Background Psoriatic arthritis (PsA) is characterised by arthritis, psoriasis, sacroilitis, enthesitis and dactylitis. The efficacy of tumor necrosis factor-α (TNF-α) inhibitor has been demonstrated in different controlled clinical trials and observational studies. However, some patients have inadequate response to TNF-α inhibitors and no alternative mechanism of action is available for those who failed more than one anti-TNF. Ustekinumab is an efficacious treatment for psoriasis and may be useful in patients with active psoriatic arthritis.
Objectives The objective of this study was to assess in Canadian clinical practice the efficacy of ustekinumab in patients with psoriatic arthritis who failed to one or more TNF-α inhibitors agents.
Methods Charts of patients taking ustekinumab at the Centre de Rhumatologie de l'Est du Québec were reviewed and detailed data including demographic information, disease characteristics, 28-joint disease activity score (DAS28-CRP), BASDAI, BASFI, SPARCC and Health Assessment Questionnaire-Disease Index (HAQ-DI) were collected. Descriptive statistics were used to describe patients initiating ustekinumab in this real-world setting.
Results A total of 9 patients starting treatment with ustekinumab were enrolled in this study. Patients have failed an average of 3.66 anti-TNF agents. Overall, DAS28-CRP decreased from 4.39 at baseline to 3.84 at month 12. HAQ-DI decreased from 1.97 to 1.52. BASDAI decreased from 8.16 to 6.9. BASFI decreased from 7.18 to 5.70. SPARCC increased from 2 to 3.66. Mean number of dactylitis decreased from 4.22 to 0. Finally, all patients have improved their psoriasis after 12 months. Two patients discontinued the treatment because of a secondary failure and an adverse event (nausea, low back pain).
Conclusions The present study suggests that ustekinumab improved active psoriatic arthritis and may offer an alternative treatment for patients who failed to respond to their previous anti-TNF. The most impressive effect is the improvement of enthesitis and dactylitis. It is even more interesting that the response was good nevertheless the number who have failed to an anti-TNF. This suggests that another mode of action will probably be a part of the treatment in PsA as it is in rheumatoid arthritis. However, this is an exploratory study and a larger sample is needed for better interpretation.
McInnes et al., 2013. Efficay and safety of ustekinumab in patients with active psoriatic arthritis: 1 year results of the phase 3, multicentre, double-blind, placebo-controlled PSUMMIT 1 trial. Lancet 382:780-789.
Mease, P.J., 2011. Measures of psoriatic arthritis, Arthritis Care and Research, 63(S11): S65-S85
GRAPPA, 2013. Group for Research and Assessment of Psoriasis and Psoriatic Arthritis.
Disclosure of Interest None declared