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Queiro R, Aurrecoechea E, Alonso Castro S, Villa Blanco I, Brandy-Garcia A, Linge R. Interleukin-17-targeted treatment in patients with spondyloarthritis and associated cardiometabolic risk profile. Front Immunol 2023; 14:1203372. [PMID: 37533855 PMCID: PMC10391638 DOI: 10.3389/fimmu.2023.1203372] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/29/2023] [Indexed: 08/04/2023] Open
Abstract
Spondyloarthritis is a group of immune-mediated rheumatic disorders that significantly impact patients' physical function and quality of life. Patients with spondyloarthritis experience a greater prevalence of cardiometabolic disorders, such as obesity, hypertension, dyslipidemia and diabetes mellitus, and these comorbidities are associated with increased spondyloarthritis disease activity and risk of cardiovascular events. This narrative review summarizes the evidence for a physiological link between inflammatory status and cardiometabolic comorbidities in spondyloarthritis, as well as the impact of interleukin (IL)-17 blockade versus other molecular mechanisms in patients with cardiometabolic conditions. The IL-23/IL-17 axis plays a pivotal role in the pathophysiology of spondyloarthritis by promoting inflammation and tissue remodeling at the affected joints and entheses. The importance of the IL-23/IL-17 signaling cascade in underlying sub-clinical inflammation in common cardiometabolic disorders suggests the existence of shared pathways between these processes and spondyloarthritis pathophysiology. Thus, a bidirectional relationship exists between the effects of biologic drugs and patients' cardiometabolic profile, which must be considered during treatment decision making. Biologic therapy may induce changes in patients' cardiometabolic status and cardiometabolic conditions may conversely impact the clinical response to biologic therapy. Available evidence regarding the impact of IL-17 blockade with secukinumab on cardiometabolic parameters suggests this drug does not interfere with traditional cardiovascular risk markers and could be associated with a decreased risk of cardiovascular events. Additionally, the efficacy and retention rates of secukinumab do not appear to be negatively affected by obesity, with some studies reporting a positive impact on clinical outcomes, contrary to that described with other approaches, such as tumor necrosis factor blockade. In this article, we also review evidence for this bidirectional association with other treatments for spondyloarthritis. Current evidence suggests that IL-17-targeted therapy with secukinumab is highly effective in spondyloarthritis patients with cardiometabolic comorbidities and may provide additional cardiometabolic benefits.
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Affiliation(s)
- Rubén Queiro
- Rheumatology and Health Research Institute of the Principality of Asturias (ISPA) Translational Immunology Division, Hospital Universitario Central de Asturias, Oviedo, Spain
- Oviedo University School of Medicine, Oviedo, Spain
| | - Elena Aurrecoechea
- Rheumatology Division, Hospital de Sierrallana, Torrelavega, Spain
- Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Sara Alonso Castro
- Rheumatology Division, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Ignacio Villa Blanco
- Rheumatology Division, Hospital de Sierrallana, Torrelavega, Spain
- Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
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Gialouri CG, Pappa M, Evangelatos G, Nikiphorou E, Fragoulis GE. Effect of body mass index on treatment response of biologic-/targeted synthetic-DMARDs in patients with rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis. A systematic review. Autoimmun Rev 2023; 22:103357. [PMID: 37150489 DOI: 10.1016/j.autrev.2023.103357] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Overweight and/or obese patients with inflammatory arthritis (IA) have higher disease activity and lower chances of achieving and/or maintaining the treatment targets. Weight/obesity also appears to negatively affect the response to tumor necrosis factor (TNF) inhibitors in patients with IA, including rheumatoid arthritis -RA, psoriatic arthritis -PsA, axial spondyloarthritis -AxSpA. We conducted a systematic literature review (SLR) for the effect of weight/body-mass-index (BMI) in the efficacy of all approved b- and targeted-synthetic (ts)- DMARDs for the treatment of IA. METHODS For this PROSPERO-registered SLR, we searched PubMed, Scopus and