What should head-to-head studies in inflammatory arthritis teach us?
The multimillion dollar question for inflammatory arthritis prescriptions is: which drug should I use next?
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IL-23 Blockade Goes Oral
A new player is entering the IL-23 arena — and it’s a tablet! Icotrokinra (ICO), a first-in-class peptide that binds and blocks the IL-23R, is showing encouraging efficacy and safety across a range of psoriasis (PSO) and psoriatic disease (PsD) studies. https://t.co/MyqCjilYGL
Dr. John Cush @RheumNow( View Tweet )
Nerandomilast for ILD
Dr. Mike Putman reports on abstract 1662 (Efficacy and Safety of Nerandomilast in Patients with Autoimmune Disease-Related Progressive Pulmonary Fibrosis: Subgroup Analysis of the FIBRONEER-ILD trial). #ACR25
https://t.co/J0e4SbVgFE https://t.co/dlOM700yVQ
Dr. John Cush @RheumNow( View Tweet )
ACR25 Best Abstracts - Day 4
Here's the last installment of our "ACR Best" abstracts as chosen by the RheumNow faculty. Most of these were from the final, day 4, but a few were noteworthy holdovers from day 3. Enjoy!
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In a 5-year EHR-based cohort, PsO patients initiating IL-17i had significantly lower incidence of PsA/IA vs IL-23i, IL-12/23i, or TNFi. IL-17i reduced time with PsA/IA by 45% vs IL-23i, 61% vs IL-12/23i, and 74% vs TNFi. Further research need investigate if IL-17i may delay https://t.co/0PTbXZpLbu
Antoni Chan MD (Prof) @synovialjoints( View Tweet )
#ACR25 Clinical Review by Prof Coates @DrLauraCoates to be applied tomorrow!
Early Diagnosis/Tx
Abstr#2689 EHR study = IL-17i could prevent #PsA vs IL-23/TNFi
Abstr#576 Oligo → Polyarthritis progression in women, no DMARD, enthesitis, dactylitis, nail psoriasis @RheumNow https://t.co/e1hCERpCNW
Links:
Md Yuzaiful Md Yusof @Yuz6Yusof( View Tweet )
Do biologics prevent PsA?
Retro cohort analysis EHR through natural language processing
5 years trends
PsO treated w/ IL-17i had lower incidence of PsA/IA than pts treated w/ IL-23i, IL-12/23i, or TNFi therapies
Adjustment on several confounding
Prospective data heavily https://t.co/W9MFaWNbWC
Aurelie Najm @AurelieRheumo( View Tweet )
Secukinumab vs Ustekinumab in PsA https://t.co/EylYHtRWsj
@synovialjoints Elaborate more on head to head trial in PsA , in a population who failed TNF biologic.
@RheumNow
#ACR25
Nouf Al hemmadi @NoufAhmedAlham2( View Tweet )
52wks data of IZOKIPEB affibody IL17Ai RCT 2b/3 PsA
Primary ACR 50 16wks
Crossover 52 wks IZO 160 Q2W, IZO 160 QW, PBO-> IZO 160 QW
ACR50 50% 57% 51%
ACR70 36% 42% 42%
PASI100 55% 64% 58%
MDA 47% 52% 47%
No specific enthesitis data presented
No new safety signal
Next https://t.co/J18rSTmyze
Aurelie Najm @AurelieRheumo( View Tweet )
#IL2 #Rx in active #SLE?
Maybe 🤔
IL2 is tricky - low dose May help #SLE but too much of a good thing may have a neg impact.
RCT of IL2i in #SLE gave a good dose response and improved TRegs.
#ACRBest #ACR25 @RheumNow @ACRheum #LB01 https://t.co/F61qz5x5We
Links:
Janet Pope @Janetbirdope( View Tweet )
ROC-SpA study assessed whether changing to an IL-17Ai was superior to rotating to a 2nd TNFi in axSpA pts who failed on a 1st TNFi
At wk 24, no significant diff in ASAS40 rates bet the 2 groups
IL-17Ai not superior to a 2nd TNFi
Rotate or change?
