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Psoriatic arthritis
FRI0464 Long-Term Efficacy of Ustekinumab Treatment in Patients Affected by Psoriatic Arthritis Previously Treated with TNF Inhibitors
  1. M.S. Chimenti1,
  2. P. Triggianese1,
  3. A. Ortolan2,
  4. M. Tonelli1,
  5. M. Talamonti3,
  6. L. Costa4,
  7. F. Caso4,
  8. M. Teoli3,
  9. M. Galluzzo3,
  10. R. Ramonda2,
  11. R. Scarpa4,
  12. L. Punzi2,
  13. R. Perricone1
  1. 1Rheumatology, allergology and clinical immunology, Department of“Medicina dei Sistemi” University of Rome “Tor Vergata”, Rome
  2. 2Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova
  3. 3Department of Dermatology, University of Rome “Tor Vergata”, Rome
  4. 4Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy

Abstract

Background IL12 and IL23 are two main cytokines involved in the pathogenesis of immune-mediated diseases. IL-12 is produced by macrophages and B lymphocytes and mediates differentiation of Th1 lymphocytes, while IL-23 is a pro-inflammatory cytokine essential for the differentiation of Th17 cells. Ustekinumab is a human monoclonal antibody directed against the p40 protein subunit shared by IL-12 and IL-23, blocking the signal transmission of both cytokines involved in the pathogenesis of both Psoriasis (PsO) and Psoriatic Arthritis (PsA)

Objectives Evaluate the long-term efficacy of treatment with Ustekinumab in PsA patients previously treated with TNF inhibitors (TNF-i) in real life

Methods We prospectively evaluated patients with PsO and moderate-severe PsA, who were treated with Ustekinumab after the failure of previous TNF-i therapies, in the period January 2013 -December 2015. Clinimetric scores (PASI, DAS44CRP, Pain VAS, Clinicians' VAS, and HAQ) were assessed and biochemical values (ESR, CRP, glucose, cholesterol, uric acid) were measured at baseline (T0) and after 6 (T6), 12 (T12) and 24 (T24) months. Differences between variables were analysed with paired T test (P<0.05 as significant)

Results 36 patients (61% men; age (mean±DS): 49.7±11.4) treated with ustekinumab were evaluated (Figure 1A). In 6/36 (16.7%) patients treated with ustekinumab for <12 months (mean duration: 7.5 months), a significant reduction of PASI (P=0.02) and Pain VAS (P=0.04) was observed after 6 months of treatment. In patients treated continuously for 12 months, a significant reduction of PASI (P<0.0001), DAS44 (P=0.008), ESR (P=0.03), CRP (P=0.04), and HAQ (P=0.002) was achieved. At T24, a persistent reduction of PASI (P<0.0001), DAS44 (P=0.04), and HAQ (P=0.02) with the rspect to T0 (Figure 1B,C,D) was maintained. Prevalence of patients on DMARDs was higher at T0 (83%) compared to the prevalence after the beginning of the ustekinumab therapy (36%). No significant differences in metabolic parameters were observed during the follow-up while a trend in reduction of uric acid resulted (2.8±2.7 at T0 vs 1±2 at T24).

Figure

Conclusions Ustekinumab offers a therapeutic benefit in PsO/PsA patiens who failed TNF-i providing good clinical response both at the skin and joint level.

Disclosure of Interest None declared

https://doi.org/10.1136/annrheumdis-2016-eular.5432

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