Cohrane-Library from inception up to June 21st 2022. Clinical-trials (randomized and non-randomized) and observational studies of RA, PsA or AxSpA patients that reported the effect of weight/BMI on response (all possible outcomes) to b/ts-DMARDs were included. Risk-of-bias was assessed via RoB2-Cochrane-tool and Newcastle-Ottawa-scale for randomized and non-randomized studies, respectively. FINDINGS Out of 996 references, 75 eventually fulfilled the inclusion criteria (of which 10 studies were retrieved through manual-search). Among the included studies (TNF-inhibitors: 34, IL-12/23 inhibitors: 4, IL-23 inhibitor: 1, IL-17 inhibitors: 7, tocilizumab: 18, abatacept: 8, rituximab: 3, JAK-inhibitors: 5), most had medium RoB. Efficacy of TNF-inhibitors was affected by BMI in all forms of IA. Data are not robust to compare the effect among various TNF-inhibitors. In contrast, favorable results of IL-23 and IL-17 inhibitors did not appear to be influenced by increased BMI in PsA or AxSpA patients. Similar evidence exists for tocilizumab (in RA) and for abatacept (in RA and PsA), while no conclusion can be drawn for rituximab. More data are needed for JAK-inhibitors, although the effect of weight/BMI does not seem to be significant so far. INTERPRETATION Weight/BMI should be considered in the treatment-plan of patients with IA, with its effect being more pronounced for TNF-inhibitors compared to other b/ts-DMARDs.
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Affiliation(s)
- Chrysoula G Gialouri
- Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Greece; Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, Medical School, National and Kapodistrian University of Athens, "Hippocration" General Hospital, Athens, Greece
| | - Maria Pappa
- Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Greece; Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, Greece
| | - Gerasimos Evangelatos
- Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Greece; Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, Greece
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, London, UK; Rheumatology Department, King's College Hospital, London, UK
| | - George E Fragoulis
- Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Greece; Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, Greece.; Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK..
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Letarouilly JG, Flachaire B, Labadie C, Kyheng M, Cohen N, Sellam J, Richette P, Dieude P, Claudepierre P, Fautrel B, Houvenagel E, Nguyen CD, Guyot MH, Segaud N, Marguerie L, Deprez X, Salmon JH, Baudens G, Miceli-Richard C, Gervais E, Chary-Valckenaere I, Lafforgue P, Philippe P, Loeuille D, Richez C, Tubach F, Pham T, Flipo RM. Secukinumab and ustekinumab treatment in psoriatic arthritis: results of a direct comparison. Rheumatology (Oxford) 2021; 60:2773-2782. [PMID: 33232465 DOI: 10.1093/rheumatology/keaa710] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/19/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To evaluate the characteristics of patients (pts) with PsA treated by ustekinumab (UST) or secukinumab (SEK) and to compare real-world persistence of UST and SEK in PsA. METHODS In this retrospective, national, multicentre cohort study, pts with PsA (CASPAR criteria or diagnosis confirmed by the rheumatologist) initiating UST or SEK with a follow-up ≥6 months were included from January 2011 to April 2019. The persistence between SEK and UST was assessed after considering the potential confounding factors by using pre-specified propensity-score methods. Causes of discontinuation and tolerance were also collected. RESULTS A total of 406 pts were included: 245 with UST and 161 with SEK. The persistence rate was lower in the UST group compared with the SEK group [median persistence 9.4 vs 14.7 months; 26.4% vs 38.0% at 2 years; weighted hazard ratio (HR) = 1.42; 95% CI: 1.07, 1.92; P =0.015]. In subgroup analysis, the persistence rate of SEK associated with MTX was significantly higher than that of UST associated with MTX: HR = 2.20; 95% CI: 1.30, 3.51; P =0.001, in contrast to SEK vs UST monotherapy: HR = 1.06; 95% CI: 0.74, 1.53; P =0.75. Discontinuation due to inefficacy was reported in 91.7% (SEK) and 82.4% (UST) of pts. Discontinuation due to an adverse event was reported in 12.2% (SEK) and 7.7% (UST) of pts. CONCLUSION In this first study comparing UST and SEK, the persistence of SEK was higher than that of UST in PsA. In subgroup analysis, this difference was only found in association with MTX.
