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Alascio L, Azuaga-Piñango AB, Frade-Sosa B, Sarmiento-Monroy JC, Ponce A, Farietta S, Gómez-Puerta JA, Sanmartí R, Cañete JD, Ramírez J. Axial Disease in Psoriatic Arthritis: A Challenging Domain in Clinical Practice. Diagnostics (Basel) 2024; 14:1637. [PMID: 39125513 PMCID: PMC11311426 DOI: 10.3390/diagnostics14151637] [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: 06/27/2024] [Revised: 07/24/2024] [Accepted: 07/27/2024] [Indexed: 08/12/2024] Open
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory condition affecting about one-third of individuals with psoriasis. Defining axial involvement in PsA (axPsA) remains debated. While rheumatologists guide clinical practice, consensus on axPsA is still lacking. This paper explores historical and upcoming definitions from the Axial Involvement in Psoriatic Arthritis (AXIS) study, which aims to establish a validated axPsA definition. Epidemiological data reveal diverse axPsA prevalence rates, emphasizing its complex relationship with peripheral arthritis and enthesitis. Unique genetic, clinical, and radiological features differentiate axPsA from ankylosing spondylitis (AS), necessitating refined classification criteria. The recommendations from the Assessment of Spondylarthritis international Society (ASAS) provide valuable guidance due to the limited direct evidence. Emerging therapies, including interleukin-23 (IL-23) inhibitors or Janus kinase (JAK) inhibitors, are under investigation for axPsA. Currently, secukinumab, an interleukin-17 (IL-17) inhibitor, is an evidence-based option for axPsA management. However, given the variability in individual patient responses and disease manifestations, personalized, evidence-based treatment approaches remain essential for optimizing patient outcomes. In the final section, two real-life cases illustrate the challenges in managing axPsA, emphasizing the importance of tailored therapies. Achieving precision in defining axPsA remains a formidable task, making detailed criteria essential for effective strategies and improving patient outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Julio Ramírez
- Arthritis Unit, Rheumatology Department, Hospital Clínic Barcelona, Villarroel Street, 170, 08036 Barcelona, Spain; (L.A.); (A.B.A.-P.); (B.F.-S.); (J.C.S.-M.); (A.P.); (S.F.); (J.A.G.-P.); (R.S.); (J.D.C.)
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Pelechas E, Kaltsonoudis E, Migkos MP, Koletsos N, Karagianni PG, Drosos AA, Voulgari PV. State of the Art Review on the Treatment of Psoriatic Disease. Mediterr J Rheumatol 2024; 35:66-72. [PMID: 38736956 PMCID: PMC11082764 DOI: 10.31138/mjr.040123.sot] [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: 01/04/2023] [Revised: 10/13/2023] [Accepted: 12/04/2023] [Indexed: 05/14/2024] Open
Abstract
Introduction Psoriasis is an inflammatory skin disease that in some cases is accompanied by systemic manifestations. Given the varied clinical manifestations, the term psoriatic disease probably better reflects the clinical picture of these patients. Literature review In most cases, the skin lesions precede joint involvement as well as other potentially involved organs such as the intestine and the eye. Various immune-mediated cellular pathways such as that of TNFα, IL-23, IL-17 as well as other cytokines are involved in the pathophysiology of the psoriatic disease. Future insights A better understanding of the way they interfere with our immune system has led to remarkably better disease control and outcomes. This review aims to highlight the newest treatments for psoriatic disease, which are expected to significantly reduce unmet needs and treatment gaps.
