IL-17

IL-17 inhibitor Brodalumab is not often talked about, but its approved for PsO & PsA. German study of 227 PsO w/ 37 PsA pts Rx w/ BRO - good, rapid response by 3 mos. 1 year drug survival rate was 76.2%, (mean discontinuation=8.3 mos. https://t.co/4byFoc96Zs https://t.co/sPomX0s8aa

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Dr. John Cush @RheumNow( View Tweet )
Bimekizumab (dual-IL-17A/F inhib), may prevent uveitis in patients with axSpA. In phase 3 RCTs (MOBILE 1 & 2) double-blind period, uveitis seen in 0.6% on BKZ vs 4.6% on PBO (p=0.001). In pts w/ hx uveitis, again lower w/ BKZ (6.2/100 PYs vs 70.4/100 PYs) https://t.co/v0wMK45chz https://t.co/CVPdg1k41V

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Dr. John Cush @RheumNow( View Tweet )
Paradoxical psoriasis w/ IL-17 inhib? Lit review 35 (SpA) pts, presenting as palmoplantar pustular and plaque PsO; median 11 weeks after IL-17i. one-third continued IL-17i w/ mostly topical Rx; 2/3 D/C IL-17i, switching to other biologic w/ good outcomes https://t.co/q2xqQyiM3b https://t.co/6hSE6NLHWw

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Dr. John Cush @RheumNow( View Tweet )
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ICYMI: 2023 EULAR Psoriatic Arthritis Recommendations

Jack Cush, MD

EULAR has updated its treatment recommendations from the prior 2019 guidelines, since there have been several newly developed agents. The updated guidance includes 7 overarching principles and 11 recommendations regarding treatment strategy and pharmacological therapies.

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heel enthesitis spur calcaneal

ICYMI: Enthesitis, Synovitis, and Tenosynovitis in Psoriatic Arthritis

Jack Cush, MD

An ultrasound study suggests that enthesitis is associated with both synovitis and tenosynovitis in patients with Psoriatic arthritis (PsA).

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Moonlake has announced its phase 3 program to develop Sonelokimab (M1095) a dual inhibitor of IL-17A & IL-17F for use in Psoriatic arthritis. IZAR-1 & IZAR-2 Ph 3 DBPCT will enroll 1,500 adults w/ active PsA, w/ ACR 50 endpoint at Week 16 https://t.co/y3UvOF4M5i https://t.co/iSUrkhIXbh

Links:

Dr. John Cush @RheumNow( View Tweet )
RheumNow Podcast square

Future Big BiTEs (6.28.2024)

Jack Cush, MD

Dr. Jack Cush reviews the news, journal articles and regulatory announcements from the past week on RheumNow.com.

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Swap or Cycle? Study OP0081 show after failure to a first TNFi in patients with axSpA, the drug retention rate was higher in the cycle strategy compared to the swap (IL-17i) strategy. No difference in the disease activity between cycle and swap strategy #EULAR2024

Dr. John Cush @RheumNow( View Tweet )

Moonlake has announced its phase 3 program to develop Sonelokimab (M1095) a dual inhibitor of IL-17A & IL-17F for use in Psoriatic arthritis. IZAR-1 & IZAR-2 Ph 3 DBPCT will enroll 1,500 adults w/ active PsA, w/ ACR 50 endpoint at Week 16 https://t.co/NUZ3cc4bUx https://t.co/nGP10y3Kuw

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Dr. John Cush @RheumNow( View Tweet )
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Achieving drug-free remission in axSpA

EurekAlert!

A clinical trial in early axial spondyloarthritis (axSpA) demonstrated sustained inactive disease status in over 60% of patients. In axSpA patients with less than 1 year of disease symptoms, male sex, abstinence from smoking and lower BASDAI score at baseline were associated with higher

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EULAR Abstract Archive OP0031 (2024) COMPARATIVE ANALYSIS OF TNF INHIBITORS & IL17 INHIBITORS IN PSORIATIC ARTHRITIS: CARDIOVASCULAR OUTCOMES signif absolute risk diff 3 % ischaemic heart disease 2 % heart failure TNFi vs IL17i https://t.co/fNIiMt4caL. @RheumNow #EULAR2024

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Peter Nash @drpnash( View Tweet )

EFFICACY & SAFETY OF IZOKIBEP, A NOVEL IL-17A INHIBITOR, IN PATIENTS WITH ACTIVE PSA: WEEK 16 RESULTS FROM A RANDOMIZED, DB,PBO CONTROLLED, MULTICENTER 2b/3 STUDY ACR responses 60:40:20 42% MDA PASI 100 47% ho hum same as others-how many IL17s do we need ? @RheumNow #EULAR2024

Peter Nash @drpnash( View Tweet )

POS0231 Safety of JAKi vs TNFi or IL-17 inhibitors in #PsA & #SpA Results from a large population-based study show reassuring data, with no increased risk of #CVD, #VTE or certain cancers compared to TNFi or IL-17i @SteZhao @RheumNow #EULAR2024

Mrinalini Dey @DrMiniDey( View Tweet )