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Affiliation(s)
| | - Benoît Flachaire
- Service de Rhumatologie, Univ. Aix-Marseille, APHM, Marseille, France
| | - Céline Labadie
- Service de Rhumatologie, Université Bordeaux, CHU Bordeaux, Bordeaux, France
| | - Maéva Kyheng
- ULR 2694 - METRICS: Évaluation des Technologies de santé et Des Pratiques Médicales, Université Lille, France.,Département des Biostatistiques, CHU de Lille, Lille, France
| | - Nicolas Cohen
- Service de Rhumatologie, Univ. Aix-Marseille, APHM, Marseille, France
| | - Jérémie Sellam
- Service de Rhumatologie, APHP, Hôpital Saint Antoine, Sorbonne Université, CRSA Inserm UMRS_938, Paris, France
| | - Pascal Richette
- Service de Rhumatologie, APHP, Hôpital Lariboisière, Paris, France.,Inserm, UMR-S 1132, Bioscar, Université de Paris, Paris, France
| | - Philippe Dieude
- Service de Rhumatologie, Université de Paris, INSERM UMR1152, Groupe Hospitalier Universitaire Bichat-Claude Bernard, APHP, Paris, France
| | - Pascal Claudepierre
- Ep, iDermE, EA7379, Université Paris Est Creteil, Creteil, France.,Department of Rheumatology, Hopital Henri-Mondor, AP-HP, Creteil, France
| | - Bruno Fautrel
- Service de Rhumatologie, Hôpital Pitié, Sorbonne Université, AP-HP, Paris, France
| | - Eric Houvenagel
- Service de Rhumatologie, Institut Catholique de Lille, Hôpital Saint Philibert, Ghicl, Lomme, France
| | | | | | - Nicolas Segaud
- Service de Médecine Interne, CH Armentières, Armentières, France
| | | | - Xavier Deprez
- Service de Rhumatologie, CH Valenciennes, Valenciennes, France
| | - Jean-Hugues Salmon
- Service de Rhumatologie, Université Reims, Champagne-Ardenne, CHU Reims, Reims, France
| | - Guy Baudens
- Cabinet, Libéral de Rhumatologie, Valenciennes, France
| | | | - Elisabeth Gervais
- Service de Rhumatologie, Université de Poitiers, CHU Poitiers, Poitiers, France
| | | | - Pierre Lafforgue
- Service de Rhumatologie, Univ. Aix-Marseille, APHM, Marseille, France
| | - Peggy Philippe
- Service de Rhumatologie, Université Lille, CHU Lille, Lille, France
| | - Damien Loeuille
- Service de Rhumatologie, Université de Poitiers, CHU Poitiers, Poitiers, France
| | - Christophe Richez
- Service de Rhumatologie, Université Bordeaux, CHU Bordeaux, Bordeaux, France
| | - Florence Tubach
- Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Institut Pierre Louis d'Epidémiologie et de Santé Publique, Hôpital Pitié Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Thao Pham
- Service de Rhumatologie, Univ. Aix-Marseille, APHM, Marseille, France
| | - René-Marc Flipo
- Service de Rhumatologie, Université Lille, CHU Lille, Lille, France
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Smolen JS, Siebert S, Korotaeva TV, Selmi C, Bergmans P, Gremese E, Joven-Ibáñez B, Katsifis G, Noël W, Nurmohamed MT, Richette P, Sfikakis PP, de Vlam K, Theander E, Gossec L. Effectiveness of IL-12/23 inhibition (ustekinumab) versus tumour necrosis factor inhibition in psoriatic arthritis: observational PsABio study results. Ann Rheum Dis 2021; 80:1419-1428. [PMID: 34162594 PMCID: PMC8522461 DOI: 10.1136/annrheumdis-2021-220263] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/27/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate 6-month effectiveness of ustekinumab versus tumour necrosis factor inhibitor (TNFi), analysing predictors of low disease activity (LDA)/remission. METHODS PsABio is a prospective, observational cohort study of patients with psoriatic arthritis (PsA) at 92 sites in eight European countries, who received first-line to third-line ustekinumab or a TNFi. Comparative achievement at 6 months of clinical Disease Activity Index for Psoriatic Arthritis (cDAPSA) LDA/remission, and minimal disease activity (MDA)/very LDA using propensity score (PS)-adjusted multivariate logistic regression was assessed. RESULTS In the final analysis set of 868 participants with 6-month follow-up data (ustekinumab, n=426; TNFi, n=442), with long-standing disease and a high mean cDAPSA score (31.0 vs 29.8, respectively), proportions of patients in ustekinumab/TNFi treatment groups achieving cDAPSA LDA at 6 months were 45.7%/50.7%. cDAPSA remission was achieved