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Ixekizumab-treated patients with psoriatic arthritis have improved clinical outcomes regardless of number of erosions at baseline, study suggests

Presenter: M. Elaine Husni, MD, MPH, Vice Chair, Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH.

Irrespective of the Number of Erosions at Baseline, Patients with Psoriatic Arthritis Treated with Ixekizumab Show Improved Clinical Outcomes. Abstract 2242. Presented Nov 14, 2023.


Patients with psoriatic arthritis (PsA) treated with ixekizumab showed improved clinical outcomes regardless of the number of erosions at baseline, according to a post hoc analysis of data from the randomized, phase 3 SPIRIT-P1 study and presented at the ACR Convergence 2023.

Irrespective of their baseline erosion score, ixekizumab-treated patients demonstrated more improvement in the achievement of low disease activity and functional outcomes as compared with placebo-treated patients, according to investigator M. Elaine Husni, MD, MPH, vice chair in the Department of Rheumatic and Immunologic Diseases at Cleveland Clinic in Cleveland, OH.

These findings shed more light on the effects of biologic treatment on the course of PsA, a chronic and progressive condition associated with high rates of joint erosions early in the disease, Dr Husni and co-authors said in a poster presentation. However, the relationship between the number of erosions at baseline and response to biological disease-modifying anti-rheumatic drugs (DMARDs) has not been extensively studied, she noted.

“The presence of erosions is considered predictive of joint damage progression, impaired quality of life, and increased mortality rates,” Dr Husni said.

Accordingly, they conducted a post hoc analysis to assess the efficacy of placebo, ixekizumab, or adalimumab on patients with erosions that were visible on hand radiographs.

The post hoc analysis was based on data from SPIRIT-P1 (NCT01695239), a phase 3 trial in which biologic-naive patients with PsA were randomized to ixekizumab 80 mg every 2 weeks or every 4 weeks after a 160 mg starting dose, or adalimumab 40 mg every 2 weeks, or placebo.

Investigators then stratified patients into two groups according to the number of baseline erosions based on modified total Sharp scores. They included 183 patients with baseline erosion scores ≤ 4 and 205 patients with baseline erosion scores > 4.

Week 24 results showed that placebo-treated patients with baseline erosion scores > 4 had worse outcomes compared with those placebo-treated patients with baseline erosion scores ≤ 4. In contrast, ixekizumab-treated patients had a significant improvement in Disease Activity index for PSoriatic Arthritis-Low Disease Activity (DAPSA-LDA), irrespective of baseline erosion score. And in the adalimumab-treated patients, significant response rates were achieved only in patients with baseline erosion scores > 4, they reported.

Turning to the Minimal Disease Activity-Psoriasis Area Severity Index (MDA-PASI), 24-week response rates in patients with baseline erosion scores > 4 were significant with ixekizumab every 2 weeks and with adalimumab. In patients with baseline erosion scores ≤ 4, MDA-PASI response rates were significant in patients treated with ixekizumab every 2 weeks and every 4 weeks.

On the Health Assessment Questionnaire-Disability Index (HAQ-DI), changes from baseline were significant for all biological DMARD-treated patients, regardless of baseline erosion score, investigators said. Likewise, the American College of Rheumatology 50% and 70% response rates were significant across biological DMARD treatments, irrespective of baseline score.

Disclosures

The study was sponsored by Eli Lilly and Company. M. Elaine Husni, MD, MPH, reported serving as a consultant for AbbVie, Amgen, Bristol Myers Squibb, Celgene, Eli Lilly and Company, Janssen Pharmaceuticals, Novartis, and UCB Pharma.

References

Touma Z, Thavaneswaran A, Chandran V, Pellett F, Cook RJ, Gladman DD. Clinical and demographic characteristics of erosion-free and erosion-present status in psoriatic arthritis in a cohort study. J Rheumatol 2016; 43(6):1057-1062. doi:10.3899/jrheum.150466

Gladman DD, Farewell VT, Wong K, Husted J. Mortality studies in psoriatic arthritis: results from a single outpatient center. II. Prognostic indicators for death. Arthritis Rheum 1998; 41(6):1103-1110. doi:10.1002/1529-0131(199806)41:6<1103::AID-ART18>3.0.CO;2-N

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