Current Therapies Help Most PsA Patients Achieve Minimal Disease Activity

George E. Fragoulis

Credit: ResearchGate

A new study found current therapeutic approaches for psoriatic arthritis (PsA) help improve the chronic inflammatory disease—as nearly half of patients had a minimal disease activity status—but unmet needs exist.¹

“Our study provides an accurate picture of the disease activity and rate of achievement of the treatment goals in the modern therapeutic era with non-biologic, biologic, and targeted synthetic agents available,” wrote investigators, led by George E. Fragoulis, from the Joint Academic Rheumatology First Department of Propaedeutic and Internal Medicine from National and Kapodistrian University of Athens in Greece.

Studies have shown patients who reach a minimal disease activity status of PsA during their first year of diagnosis experience better health-related quality of life—and achieving a minimal disease activity status after a year is linked to worse patient-reported outcomes which persist over time.²

Due to limited information in the modern therapeutic era for PsA, investigators conducted a cross-sectional, multi-center, nationwide study of 923 patients to evaluate demographic, clinical, and therapeutic characteristics. The team assessed for data under 6 domains: demographics, disease clinical characteristics, imaging, comorbidities, infections, and treatment.

Participants had a mean age of 57 years (range: 48 – 65 years) and a mean disease duration of 9.5 years. The sample included 55% of females, and the mean BMI was 29.1 kg/m2.

Investigators found many participants had psoriasis before (66.7%) or during (15.9%) their diagnosis of PsA. Moreover, 17.4% of participants had arthritis before psoriasis. The mean time from musculoskeletal symptom onset to PsA diagnosis was 1 (0-3) years.

In the sample, 28.3% and 6.3% had a family history of psoriasis and PsA, respectively. Most patients had limited psoriasis (BSA < 3: 83%), but patients also had enthesitis (48.3%), nail (43%), dactylitis (33.2%), and axial (25.9%) involvement.

“An interesting finding, that could be explained in part by the younger age of PsA patients and the less frequent use of glucocorticoids, was the lower history of serious infections in the PsA compared to the [rheumatoid arthritis] cohort (3.2% vs. 9.6%),” investigators wrote. “This is an important finding that should be considered when making therapeutic decisions in this patient population.”

As for comorbidities, nearly half of the patients had dyslipidemia (42%) or hypertension (45.4%). Additionally, 36.8% were obese, 17% had diabetes, and 22.7% had a depressive disorder.

“[An] interesting finding of our study was that 15% of our patients had hyperuricemia and 1.8% gout, which is an underrecognised comorbidity in the setting of PsA,” investigators wrote.

At the baseline visit, 53.6% of participants reported having treatment with conventional non-biologic agents, the most common being methotrexate (43.4%) at a mean dose of 14.1 mg/week, followed by leflunomide (7.7%), cyclosporine (1.8%), and sulfasalazine (0.8%). About a quarter (25.4%) of participants were on non-biologics alone.

More than half of the patients (60.1%) received biologics. Additionally, 70.6% of participants received tumor necrosis factor inhibitors, and 28.8% received anti-interleukin (IL)-12/23 (20.9%) or anti-IL-17 (7.9%) drugs.

Out of patients treated with biologics, 52.1% received monotherapy. More patients treated with anti-IL-17 or -12/23 agents were on monotherapy (64.2%) compared to patients on TNFi monotherapy (49.4%) (P = .0001).

Participants discontinued biologics either due to inefficacy or drug-related adverse events. Discontinuing a drug due to adverse events ranged from 6.25% for ustekinumab to 28.87% for infliximab.

The DAPSA, assessing median PsA activity, received a score of 6 (IQR, 2.3 – 13.1). Although most patients had minimal psoriasis skin involvement (body surface area < 3: 82.6%), 15.1% had a body surface area involvement of 3 – 10% and 2.4% had a body surface area involvement of > 10. Nearly half (46%) of patients received minimal disease activity status.

Investigators outlined several limitations, including how most patients were followed up in hospitals instead of private practices which impacted the severity of cases, not evaluating newer drugs like IL-23p1 inhibitors as they were not available at the time of the study, and having missing data in some of the parameters.

“These findings, which are close to those reported in other real-world studies and a recent meta-analysis, highlight the success of the newly introduced therapeutic agents and current management approach while at the same time emphasize the need for more efficacious treatment strategies in PsA,” investigators wrote.

^References

1. ^{Fragoulis GE, Papagoras C, Gazi S, et al. Disease Profile and Achievement of Therapeutic Goals in a Modern, Nationwide Cohort of 923 Patients with Psoriatic Arthritis. Mediterr J Rheumatol. 2023;34(4):418-426. Published 2023 Dec 30. doi:10.31138/mjr.301223.dpa}
2. ^{Pine, L. Early Achievement of Minimal Disease Activity Linked to Better Outcomes in Psoriatic Arthritis. HCPLive. January 9, 2023. https://www.hcplive.com/view/early-achievement-of-minimal-disease-activity-linked-to-better-outcomes-in-psoriatic-arthritis. Accessed February 27, 2024.}