in 14.9%/19.2%, and MDA in 26.4%/30.8% of patients. PS-adjusted odds ratios (OR; 95% confidence interval (CI)) of reaching cDAPSA LDA and MDA were 0.73 (0.46 to 1.15) and 0.87 (0.61 to 1.25) with ustekinumab versus TNFi, indicating no significant difference. High baseline body mass index or high cDAPSA were associated with a lower chance (OR (95% CI)) of reaching cDAPSA LDA with TNFi (0.94 (0.89 to 0.99) and 0.64 (0.52 to 0.79), respectively). Predictive factors were similar to previously published evidence, with cDAPSA and 12-item Psoriatic Arthritis Impact of Disease scores and chronic widespread pain at baseline appearing as new risk factors for unfavourable outcome. Safety data were similar between groups. CONCLUSION Treatment targets were reached similarly after 6 months of treatment with ustekinumab and TNFi.
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Affiliation(s)
- Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Stefan Siebert
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Tatiana V Korotaeva
- Department of Spondyloarthritis and Psoriatic Arthritis, VA Nasonova Research Institute of Rheumatology, Moscow, Russian Federation
| | - Carlo Selmi
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center IRCCS and Humanitas University, Milan, Italy
| | - Paul Bergmans
- Biostatistics, Janssen-Cilag B.V, Breda, The Netherlands
| | - Elisa Gremese
- Division of Rheumatology, Fondazione Policlinico A Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Gkikas Katsifis
- Rheumatology Clinic, Naval Hospital of Athens, Athens, Greece
| | - Wim Noël
- Medical Affairs, Janssen Pharmaceuticals NV, Beerse, Belgium
| | - Michael T Nurmohamed
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade & VU University Medical Center, Amsterdam, The Netherlands
| | - Pascal Richette
- Service de Rhumatologie, Centre Viggo Petersen Hôpital Lariboisière, Paris, Île-de-France, France.,INSERM UMR-S 1132 Bioscar, Universite Paris Diderot UFR de Médecine, Paris, Île-de-France, France
| | - Petros P Sfikakis
- First Department of Propaedeutic and Internal Medicine, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Kurt de Vlam
- Department of Rheumatology, Universitaire Ziekenhuizen Leuven, Leuven, Belgium.,Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | | | - Laure Gossec
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France.,APHP, Department of Rheumatology, L'Hôpital Universitaire Pitié-Salpêtrière, Paris, France
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5
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Llamas-Velasco M, Baniandrés O, Rivera R, Reymundo Jimenez A, Hospital M, García Zamora E, González-Cantero Á, Andrés Lencina JJ, Daudén E, de la Cueva P. A retrospective, observational multicenter study of 141 patients treated with ustekinumab 90 mg. Dermatol Ther 2020; 33:e13678. [PMID: 32447810 DOI: 10.1111/dth.13678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/04/2020] [Accepted: 05/21/2020] [Indexed: 11/27/2022]
Abstract
A change of pricing policy in Spain have made both doses of ustekinumab (UST), 45 and 90 mg, recently available at the same price. Our primary objective was to evaluate effectiveness of UST 90 mg at 52 and 104 weeks in psoriasis patients in clinical practice; secondary objectives were to study the reasons for using this dose and to delineate its efficacy in patients previously treated with anti-IL17 drugs. 91.8% of the 141 patients treated with UST 90 started with 45 mg and later increased their dose. Clinicians changed dose due to weight over 100 kg in 20.6% of the cases and all the other dose changes were off-label to improve partial cutaneous or articular response or due to a previous failure of anti-IL17 therapy. After 12 months of UST 90 treatment, absolute PASI was lower than 3 in 87.5% of patients and lower than 1 in 72.2%. Efficacy data were even better for patients with body mass index (BMI) <25. UST 90 can be effective in patients with previous use of anti-IL17 drugs. It appears to be an alternative treatment option not only for high BMI patients, but also to increase the cutaneous or articular efficacy of the drug in patients with normal BMI.