1200 PsA pts 6 countries IL17is as effective as TNFi and JAK despite more failed bDMARDs and monotherapy & faster onset action than IL23s ⁦@RheumNow⁩ #EULAR2024 https://t.co/SM5CA7KUvd

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Peter Nash @drpnash( View Tweet )
Do we need more IL-17 and JAK Inhibitors in Spondyloarthritis? Dr. Eric Ruderman shares his perspectives on the following abstracts being presented at #EULAR2024 in Vienna, Austria: OP0195 LBA0005 POS0803 OP0138 https://t.co/MnefRxYqMh https://t.co/Mwq4s7eTKY

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Dr. John Cush @RheumNow( View Tweet )
500+ pts AxSPA No difference in drug discontinuation between IL-17i, TNFi, IL23i over time Adjusted for CRP, co-medication w/ MTX + classic covariates IL-17i and IL-23i had experienced a higher number bDMARD failures #EULAR2024 POS0259 @RheumNow https://t.co/F3B6uXyAca

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Aurelie Najm @AurelieRheumo( View Tweet )
Cycle or swap 2? Post failure to a first TNFi in patients with PsA, there was no difference in cycle versus swap to IL17i for drug retention rate or disease activity. In male PsA patients a cycle strategy had a longer drug retention rate compared to a swap (IL-17i) strategy.… https://t.co/5BykvDwFWV https://t.co/GfcnIltV2A

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Dr. Antoni Chan @synovialjoints( View Tweet )
The age old question in #inflammatory #arthritis Should you cycle within TNFi class or move on to another MOA in #PsA #psoriatic #arthritis Better retention to go to a IL17i vs another TNFi in observational study comparing the 2 POS0266 #EULAR2024 @RheumNow @eular_org https://t.co/CXcmYAG4m9

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Janet Pope @Janetbirdope( View Tweet )
12-week ARGO Phase 2 trial data of IL-17A- and IL-17F-inhibiting Nanobody sonelokimab delivers rapid onset and robust levels of clinical response, including high-threshold outcomes, compared with placebo in patients with active PsA, with a favorable benefit–risk profile. It met… https://t.co/4wj222FkzP https://t.co/ipUSjKvpuB

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Dr. Antoni Chan @synovialjoints( View Tweet )
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EULAR 2024 - Day 1 Report

Jack Cush, MD

Wednesday was Day One at EULAR 2024 in Vienna. While the day was a slow start, the poster halls and auditoriums quickly filled with thousands of rheumatologists, eager to reunite at this international educational forum. Below are a few of my favorites from Day 1.

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hand stopping falling dominos

Can we prevent psoriatic arthritis?

Antoni Chan, MD, PhD

Psoriatic arthritis (PsA) can affect up to 30% of patients with psoriasis (PsO). Understanding the factors that predispose patients with PsO who progress to PsA is the first step in understanding how early interventions in PsO may augment the progression to PsA. At #EULAR2024, there are a few

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Swap or Cycle? Study OP0081 show after failure to a first TNFi in patients with axSpA, the drug retention rate was higher in the cycle strategy compared to the swap (IL-17i) strategy. No difference in the disease activity between cycle and swap strategy #EULAR2024 @RheumNow https://t.co/vr5DvNOb21

Links:

Dr. Antoni Chan @synovialjoints( View Tweet )
In patients with bio-naïve r-axSpA, Ixekizumab treatment for 16 weeks decreased erosion scores and increased backfill scores, particularly in the IXE Q2W group, consistent with rapid tissue repair #EULAR2024 Abst OP0046 @RheumNow https://t.co/wMasGSZj2o

Links:

Dr. Antoni Chan @synovialjoints( View Tweet )
A potentially notable association between TNFi in PsA and an increased risk of ischemic heart diseases and heart failure compared to IL-17i treatment. Limitations of the study noted. This may be due to patient selection and channeling of patients to the TNFi group and more… https://t.co/Q2LotHZwjQ https://t.co/uwl6vBIMsb

Links:

Dr. Antoni Chan @synovialjoints( View Tweet )
OP0031 (2024) COMPARATIVE ANALYSIS OF TNF INHIBITORS AND IL17 INHIBITORS IN PSORIATIC ARTHRITIS: EXPLORING CARDIOVASCULAR OUTCOMES signif absolute risk difference 3 % ischaemic heart disease 2 % heart failure TNFi vs IL17i @rheumnow #EULAR2024

Peter Nash @drpnash( View Tweet )

Recent Blogs

Best of 2022: The Enthesitis Challenge in Psoriatic Arthritis

Robert Chao, MD
heel enthesitis spur calcaneal
A colleague of mine once told me an interesting story of how her father, who was a doctor, misdiagnosed his wife with fibromyalgia when she actually had psoriatic arthritis with enthesitis all along. I would venture out and say that the average physician would have trouble evaluating enthesitis because even we, as rheumatologists do!  Read Post

Best of 2022: Toss of a Coin - How do You Choose PsA Medication?

M. Elaine Husni, MD, MPH
Coin toss
When balancing all these disease domains, individual phenotypes, and comorbidities, sometimes treatment decisions can feel like tossing a coin. Fortunately, numerous guidelines have been published to help us do better than tossing a coin…or do they?  Read Post

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