Ixekizumab Significantly Benefits Patients with PsA Plus Nail, DIP Involvement

Christopher Ritchlin, MD, MPH

Credit: University of Rochester Medical Center

Ixekizumab significantly improved quality of life and joint pain compared to adalimumab in patients with psoriatic arthritis (PsA), nail disease and distal interphalangeal joint (DIP) involvement, according to new data.

In findings presented at the Congress of Clinical Rheumatology (CCR) East 2023 Annual Meeting in Destin, FL, this week, a multinational team of investigators reported that the interleukin-17A (IL-17A) inhibitor provided significantly improved benefit to patients with PsA and concomitant nail disease and DIP involvement versus tumor necrosis factor (TNF) inhibitor adalimumab over 52 weeks. The report could help to inform prescribing strategies with regard to the common, burdensome comorbidities associated with PsA.

Led by Christopher Ritchlin, MD, MPH, professor of allergy, immunology, and rheumatology at University of Rochester Medical Center, investigators conducted a post-hoc analysis of the SPIRIT-H2H trial to determine the effects of ixekizumab and adalimumab on the quality of life, function and joint pain of treated patients with PsA and concomitant nail and DIP involvement. Given that two-thirds (65.0%) of SPIRIT-H2H participants had baseline nail psoriasis and 96.2% had simultaneous DIP, the trial population was ideal for their assessment.

“Nail psoriasis is a strong predictor for the development of PsA and may be linked to arthritis in the adjacent DIP,” investigators wrote.

Ritchlin and colleagues included SPIRIT-H2H participants receiving either ixekizumab or adalimumab who had simultaneous nail and DIP involvement in ≥1 digit at baseline. Nail psoriasis was measured by Nail Psoriasis Severity Index (NAPSI) while join involvement was measured by tender or swollen joint count (TJC; SJC) scores.

Investigators additionally measured joint paint via Pain Visual Analogue Scale (VAS), and quality of life by the Dermatology Life Quality Index (DLQI), Health Assessment Questionnaire-Disability Index (HAQ-DI), and Short Form-36 Mental and Physical Component Summary Scores (SF-36 MCS/PCS). Analyses were conducted 9 times from baseline through week 52. They team analyzed joint pain and SF-36 MCS/PCS changes from baseline via mixed effects modeling; they additionally analyzed proportions of patients achieving DLQI ≤1 or HAQ-DI changes of ≥0.35 through a logistics regression.

The assessment included 354 patients (ixekizumab, n = 186; adalimumab, n = 168) with simultaneous baseline NAPSI total score >0 and ≥1-digit DIP involvement. Patients receiving ixekizumab reported a significant mean improvement in joint pain per VAS by week 4, and eventually a greater sustained improvement versus adalimumab at week 52.

Also by week 4, 39.2% of patients receiving ixekizumab reported a DLQI score ≤1, versus just 19.6% of patients receiving adalimumab. By week 52, these proportions were 60.2% and 42.9%, respectively (P <.01). In another quality-of-life outcome, patients receiving ixekizumab reported statistically significant improvements in SF-36 MCS versus the adalimumab arm at weeks 4, 12, and 32; MCS and PCS scores for the patient-reported test were improved with ixekizumab versus adalimumab at each of the 9 analyses through week 52.

Ritchlin and colleagues concluded patients with PsA plus nail and DIP involvement more likely to significantly benefit from ixekizumab in measures of pain and quality of life over a year of treatment.

“In patients with simultaneous nail and DIP involvement in ≥1 digit at baseline, ixekizumab treatment resulted in significant improvements across multiple quality of life measures, and greater improvements in joint pain compared to adalimumab treatment,” they wrote. “This data may help health care providers make clinical decisions concerning the care of PsA in patients with nail and DIP involvement.”

Reference

1. ^{Ritchlin C, Kavanaugh A, Kristensen LE, Merola J, et al. Ixekizumab Significantly Improved Quality of Life and Joint Pain in Patients With Psoriatic Arthritis, Nail Disease and DIP Involvement From SPIRIT-H2H. Paper presented at: Congress of Clinical Rheumatology (CCR) East 2023 Annual Meeting. Destin, FL. May 4 – 7, 2023.}