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Affiliation(s)
| | | | | | | | | | | | - Álvaro González-Cantero
- Hospital Universitario Ramón y Cajal. Previously at Complejo Hospitalario de Toledo, Madrid, Spain
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Azuaga AB, Frade-Sosa B, Laiz A, Estrada P, Prior-Español A, Horcada L, Polino L, Moreno M, Moragues C, Urruticoechea-Arana A, Sellas A, Tandaipan JL, Torrente-Segarra V, Garcia-Miguel J, Ros I, Ordoñez S, Moya P, Reina D, Mateo-Soria L, Fito C, Beltrán E, Pujol M, Cuervo AM, Cañete JD, Ramírez J. Effectiveness of ustekinumab in patients with psoriatic arthritis in a real-world, multicenter study. Clin Rheumatol 2020; 39:2963-2971. [DOI: 10.1007/s10067-020-05057-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/15/2020] [Accepted: 03/20/2020] [Indexed: 11/30/2022]
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Rossini M, Epis OM, Tinazzi I, Grembiale RD, Iagnocco A. Role of the IL-23 pathway in the pathogenesis and treatment of enthesitis in psoriatic arthritis. Expert Opin Biol Ther 2020; 20:787-798. [PMID: 32129102 DOI: 10.1080/14712598.2020.1737855] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Enthesitis is a key feature of spondyloarthritis (SpA). Several studies have underlined the role of interleukin (IL)-23 in SpA development as a crucial cytokine in the pathogenesis of enthesitis. AREA COVERED This review summarizes recent evidence of the role of IL-23 in the pathogenesis of and as a target of the treatment of enthesitis. We review the definition, diagnosis and clinical impact of enthesitis and its connection with microbial infections, gut dysbiosis, and mechanical stress. We also review clinical trials and real-life studies of drugs targeting the p19 or p40 subunits of IL-23. EXPERT OPINION Novel therapies targeting the p19 or p40 subunit of IL-23 appear to be promising treatment options for patients with enthesitis. Although we are currently unable to identify the best therapeutic window to target IL-23 in SpA disease evolution, the promising ability of this therapy to control the gut-entheseal axis is increasing our knowledge of SpA pathogenesis.
