Biologic Agents have Equal Efficacy in Enthesitis and Dactylitis Save

A systematic review has shown that TNF inhibitors (TNFi) are equaled in efficacy by other biologic agents (ustekinumab, secukinumab, and ixekizumab) in psoriatic arthritis (PsA) patients with in dactylitis and enthesitis.

The literature review analyzed datafrom randomized controlled trials (RCTs) with TNFi (infliximab, golimumab, adalimumab), antiinterleukin- 12/23 (ustekinumab) and anti-interleukin-17 (secukinumab, ixekizumab).

The analysis was narrowed to 18 RCTs and 6981 patients.

The ability of the biologic to yield significant resolution of dactylitis at week 24 revealed the following risk ratios (RRs) versus placebo: 

• TNFi: RR 2.57 (95% CI: 1.36-4.84)
• Novel biologics RR 1.88 (95% CI: 1.33-2.65), respectively

Resolution of enthesitis at week 24 revealed:

• TNFi: RR 1.93 (95% CI: 1.33-2.79)
• Novel biologics: RR 1.95 (95% CI: 1.60-2.38)

Both the TNFi and novel biologic had overlapping ranges of ACR20 responses:

• TNFi: RR=2.23, 95% CI: 1.60-3.11
• Anti-IL-12/23 and IL-17 agents: RR=2.30, 95% CI 1.94-2.72)

Pooled analysis demonstrates agents targeting TNFi, IL-17, and IL-12/23 have equivalent efficacy in managing dactylitis and enthesitis in PsA patients.