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Affiliation(s)
- Eleftherios Pelechas
- Department of Rheumatology, Medical School, University of Ioannina, Ioannina, Greece
| | | | - Michalis P. Migkos
- Department of Rheumatology, Medical School, University of Ioannina, Ioannina, Greece
| | - Nikolaos Koletsos
- Department of Rheumatology, Medical School, University of Ioannina, Ioannina, Greece
| | | | - Alexandros A. Drosos
- Department of Rheumatology, Medical School, University of Ioannina, Ioannina, Greece
| | - Paraskevi V. Voulgari
- Department of Rheumatology, Medical School, University of Ioannina, Ioannina, Greece
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Mastorino L, Susca S, Cariti C, Sliquini N, Verrone A, Stroppiana E, Ortoncelli M, Dapavo P, Ribero S, Quaglino P. Efficacy of anti-IL-23 and anti-IL-17 after adalimumab failure in psoriatic patients. J Eur Acad Dermatol Venereol 2023; 37:1848-1853. [PMID: 37113043 DOI: 10.1111/jdv.19135] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/05/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Many national guidelines at the European level recommend first-line therapy based on the anti-TNF-alpha adalimumab for treatment of psoriasis and psoriatic arthritis, mainly for economic reasons. Consequently, patients being treated with newer IL-17 and IL-23 inhibitors underwent previous unsuccessful first-line adalimumab-based therapy. OBJECTIVES Evaluate the efficacy and safety of IL-17 and IL-23 inhibitors after treatment with adalimumab compared to adalimumab-naive psoriatic patients. METHODS We retrospectively analysed 1053 psoriatic patients treated with anti-IL17 and anti-IL23 agents, which included 68 and 24 adalimumab-experienced and 399 and 260 bio-naive patients. Efficacy was assessed with mean PASI, PASI90, PASI100, and <3. RESULTS Concerning the achieving of PASI100, PASI90 and PASI < 3 in patients treated with anti-IL17 agents, no significant differences were observed between adalimumab-experienced and bio-naive patients. In patients treated with an anti-IL-23 agent, a faster response was observed in bio-naive patients, with PASI < 3 significantly higher than ADA-experienced patients at 16 weeks (77% vs. 58% p = 0.048). In a sub-analysis that evaluated the performance of anti-IL17 and anti-IL23 agents in adalimumab-experienced patients with a history of secondary failure, no significant differences were found. In multivariate analysis of PASI100, only anti-IL-17 therapy appeared to have a negative impact at 52 weeks (OR: 0.54 p = 0.04) independently of previous treatment. For PASI90, type of treatment and bio-naïve status did not seem to have an impact at any time point. CONCLUSIONS Anti-IL 23 and anti-IL 17 agents are not significantly different in terms of efficacy in bio-naive patients or as second-line therapy after failure with a biosimilar or originator adalimumab.
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Affiliation(s)
- L Mastorino
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - S Susca
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - C Cariti
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - N Sliquini
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - A Verrone
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - E Stroppiana
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - M Ortoncelli
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - P Dapavo
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - S Ribero
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - P Quaglino
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
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Panagiotopoulos A, Koutsianas C, Kougkas N, Moschou D, Bournia VK, Gazi S, Tektonidou MG, Vassilopoulos D, Sfikakis PP, Fragoulis GE. Ixekizumab therapy following secukinumab inadequate response in psoriatic arthritis: a case series focusing on axial disease. Rheumatol Int 2023; 43:969-973. [PMID: 36840819 DOI: 10.1007/s00296-023-05289-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/15/2023] [Indexed: 02/26/2023]
Abstract
There are limited data regarding cycling between interleukin-17 (IL-17) inhibitors in psoriatic arthritis (PsA). We aimed to report the efficacy of an IL-17 inhibitor (ixekizumab-IXE) after inadequate response (IR) of another one (secukinumab-SEC) in patients with PsA. Case series of PsA patients who received IXE after SEC-IR in four rheumatology centers between 1/9/2021 and 1/9/2022 were included. Peripheral arthritis was assessed with disease activity in psoriatic arthritis score (DAPSA) and skin involvement with body surface area (BSA). Axial disease was defined as having both imaging and clinical features and its activity was measured with the ankylosing spondylitis disease activity score (ASDAS). Twenty-four patients (54.2% female, mean [SD] age: 51.6 [14.1]) who were SEC-IR and received IXE either immediately (n = 11) or after ≥ 1 interposed biologic disease modifying anti-rheumatic drug (bDMARD) (n = 13) were included. Patients were followed on IXE for a mean [SD] period of 9.6 [4.9] months. Among patients with peripheral arthritis (n = 24), the mean [SD] DAPSA decreased from 22.8 [8.6] to 13.6 [7.8] during follow-up (p = 0.0001) with 62.5% of patients showing improvement in the DAPSA disease activity categories. For patients with axial involvement (n = 16), a clinically meaningful improvement (Δ ≥ 1.1 in ASDAS) was noted in 50% (8/16), while dactylitis and enthesitis resolution was observed in 60% (3/5) and 83% (5/6) of patients, respectively. Regarding psoriasis, the mean [SD] BSA of involved skin decreased from 8.7 [8.7] to 2.4 [3.3] (p = 0.001). In this case series, treatment with IXE after inadequate response to another IL-17 inhibitor (SEC) was efficacious in a real-world setting in patients with PsA, including axial disease.
