Comorbid psoriatic arthritis may influence the benefit of biologics for psoriasis
Comorbid psoriatic arthritis may influence the clinical response to biologic therapy in patients with plaque psoriasisaccording to new findings.
In data from a non-interventional trial, a team of international investigators found that 7 subgroups of psoriasis patients treated with various pathway-targeted biologics actually reported response rates similar to those of the overall treatment cohort, suggesting a similar rate of efficacy in all biological treatments. agents However, patients with comorbid psoriatic arthritis had up to 10% lower treatment response rates.
Led by Charles Lynde, MD, associate professor of medicine at the University of Toronto, the researchers sought to interpret actual and direct comparative efficacy data between interleukin 17A (IL-17A) inhibitors relative to other biologics approved for the treatment of psoriasis worldwide. 7 clinically relevant patient subgroups.
The Psoriasis Study of Health Outcomes (PSoHO) trial provided 12-week results showing early skin clearance and significant efficacy of IL-17A inhibitors, as seen in randomized controlled trials, which correlated with their results. in the real world compared to other biologics. This new analysis included the following subgroups of patients:
- Age (<65 vs ≥65 years)
- Body mass index (BMI; ≤30 vs. >30 kg/m2)
- Race (white vs Asian)
- Duration of psoriasis disease (<15 vs ≥15 years)
- Psoriatic arthritis comorbidity
- Previous biological use
The investigators presented pairwise comparisons of ixekizumab versus secukinumab, guselkumab, risankizumab, adalimumab, and ustekinuab. The recruited population included 1981 patients.
Only 9% of patients were ≥65 years; 47.1% had been diagnosed with psoriasis ≤15 years ago; almost two-thirds (64.3%) had no biologic treatment at baseline. At baseline, 39% started a biologic IL-17A inhibitor, compared with 61% who started another biologic. The only differences in patient profile between the 2 treatment arms were that there were more patients ≥65 years receiving IL-17A inhibitors (11.5% vs 7.5%) and more patients with psoriatic arthritis (29 .4% vs. 19.4%).
Lynde and colleagues found that, in general, patients receiving IL-17A inhibitors were significantly more likely to achieve the primary endpoints of sPGA 0 or 1 and/or PASI 90, as well as PASI 100, within week 12.
Patients in each of the 7 subgroups achieved consistent treatment response rates at 12 weeks, except for patients with comorbid psoriatic arthritis who were treated with biologics. This population reported 7-10% lower response rates for the primary endpoint.
Indeed, the cohort of patients with comorbid psoriatic arthritis receiving IL-17A inhibitors was 4 times more likely to achieve PASI 100 than the cohort receiving other biologics (OR, 4.0; 95% CI, 2.5 to 6.5). “Further stratification showed that PsA patients in any of the treatment cohorts (but not all individual biologics) had lower unadjusted response rates when biologic-experienced compared with biologic naives,” the researchers added.
The team concluded that despite evidence of variable clinical outcomes among patients with moderate to severe psoriasis, the PSoHO findings indicated relative consistency among biologics, regardless of the demographics and disease characteristics of most patients. the patients.
“Notably, our results indicate that the presence of comorbid PsA may affect a patient’s clinical response to some treatments and that these patients have significantly higher odds of achieving skin clearance at week 12 with anti-IL biologics. -17A compared to other biologics”. they wrote.
The study, “Comparative Efficacy of Biologics in Subgroups of Patients With Moderate-Severe Plaque Psoriasis: Results at Week 12 of the PSoHO Study in a Real-World Setting”, was posted online at Advances in Therapy.