Psoriatic Arthritis News You Can Use From EULAR 2022
Important research presented at the annual medical conference points to progress on PsA.
Psoriatic arthritis (PsA) is a type of inflammatory arthritis where people experience pain and swelling in joints and at spots where tendons and ligaments attach to the bones. The disease affects roughly one-third of people who have the autoimmune condition psoriasis — roughly 1.5 million people in the United States.
But when it comes to research and medical advances, PsA often falls behind other rheumatic conditions like rheumatoid arthritis (RA).
So it is important that several key studies — including one on a potential new medication — were presented at the annual conference of the European Alliance of Associations for Rheumatology (EULAR), held in early June 2022 in Copenhagen, Denmark, as well as virtually.
Here is key information everyone can take away from these panels:
Doctors have long believed that helping patients get to the point of minimal disease activity (MDA) within the first year of diagnosis is the most important way to help people with the condition have a better quality of life. But until now, there has not been research proving that early achievement of MDA has a lasting impact.
Research presented by a team of Dutch researchers compared quality of life for three years in 243 people with PsA who achieved MDA in the first year with those patients who did not. The people who achieved and sustained their MDA were found to have similar quality of life as those in the general public in all three years of follow-up, while the others, who did not reach MDA, had persistently reduced quality of life.
This study reveals how important it is for doctors and patients to work together to achieve early MDA. But other research presented at EULAR shows how both parties are not always aligned when it comes to treatment goals.
The web-based international survey known as Understanding Psoriatic Disease Leveraging Insights for Treatment (UPLIFT) asked people with PsA and rheumatologists to rank treatment goals, among other questions.
Patients said their top three treatment goals were, in order:
Rheumatologists, however, ranked reducing joint pain third, behind achieving remission and inhibiting progression.
Not surprisingly, then, 87 percent of patients reported in the survey that they did not feel their treatment goals matched that of their current healthcare provider’s.
The researchers emphasize the importance of open communication between patients and their doctors around their treatment goals so they can be aligned.
Two separate randomized, multicenter, phase 3 clinical trials for people with psoriatic arthritis taking the new biologic bimekizumab were presented at EULAR. Both showed favorable results.
Bimekizumab is a monoclonal antibody designed to selectively inhibit two key cytokines in the inflammatory process, 17A (IL-17A) and interleukin 17F (IL-17F).
One of the trials, known as BE OPTIMAL, is an ongoing study involving people who have not had any prior biologic disease-modifying anti-rheumatic drug (bDMARD). The data presented by researchers looked at the interim results at 24 weeks.
The second trial, BE COMPLETE, compared people on bimekizumab with those who have not adequately improved on a prior TNF-inhibitor medication. This research, which was presented by researchers, lasted 16 weeks.
In both trials, a higher proportion of people treated with bimekizumab showed significant improvements in joint symptoms compared with those taking a placebo.
Some 45 percent of those taking the drug achieved minimal disease activity in both studies, compared with 13 percent and 6 percent, respectively, of those on placebos. Joint symptoms, as measured by the primary endpoint of having at least 50 percent or more improvement in the American College of Rheumatology response criteria known as ACR50, improved some 44 percent in both studies (versus 10 percent and 7 percent of placebo-takers, respectively).
The findings of both studies “provide clear evidence supporting the potential of bimekizumab … in the treatment of active psoriatic arthritis," Joseph F. Merola, MD, associate professor at Harvard Medical School in Boston, and a researcher on both studies, said in a statement put out by the drug’s manufacturer, UCB.
The most significant side effects were fungal infections (4.5 percent in those taking the drug compared with 0 percent taking the placebo), inflammation of the nasal cavities known as nasopharyngitis (3.7 percent versus 0.8 percent for placebo), oral candidiasis or thrush (2.6 percent versus 0 percent) and upper respiratory tract infection (2.2 percent versus 1.5 percent).
Bimekizumab is not currently available in the United States. It has been approved for the condition of moderate to severe plaque psoriasis by the European Union and the United Kingdom under the brand name Bimzelx, as well as in Canada and several other countries.
UCB is currently seeking approval for the drug for the indication of plaque psoriasis in the United States.
Scientists don’t know much about how the condition of psoriatic arthritis might differ by race. Even the basic question of whether people of different races or ethnicities have different burdens of this disease has not been clear, which is why scientists at the Perelman School of Medicine at the University of Pennsylvania in Philadephia decided to see if such distinctions appeared in their own PsA patient population.
In research presented at the conference, the researchers examined the records of 742 psoriatic arthritis patients who had at least one outpatient visit during the prior 10 years. The vast majority (80 percent) of these patients were white, with Black patients making up 7 percent, Asian patients 5 percent, and Hispanic patients just over 3 percent.
The researchers recorded disease activity for each patient using a scale known as the Routine Assessment of Patient Index Data 3, or RAPID3 (PDF). This asks patients to rank on a 1-to-10 scale their level of functional impairment, pain, and assessment of their disease. This scale, where a higher score indicates more disease, which was originally developed for rheumatoid arthritis, has been found to be a simple but reliable way to document the status of PsA patients.
Disease activity turned out to be higher for Black people with PsA and Hispanic people with PsA than for white people with PsA.
However, when researchers controlled for such factors as sociodemographic issues, treatment history, and comorbid conditions, among others, the difference was no longer significant for Black patients. Hispanic patients did still have higher levels of disease burden than white patients.
But even this difference is more likely due to socioeconomic factors than anything intrinsically related to race, says study author Junko Takeshita, MD, PhD, assistant professor of biostatistics, epidemiology, and informatics at Penn Medicine in Philadelphia. Perhaps Hispanic patients have more difficulty accessing quality care and so may come to their doctor at a later disease stage, for example, or other social factors might be behind these findings, she says.
Still, understanding which racial and ethnic groups have the highest levels of disease burden is “a first and necessary step in ensuring equitable outcome and care among patients with psoriatic arthritis,” Dr. Takeshita says. Additional studies are still needed to get a handle on all of the myriad factors that might contribute to Hispanics having higher rates of severe disease, she says.
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