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Affiliation(s)
- Alexandros Panagiotopoulos
- Joint Rheumatology Program, First Department of Internal Medicine, Propedeutic Clinic, "Laiko" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Koutsianas
- Joint Rheumatology Program, Second Department of Internal Medicine, "Hippokration" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Kougkas
- Fourth Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitra Moschou
- Rheumatology Department, KAT General Hospital, Athens, Greece
| | - Vasiliki-Kalliopi Bournia
- Joint Rheumatology Program, First Department of Internal Medicine, Propedeutic Clinic, "Laiko" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Sousana Gazi
- Rheumatology Department, KAT General Hospital, Athens, Greece
| | - Maria G Tektonidou
- Joint Rheumatology Program, First Department of Internal Medicine, Propedeutic Clinic, "Laiko" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Vassilopoulos
- Joint Rheumatology Program, Second Department of Internal Medicine, "Hippokration" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros P Sfikakis
- Joint Rheumatology Program, First Department of Internal Medicine, Propedeutic Clinic, "Laiko" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - George E Fragoulis
- Joint Rheumatology Program, First Department of Internal Medicine, Propedeutic Clinic, "Laiko" Hospital, National and Kapodistrian University of Athens, Athens, Greece.
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Lubrano E, Scriffignano S, Perrotta FM. Sequencing of Biologic and Target Synthetic Disease-Modifying Anti-Rheumatic Drugs in Psoriatic Arthritis: Are we Ready to Redefine the Treatment Strategy? A Perspective. Rheumatol Ther 2023; 10:301-306. [PMID: 36495403 PMCID: PMC10011266 DOI: 10.1007/s40744-022-00514-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022] Open
Affiliation(s)
- Ennio Lubrano
- Head of Academic Rheumatology Unit and MoRhe Project, Dipartimento di Medicina e Scienze Della Salute "Vincenzo Tiberio", Università Degli Studi del Molise, Via Giovanni Paolo II, C/da Tappino, 86100, Campobasso, Italy.
| | - Silvia Scriffignano
- Head of Academic Rheumatology Unit and MoRhe Project, Dipartimento di Medicina e Scienze Della Salute "Vincenzo Tiberio", Università Degli Studi del Molise, Via Giovanni Paolo II, C/da Tappino, 86100, Campobasso, Italy
| | - Fabio Massimo Perrotta
- Head of Academic Rheumatology Unit and MoRhe Project, Dipartimento di Medicina e Scienze Della Salute "Vincenzo Tiberio", Università Degli Studi del Molise, Via Giovanni Paolo II, C/da Tappino, 86100, Campobasso, Italy
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Tahir H, Grewal S. Current unmet needs and emerging novel pharmacotherapies in psoriatic arthritis. Expert Opin Pharmacother 2021; 23:417-420. [PMID: 34787511 DOI: 10.1080/14656566.2021.2006184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Hasan Tahir
- Royal Free London NHS Foundation Trust, London, UK.,Division of Medicine, University College London, London, UK
| | - Simran Grewal
- East Surrey Hospital NHS Foundation Trust, Redhill, UK
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