#ACR25 @Rheumnow AbsLB09 https://t.co/4EtNEFTSN9
sheila @RHEUMarampa( View Tweet )
Gladman et al. PsA patients treated with guselkumab in DISCOVER-2. Male patients had more radiographic progression. Males exhibit stronger relationship between early joint response and lower subsequent rates radiographic progression. @RheumNow #ACR25 Abstr#2345 https://t.co/TSNwesvPzj
Richard Conway @RichardPAConway( View Tweet )
Late breaking: secukinumab out-performs ustekinumab in PsA pt who have failed TNF therapy
RCT of 119 pt
57.1% response at wk 28 in SEC
27% response at wk 28 in UST
Numerically lower adverse events leading to d/c in SEC
@RheumNow #ACR25 #ACRBest Abst LB06 https://t.co/wDxtscP2ku
Brian Jaros, MD @Dr_Brian_MD( View Tweet )
To be continued (or discontinued?): Abstract 2360: Compared to TNFi, IL-17i & JAKi users had 🔹 Higher odds of med switching <180 days 🔹 Shorter time to discontinuation @RheumNow #ACR25 #axSpA https://t.co/IOHaFSJqHn
Akhil Sood MD, MS @AkhilSoodMD( View Tweet )
Meta-analysis of 3 RCTs (n=1990) shows IL-17i offers comparable joint response but superior skin clearance vs adalimumab in biologic-naive PsA. IL-17i also had fewer discontinuations due to adverse events. Supports sequencing of biologics through different mechanisms of action in https://t.co/SJgFUMxWVb
Antoni Chan MD (Prof) @synovialjoints( View Tweet )
Heydari-Kamjani et al. TriNetX study. 28973 PsA patients. IL-17i and IL-23i lower rates stroke, MI, DVT/PE than TNFi. IL-12/23i higher rate of stroke vs TNFi. @RheumNow #ACR25 Abstr#2363 https://t.co/fNHaxyYPCP
Richard Conway @RichardPAConway( View Tweet )
Rotation or Change in Biologic post TNFi failure in axSpA. Switching biologic class after TNFi failure improved outcomes in axial SpA. In a randomized trial of axSpA patients with inadequate response to a first TNFi, switching to an IL-17Ai was not superior to cycling to a second https://t.co/MEsokWeT8e
Antoni Chan MD (Prof) @synovialjoints( View Tweet )
Late-Breaking Trials in axSpA and PsA https://t.co/Fw8wiAPLoN
The amazing @Janetbirdope discussing head to head trials in Axial SpA and PsA with primary failure to TNF.
To switch to another TNF or IL17?
IL17 for my PsA patient for sure.
@RheumNow
#ACR25
Nouf Al hemmadi @NoufAhmedAlham2( View Tweet )
Psoriatic Arthritis: Which biologic agent is the best first choice?
A growing arsenal of therapeutic targets in psoriatic arthritis (PsA) has enhanced the landscape of treatment in patients with this disease.
While it’s never bad to have more options, this does pose a question for rheumatologists regarding which agents should be
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In the SERENA study (n=292), secukinumab reduced PsA incidence to 0.49/100 PY over 5 years in PsO patients with nail involvement, an ~82% drop vs historic non-biologic rates (2.7/100 PY). 98.3% remained PsA-free; PASI 90 achieved in 63%. Abstract#1463 @RheumNow #ACR25 https://t.co/ySOuFJiwge
Antoni Chan MD (Prof) @synovialjoints( View Tweet )
Fragoulis et al. Real world study of bimekizumab demonstrates equal efficacy in IL-17i naive and exposed. @RheumNow #ACR25 Abstr#1439 https://t.co/aCcLgnKvFJ
Richard Conway @RichardPAConway( View Tweet )
Gensler et al. Bimekizumab in male and female axSpA patients. Greater benefit in males at week 16, but similar responses at week 52 @RheumNow #ACR25 Abstr#1449 https://t.co/zDYI2zItqT
Richard Conway @RichardPAConway( View Tweet )
Bimekizumab showed sustained 1-year efficacy in axSpA across age, BMI, CRP, and HLA-B27 subgroups. ASAS40, ASDAS, BASDAI, ASQoL, and MRI scores improved in most groups—especially age ≤35, BMI 25–30, CRP >5, and HLA-B27+. Abstract 1451 @RheumNow #ACR25
Antoni Chan MD (Prof) @synovialjoints( View Tweet )
Abstract 0878: In PsA pts w/ lateral epicondyle enthesitis on secukinumab (n=11):
🔹 Improved DAPSA & SPARCC scores
🔹 entheseal tissue biopsy showing shift toward pro-resolving fibroblasts (↑DKK3/CD200⁺)
🔹 ↓ osteoblast-related pathways
@RheumNow #ACR25
Akhil Sood MD, MS @AkhilSoodMD( View Tweet )
In high-risk psoriasis patients with nail disease, Secukinumab reduced PsA onset over 5 years with a total exposure of 1022 patient-years. Annual incidence dropped from 2.7 to 0.49 per 100 patient-years. Data from the real world SERENA study. Abstract 1463 @RheumNow #ACR25
Antoni Chan MD (Prof) @synovialjoints( View Tweet )
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