatial transcriptomics - colocalizarjon of ILC2, CD200+ fibroblasts
@RheumNow #ACR24 https://t.co/kMiqpBRxuE
Eric Dein ericdeinmd ( View Tweet)
Walsh et al. Direct mailing of PEST questionnaire to psoriasis patients. 13% PEST+, 4% seen by rheum (to date). 75% deemed appropriate for rheum to see - breakdown in picture. @RheumNow #ACR24 Abstr#2635 https://t.co/vlGJ977SV7 https://t.co/dbDUpwDZxy
Links:
Richard Conway RichardPAConway ( View Tweet)
Sharma @Amansharmapgi et al. DADA2. Clinical manifestations of 101(!) patients. @RheumNow #ACR24 Abstr#2647 https://t.co/Tkk6Rz6rtT https://t.co/frvFPYy4xf
Links:
Richard Conway RichardPAConway ( View Tweet)
Evaluation of Bimekizumab in PsA
At last year’s ACR, I shared about the early clinical trial data on bimekizumab in psoriatic arthritis. Bimekizumab (BKZ), a monoclonal IgG1 antibody that selectively inhibits interleukin (IL)‑17A and F. There have been more updates on the 2… https://t.co/lphZUiiq5T https://t.co/zuHpBaMtEv
Dr. John Cush RheumNow ( View Tweet)
Zou et al. Phase 2 RCT Vunakizumab, humanized IL17A in PsA. 12 week study. ACR responses shown in figure, looks similar to existing IL17As. @RheumNow #ACR24 Abstr#2581 https://t.co/Td5xlMYrAd https://t.co/Rl4gkmDFOR
Links:
Richard Conway RichardPAConway ( View Tweet)
A#2363
Deodhar
Bimekizumab fast time to work:
BE MOBILE 1 and 2 - rapid treatment responses with separation from PBO as early as 1-2 weeks after single dose.
@RheumNow #ACR24 https://t.co/T81Lzyoy7m
Eric Dein ericdeinmd ( View Tweet)
Ahmadzay et al. Real world secukinumab in PsA data in 1202 patients. Smokers/ex-smokers have 30% lower treatment retention. But if they maintain treatment, appear to respond equally well. BMI no effect. @RheumNow #ACR24 Abstr#2350 https://t.co/XVPmEBbRu8 https://t.co/QyJirWRKvq
Links:
Richard Conway RichardPAConway ( View Tweet)
In their cohort, Dr. Abarza et al reported a small percentage of pts developing PsA before Pso (8.6%)
This group also had faster radiographic progression vs. the Pso before PsA group.....something to consider when evaluating these pts.
@rheumnow #ACR24 abs2328 https://t.co/YPcAaKFS2I
sheila RHEUMarampa ( View Tweet)
A study investigating weight trends in Psoriatic Arthritis (PsA) and the impact of various medications. Analyzing 1754 patients, it explored multifactorial influences on weight changes
Key findings:
- Significant weight loss after starting IL17i, IL23i, and csDMARDs.
- TNFi &… https://t.co/qOl2ojV9rL https://t.co/Eh2ZNLeKhn
Links:
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
A study evaluating the effectiveness of Direct-to-Patient (D2P) screening for psoriatic arthritis (PsA) in psoriasis patients.
Key findings:
- 30% response rate from 825 patients; 13% screened positive.
- 75% of referrals deemed appropriate, with one-third receiving a new PsA… https://t.co/bcQN6KkC8m https://t.co/zogI2PYvtO
Links:
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Low uveitis rates in patients with axial spondyloarthritis and psoriatic arthritis treated with bimekizumab (BKZ) over the long term.
Key findings:
- AxSpA: 3.7% incidence (1.3/100 PY) with BKZ.
- PsA: Only 0.2% incidence (0.1/100 PY).
- All events were mild/moderate, with no… https://t.co/jkUwHJk3FJ https://t.co/gTcCzeC88e
Links:
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