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Affiliation(s)
- Maurizio Rossini
- Rheumatology Section, Department of Medicine, University of Verona , Verona, Italy
| | | | - Ilaria Tinazzi
- Unit of Rheumatology, IRCCS Sacro Cuore Don Calabria Hospital , Verona, Italy
| | | | - Annamaria Iagnocco
- Academic Rheumatology Centre, Università Degli Studi Di Torino , Turin, Italy
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8
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Minimal Disease Activity and Patient-Acceptable Symptom State in Psoriatic Arthritis: A Real-World Evidence Study With Ustekinumab. J Clin Rheumatol 2019; 24:381-384. [PMID: 29509560 DOI: 10.1097/rhu.0000000000000751] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND/AIMS Ustekinumab (UST) is a fully human immunoglobulin G1 monoclonal antibody approved for treating moderate to severe psoriasis and, more recently, psoriatic arthritis (PsA) as well. However, information regarding its clinical usefulness in a real-world setting is scarce. We aimed to evaluate the effectiveness and safety of UST in a real-world clinical setting. METHODS This single-center observational study included PsA outpatients (n = 50) treated with UST from March 2015 to March 2017. Only patients who used at least 3 doses of UST were analyzed. The percentage of patients who achieved a minimal disease activity (MDA) response was collected. The impact of the disease was also evaluated according to the recently developed Psoriatic Arthritis Impact of Disease (PsAID) questionnaire. A binary logistic regression multivariate model was performed to look for variables predicting MDA. RESULTS Twenty-seven patients (54%) reached an MDA state. Mean PsAID in MDA group was 3.5 ± 2.9 versus 6.8 ± 5.1 in non-MDA patients (p < 0.001). Among the patients who achieved MDA, 19 (70.4%) had a patient-acceptable symptom state according to the PsAID, whereas only 5 (21.7%) of the 23 patients who did not reach an MDA achieved a patient-acceptable symptom state (p < 0.001). Higher basal Psoriasis Area and Severity Index decreased the odds of achieving MDA (odds ratio [OR], 0.80; 95% CI, 0.65-0.99; p = 0.038), whereas a longer use of UST (OR, 1.52; 95% CI, 1.13-2.06; p = 0.015) and a previous failure to 1 anti-tumor necrosis factor α (OR, 18; 95% CI, 2.52-128.63; p = 0.004) increased this odds. We found no major safety problems. CONCLUSIONS Ustekinumab was effective and safe in this PsA population. Minimal disease activity and PsAID may be useful tools in the evaluation of PsA therapeutic interventions in routine clinical practice.
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Queiro R, Coto-Segura P. Ustekinumab in psoriatic arthritis: need for studies from real-world evidence. Expert Opin Biol Ther 2018; 18:931-935. [DOI: 10.1080/14712598.2018.1504919] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Rubén Queiro
- Rheumatology Division, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
| | - Pablo Coto-Segura
- Dermatology Division, Hospital Alvarez Buylla, Mieres, Asturias, Spain
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10
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Thibodaux RJ, Triche MW, Espinoza LR. Ustekinumab for the treatment of psoriasis and psoriatic arthritis: a drug evaluation and literature review. Expert Opin Biol Ther 2018; 18:821-827. [PMID: 29949399 DOI: 10.1080/14712598.2018.1492545] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Psoriasis (PsO) is an inflammatory disorder characterized by proliferation of keratinocytes, and it may be associated with a systemic inflammatory articular disorder, psoriatic arthritis (PsA). The presentations of PsO and PsA are heterogeneous, and our understanding of pathogenesis has led to a better understanding of the role of the interleukin (IL)-23/T-helper 17 (Th17) axis. Areas covered: Ustekinumab is a monoclonal antibody against IL-12 and IL-23. The pathogenesis of PsO and PsA is a multifactorial process involving genetic, environmental, and lifestyle factors. IL-23 signaling and activation of Th17 cells leads to a self-perpetuating inflammatory loop resulting in continuous keratinocyte proliferation and synovitis. Treatment options are varied, ranging from topical therapy to injection of targeted biologic disease-modifying antirheumatic drugs (bDMARDs). Evidence on the use of ustekinumab in the management of PsO is strong, but it is not as impressive in management of PsA. Expert opinion: IL-12/23 inhibition appears to be a good first-line option for plaque PsO, but efficacy in PsA does not compare favorably to IL-17 inhibition. In general, poorer responses to therapy with any bDMARD in PsA cohorts highlight psoriatic disease heterogeneity. Until new knowledge can remedy the failure of monotherapy, synergistic methods may have to be explored, including combination biologic therapy.
