Predictors of Treatment Response in Psoriatic Arthritis Save
Dr. Janet Pope reviews three abstracts presented at Eular 2024 in Vienna, Austria. Abstracts discussed:
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Transcription
Hi, I'm Doctor. Janet Pope. I'm reporting from AtRoomNow. I'm here at EULAR twenty twenty four in Vienna, Austria. My Twitter or X handle is janitburdope.
I'm going to report a few things on the meeting today, and these are posters that I thought were interesting. And I'll tell you shortly why I chose them. So I'm titling this thematically, A Predictors of Treatment Response in Psoriatic Arthritis. So the first poster was poster nine ninety. This was looking at psoriatic arthritis on looking at a durability of response of treatment in psoriatic arthritis patients who were active, who are treated with TNF inhibitors or a PDE4 inhibitor, which is a Premalast.
The data came from formerly known as the Corona registry, the Coravitas registry of patients with psoriatic arthritis. So a very large N. And the question is, what drug will last longer, and then what will be some of the predictors? So when you're starting your first line advanced therapy, if you use a TNF inhibitor, there was more durability than using a PDE4 inhibitor. And that's not surprising as we often think that the TNF inhibitor might be stronger, might give a deeper response.
So they went on to look at predictors, including some of the patients who were on both TNF and then adding apramilose. They also looked at predictors, male versus female, disease duration and things that might be predictive. But I think for me, the take home message from this poster was the bottom line is it looks like TNF inhibitor might give a longer response or longer utilization than a Premalast. So the next question is the age old question. If a patient has psoriatic arthritis and they've been on a TNF inhibitor with psoriatic arthritis, should you go to another TNF inhibitor or should you change the mechanism of action?
And this study, poster two sixty six, looked at the second line therapy of advanced therapies in active psoriatic arthritis after a first TNF inhibitor, going to another TNF inhibitor, or to go to an IL-seventeen inhibitor. And the results were a little bit surprising to me. It looked like in general, was no difference whether you stayed within the class of drugs, TNF to TNF, on response and durability of the response or drug retention over time, versus if you switch to a new class, like an IL-seventeen. They also looked at predictors of who would do better, and interestingly, it did look like men had less good retention, sorry, it looked like by gender the retention could vary, but it varied by the drug. So men might've had a different retention than women, men being better on a TNF inhibitor.
And some studies have shown that treatment response is attenuated in women on IL-23s, IL-twelve, IL-twenty three, and IL-17s, but not so much TNF inhibitor. So it is a study that you have to think about, but I think it allows us to have options. What's my question here though? What would be the data if we looked at maybe going to an IL-twenty three or an IL-seventeen, as IL-17s are quite often used after a TNF and sometimes even before? So we don't know that yet, and we'll await the publication, but the N is large and some insights are coming from it.
The final thing is, can I predict who might respond with psoriatic arthritis treatment when you use a TNF inhibitor? And wouldn't that be great to have personalized medicine? So this was poster nine ninety two. And what they looked at were a series of biomarkers, cytokines, other molecules that were signaling that might or might not be important to suggest a better response to a TNF inhibitor. At this point in time, we don't have like a blood glucometer of a response, we don't have a lot of tests that will help us figure out who will respond.
The usual predictors of response are usually present. You're younger, you have active disease, but not really active, obviously you haven't failed a lot of other treatments and it's your first advanced therapy, those patients will do better than older or failing a lot of therapies already. So it's not ready for prime time, but I think these sort of data are the start of precision medicine for looking at biomarkers of a response to treatment before we even start the treatment. So please follow us at RheumNow, and thanks for listening. Bye now.
I'm going to report a few things on the meeting today, and these are posters that I thought were interesting. And I'll tell you shortly why I chose them. So I'm titling this thematically, A Predictors of Treatment Response in Psoriatic Arthritis. So the first poster was poster nine ninety. This was looking at psoriatic arthritis on looking at a durability of response of treatment in psoriatic arthritis patients who were active, who are treated with TNF inhibitors or a PDE4 inhibitor, which is a Premalast.
The data came from formerly known as the Corona registry, the Coravitas registry of patients with psoriatic arthritis. So a very large N. And the question is, what drug will last longer, and then what will be some of the predictors? So when you're starting your first line advanced therapy, if you use a TNF inhibitor, there was more durability than using a PDE4 inhibitor. And that's not surprising as we often think that the TNF inhibitor might be stronger, might give a deeper response.
So they went on to look at predictors, including some of the patients who were on both TNF and then adding apramilose. They also looked at predictors, male versus female, disease duration and things that might be predictive. But I think for me, the take home message from this poster was the bottom line is it looks like TNF inhibitor might give a longer response or longer utilization than a Premalast. So the next question is the age old question. If a patient has psoriatic arthritis and they've been on a TNF inhibitor with psoriatic arthritis, should you go to another TNF inhibitor or should you change the mechanism of action?
And this study, poster two sixty six, looked at the second line therapy of advanced therapies in active psoriatic arthritis after a first TNF inhibitor, going to another TNF inhibitor, or to go to an IL-seventeen inhibitor. And the results were a little bit surprising to me. It looked like in general, was no difference whether you stayed within the class of drugs, TNF to TNF, on response and durability of the response or drug retention over time, versus if you switch to a new class, like an IL-seventeen. They also looked at predictors of who would do better, and interestingly, it did look like men had less good retention, sorry, it looked like by gender the retention could vary, but it varied by the drug. So men might've had a different retention than women, men being better on a TNF inhibitor.
And some studies have shown that treatment response is attenuated in women on IL-23s, IL-twelve, IL-twenty three, and IL-17s, but not so much TNF inhibitor. So it is a study that you have to think about, but I think it allows us to have options. What's my question here though? What would be the data if we looked at maybe going to an IL-twenty three or an IL-seventeen, as IL-17s are quite often used after a TNF and sometimes even before? So we don't know that yet, and we'll await the publication, but the N is large and some insights are coming from it.
The final thing is, can I predict who might respond with psoriatic arthritis treatment when you use a TNF inhibitor? And wouldn't that be great to have personalized medicine? So this was poster nine ninety two. And what they looked at were a series of biomarkers, cytokines, other molecules that were signaling that might or might not be important to suggest a better response to a TNF inhibitor. At this point in time, we don't have like a blood glucometer of a response, we don't have a lot of tests that will help us figure out who will respond.
The usual predictors of response are usually present. You're younger, you have active disease, but not really active, obviously you haven't failed a lot of other treatments and it's your first advanced therapy, those patients will do better than older or failing a lot of therapies already. So it's not ready for prime time, but I think these sort of data are the start of precision medicine for looking at biomarkers of a response to treatment before we even start the treatment. So please follow us at RheumNow, and thanks for listening. Bye now.
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