Ixekizumab Significantly Improves Symptom Burden in PsA

Sherry Rohekar, MD

Credit: Schulich School of Medicine and Dentistry

Treatment with ixekizumab, a high-affinity monoclonal antibody selectively targeting interleukin (IL)-17A, was shown to significantly improve disease severity and symptom burden among patients with psoriatic arthritis (PsA), according to a study published in ACR Open Rheumatology.¹

“The impact on patients varies depending on presentation and severity and can impair quality of life from both a physical and emotional perspective,” wrote a team of investigators led by Sherry Rohekar, MD, a rheumatologist associated with Western University in Ontario, Canada. “Because of the heterogeneity of presentation, treatment for PsA can be complex.”

Typical treatments include conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) for those with early or mild disease, while advanced therapies include biologic DMARDs (bDMARDs), like ixekizumab, or targeted synthetic DMARDS (tsDMARDs). Treatment decisions are often based on the prevalence and severity of symptoms.²

Data were extracted from the US-based cross-sectional survey—the Adelphi PsA Plus Disease Specific Programme (DSP)—to determine the real-world characteristics and clinical status of adult patients with clinically diagnosed PsA receiving ixekizumab. Information including demographic data, such as age, sex, and employment status, and clinical characteristics, including improving, stable, unstable, or deteriorating clinical status, were provided by rheumatologists. Other data included the current and historic symptom burden, disease severity, treatment history, satisfaction with ixekizumab treatment, and the reasons for treatment choice. Patients were then given the opportunity to complete a questionnaire designed to evaluate perceived symptom burden, disease severity, and treatment satisfaction.

A total of 68 rheumatologists provided information on 275 patients with PsA, 90 of whom completed the survey. The mean treatment time was 11.7 months, and the mean age was 46.8 years. Most (68%) patients were White, 51% were female, and the mean body mass index was 27.5. The most commonly reported comorbidities were depression (21%), hyperlipidemia (20%), hypertension (19%), anxiety (19%), osteoarthritis (16%), and obesity (14%). Most (79%) patients had been previously diagnosed with psoriasis (PsO). Ixekizumab was prescribed as a first-line advanced therapy in approximately half of patients (55%).

After treatment initiation, disease severity, symptom burden, and clinical characteristics were significantly improved, including tender joint counts, swollen joint counts, and body surface area affected by psoriasis (P <.001). Improvements were also observed in pain and fatigue. Between initiation and the most recent consultation, the mean overall number of symptoms decreased from 5.8 to 3.4 (P <.001). Tender joint counts decreased from 12.3 to 2.9, and swollen joint counts decreased from 10.3 to 3.0 (both P <.001).

Although only 2% of patients were classified as having mild PsA at treatment initiation, this number increased to 77% at their most recent consultation (P <.001). Similarly, the percentage of patients with severe PsA at initiation (19%) was reduced to 2% at follow-up.

Both patients and providers were reported being satisfied with ixekizumab treatment. Improvements were described after > 3 months of initiation with no differences noted among those with prior exposure to an advanced therapy and those who were treatment naïve.

Investigators noted limitations including the possibility that more engaged rheumatologists and patients were more willing to complete the survey, which may have somewhat skewed results. Additionally, patients who visit a rheumatologist more frequently are more likely to have more severe disease. As the study only included patients currently treated with ixekizumab, this may have resulted in choosing patients with more favorable outcomes, compared to those who discontinued treatment due to lack of efficacy or side effects.

“These data add to the growing body of real-world evidence demonstrating the effectiveness of ixekizumab for the treatment of PsA,” investigators concluded. “These findings may guide rheumatologists and their patients in making informed treatment choices, particularly regarding the management of both articular and cutaneous symptoms.”

References

1. ^{Rohekar S, Vadhariya A, Ross S, et al. Real-World Treatment Patterns, Clinical Outcomes, and Symptom Burden in Patients With Psoriatic Arthritis Prescribed Ixekizumab in the United States. ACR Open Rheumatol. Published online May 5, 2024. doi:10.1002/acr2.11676}
2. ^{Singh JA, Guyatt G, Ogdie A, et al. 2018 American College of Rheumatology/National Psoriasis Foundation guideline for the treatment of psoriatic arthritis. Arthritis Rheumatol 2019; 71(1): 5–32.}