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Affiliation(s)
- Ross J Thibodaux
- a Section of Rheumatology, Department of Internal Medicine , LSU Health Sciences Center at New Orleans , New Orleans , LA , USA
| | - Mallory W Triche
- b Clinical Pharmacy Department , Thibodaux Regional Medical Center , Thibodaux , LA , USA
| | - Luis R Espinoza
- a Section of Rheumatology, Department of Internal Medicine , LSU Health Sciences Center at New Orleans , New Orleans , LA , USA
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Costanzo A, Malara G, Pelucchi C, Fatiga F, Barbera G, Franchi A, Galeone C. Effectiveness End Points in Real-World Studies on Biological Therapies in Psoriasis: Systematic Review with Focus on Drug Survival. Dermatology 2018; 234:1-12. [DOI: 10.1159/000488586] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/17/2018] [Indexed: 12/26/2022] Open
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Roberts J, O'Rielly DD, Rahman P. A review of ustekinumab in the treatment of psoriatic arthritis. Immunotherapy 2018; 10:361-372. [DOI: 10.2217/imt-2017-0149] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Psoriatic arthritis is an inflammatory arthritis associated with psoriasis. The IL-23/IL-17 axis is an important pathway in the development of psoriatic disease. Ustekinumab is a fully human monoclonal IgG1 antibody that binds to the p40 subunit of IL-12 and IL-23, which, in turn, inhibits downstream signaling pathways. PSUMMIT-1 and PSUMMIT-2 are two pivotal Phase III trials demonstrating global improvement in primary and secondary outcomes including inhibition of radiographic progression. Therapeutic benefit of ustekinumab for synovitis appears independent of previous disease modifying antirheumatic disease or anti-TNF exposure. At present, the data support the use of ustekinumab in the treatment of psoriatic arthritis after the failure of NSAIDs and conventional disease modifying antirheumatic diseases as an alternative to, or after failure of an anti-TNF agent.
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Affiliation(s)
- Janet Roberts
- Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Darren D O'Rielly
- Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland & Labrador, Canada
| | - Proton Rahman
- Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland & Labrador, Canada
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Drug survival and effectiveness of ustekinumab in patients with psoriatic arthritis. Real-life data from the biologic Apulian registry (BIOPURE). Clin Rheumatol 2018; 37:667-675. [PMID: 29411182 DOI: 10.1007/s10067-018-3989-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 01/06/2018] [Accepted: 01/12/2018] [Indexed: 02/04/2023]
Abstract
This study aims to evaluate the drug survival and effectiveness of ustekinumab in psoriatic arthritis (PsA) patients naïve to biologics or inadequate responders to tumor necrosis factor (TNF-IR) inhibitors in real life. PsA patients starting ustekinumab were enrolled from 2014 to 2016. Joint involvement, peripheral or axial, Psoriatic Area Severity Index, Disease Activity Psoriatic Arthritis (DAPSA), Lee Enthesitis Index, Health Assessment Questionnaire, body mass index, comorbidities, co-therapies, mechanism of action, and causes of discontinuation of prior TNFi were collected at baseline, and 6 and 12 months. Twelve-month drug survival was evaluated by Kaplan-Meier curves. Hazard ratios (HRs) of drug discontinuation adjusted for baseline factors were estimated by multiple Cox regression analysis. Percentages of DAPSA-based remission, as crude value and adjusted for drug retention (LUNDEX index), were compared by χ2 test. Mean differences of DAPSA from baseline to 6 and 12 months were compared between naïve and TNF-IR patients by ANOVA. Of 160 PsA patients starting ustekinumab, 54 were naïve and 106 were TNF-IR. Twelve-month drug survival was significantly higher in naïve (87%) than in TNF-IR (68%, p = 0.01). Baseline co-therapy with methotrexate did not increase the persistence on ustekinumab. Naïve patients had the lowest risk of ustekinumab discontinuation (HR 0.27, p = 0.01), and the highest DAPSA-based remission (34%, LUNDEX 26%). Mean differences from baseline of DAPSA was significantly greater in naïve than in TNF-IR patients at 12 months (- 14.4 ± 10 vs. - 4.1 ± 17, p = 0.01). Our data showed that ustekinumab has a good effectiveness in real life and the best outcomes are achieved in biologic-naïve PsA patients.
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14
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Effectiveness and safety of ustekinumab in naïve or TNF-inhibitors failure psoriatic arthritis patients: a 24-month prospective multicentric study. Clin Rheumatol 2018; 37:397-405. [DOI: 10.1007/s10067-017-3953-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 12/05/2017] [Accepted: 12/12/2017] [Indexed: 01/18/2023]
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