Key Psoriatic Arthritis topics and updates at EULAR 2022 Save

At EULAR 2022, I have been looking at topics and presentations in psoriatic arthritis (PsA). 

How do PsA patients do on csDMARDs and is the time to switch or escalate to biologics the same as for RA? A Swedish study by Lindstrom U et al  POS0073 of over 3000 PsA patients matched with RA comparators showed that the length of time on MTX (PsA 4.5 and RA 4.4 years) before adding or switching to b/tsDMARD was identical in PsA (34%) and matched RA controls (33%). On drug persistence, a real world study of over 6500 patients from a French Health Insurance database by Pina Vegas et al POS0075 showed higher persistence of IL17i than TNFi for PsA and PsO. IL17i had better persistence than IL12/23 for PsA and no difference for PsO over 3 years. 

In the area of new therapies, we are starting to get more experience of using them. This includes the selective p19 inhibitors such as Guselkumab and Risankizumab. In POS0082 by Boehncke et al from the Guselkumab DISCOVER-1 and 2 looked at the effect of treatment on composite end points for skin and joints. This is important in treating the multi-faceted aspects of PsA. The PASDAS assesses both skin and joints but is difficult to implement in clinical practice. The DAPSA is easy to use but does not cover skin disease. Here it is shown that the new composite endpoint combines DAPSA low disease activity (LDA) and Investigator Global Assessment (IGA) of psoriasis score < 1 (range 0-4). DAPSA LDA + IGA <1 at Week 16 predicted Week 52 ACR 50 and MDA response. This composite score is more practical to implement than the PASDAS. POS1017 by Coates et al also looked at the continued improvement in key domains in PsA over 2 years of treatment with Guselkumab from the DISCOVER-2 study. Risankizumab (RZB), another selective p19 inhibitor, was reviewed in POS1024 by Kristensen et al in a 52 week study of patients with active PsA in the Keepsake 1. At 24 weeks, the ACR20 was RZB 55% vs PBO 33%, PASI 90 RZB 68% vs PBO 10%. The benefit with RZB continued to Week 52.

Another newer agent, Deucravacitinib (DEUC), an oral selective tyrosine kinase 2 inhibitor, is studied in a Phase 2 trial in PsA in POS1039 by Kavanaugh et al. In this study, patients treated with DEUC achieved a higher rate of MDA (23% in the 6mg od and 24% in the 12 mg od groups) compared to PBO at 8%. The safety aspect of Deucravacitinib was looked at in POS1040 by Fleischmann et al. DEUC treatment in PsA did not result in clinically meaningful laboratory changes after 16 weeks of treatment in the Phase 2 study. I covered this topic at ACR 2021 and am glad to see there is more data presented at EULAR 2022. For those interested to read more, DEUC has also been used in SLE. For this see Late Breaking (LB) Abstract 0004 by Morand et al.

Bimekizumab (BKZ) is a IL-17A/IL-17F inhibitor and its use in PsA was presented at EULAR 2022. Merola et al in OP0255  showed that Bimekizumab (BKZ) vs PBO at 16 week in the BE COMPLETE study for PsA with inadequate response to TNFi showed ACR50 44% vs 7%, PASI90 69% vs 7%, ACR20 67% vs 16%, ACR70 27% vs 0.8%, PASI 100 60% vs 5%, MDA 44% vs 6%, no new safety signals reported. In bDMARD-naive patients with PsA, the 24 week efficacy and safety of BKZ was reported in BE OPTIMAL by McInnes et al in LB0001. At Week 16 ACR50 was 44% BKZ , 10% PBO, ADA 46%. This continued to week 24. For PASI 90 at Week 16, it was 62% BKZ, PBO 3%, ADA 41% and the benefit continued to Week 24.

How are advanced therapies applied in clinics and what is the real world experience of this? POS1019 by Littlejohn et al looks at the real world evaluation, treatment patterns and persistence of tofacitinib (TOF) in PsA from the OPAL dataset. TOF was more commonly used as a later line therapy for PsA patients. Patients on TOF had a higher persistence when used as first line therapy (overall median persistence of 16.5 months) and comparable to IL-17i (17.7 months) and TNFi (17.2 months).  How long does the drug treatments last when we switch therapies? POS1018 by Hansen et al looks at drug survival and treatment response rates in PsA patients switching to first or second line IL-17 inhibitor treatment. In this Danish study from the DANBIO registry, first and second line IL-17i treatment had almost identical drug survival.  

These are some of the key topics in the treatment of PsA that I have picked from EULAR 2022. I have also shared some other topics as videos on the RheumNow site. I hope you have enjoyed the coverage of PsA topics.