Regarding drugs acting through new pathways, Dr. Ruderman said these have been “the most exciting thing in this space.”
Ustekinumab
The monoclonal antibody ustekinumab, targeting the pb40 subunit present in both IL12 and IL23, produced good ACR responses, with a “decent” skin response, he said. In this instance, the key target is IL23.3
“The advantage to this drug for skin disease is you give it every three months, so it’s a really convenient drug,” he said. It also showed radiographic benefit.
Ixekizumab & Secukinumab
Both of these IL17 inhibitors produce highly impressive results in skin, with 80–90% improvement in some cases, Dr. Ruderman said. They also have been found to work in enthesitis and dactylitis.
For secukinumab, Dr. Ruderman said, “Patients who have been on a TNF [inhibitor] are a bit less likely to respond to the 150 mg dose than the 300 mg dose. Both doses are approved for the treatment of psoriatic arthritis, but probably the higher dose is going to be the more appropriate dose in that population of patients.”
The trial, presented recently at the 2017 ACR/ARHP Annual Meeting in November, was the first with this agent to show radiographic improvement in patients who hadn’t received IV loading first, he said.
On the Horizon
Drugs that are even newer, but not as far down the road toward approval, include bimekizumab, which targets both IL17A and IL17F to yield deeper inhibition, and the IL23 inhibitors risankizumab and guselkumab.
With all these new therapies, more data are needed to sort through what can be confusing options, Dr. Ruderman said. “We need good comparative efficacy studies. We’re beginning to get that in rheumatoid arthritis. We’re behind the eight ball here. We need that for sure. We’ve got good drugs. … We need to know how to use them.”
Thomas R. Collins is a freelance writer living in South Florida.
References
- Nash P, Ohson K, Walsh J, et al. Early and sustained efficacy with apremilast monotherapy in biological-naïve patients with psoriatic arthritis: A phase IIIB, randomised controlled trial (ACTIVE). Ann Rheum Dis. 2018 May;77(5):690–698.
- Mease P, Hall S, FitzGerald O, et al. Tofacitinib or adalimumab versus placebo for psoriatic arthritis. N Engl J Med. 2017 Oct 19;377(16):1537–1550.
- Ritchlin C, Rahman P, Kavanaugh A, et al. Efficacy and safety of the anti-IL-12/23 p40 monoclonal antibody, ustekinumab, in patients with active psoriatic arthritis despite conventional non-biological and biological anti-tumour necrosis factor therapy: 6-month and 1-year results of the phase 3, multicentre, double-blind, placebo-controlled, randomised PSUMMIT 2 trial. Ann Rheum Dis. 2014 Jun;73(6):990–999.
