Efficacy and safety of early treatment of patients with skin psoriasis and axial arthritis with IL-17 inhibitors
- Authors: Pereverzina N.O.1, Kruglova L.S.1, Korotaeva T.V.2
-
Affiliations:
- Central State Medical Academy of Department of Presidential Affairs
- V.A. Nasonova Research Institute of Rheumatology
- Issue: Vol 26, No 1 (2023)
- Pages: 13-24
- Section: DERMATOLOGY
- URL: https://journals.rcsi.science/1560-9588/article/view/132591
- DOI: https://doi.org/10.17816/dv114932
- ID: 132591
Cite item
Abstract
BACKGROUND: On average, within 7 years from the debut of skin psoriasis, patients may develop psoriatic arthritis, characterized by a chronic, relapsing progressive course. Early manifestations of psoriatic arthritis may be axial lesions presenting with inflammatory back pain. Currently, many experts are raising the topic of early prescription of genetically engineered biological drugs for axial lesions in order to prevent disability. Members of the GRAPPA expert group (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) currently do not provide specific recommendations for the treatment of axial lesions in psoriatic arthritis. The most commonly used regimens are those for axial spondyloarthritis and ankylosing spondylitis. There are also no treatment regimens for early manifestations of axial lesions in patients with smooth skin psoriasis without an established diagnosis of psoriatic arthritis. All regimens consider axial lesions in patients who have already been diagnosed with psoriatic arthritis. Thus, it is necessary to form interdisciplinary standardized protocols for the management of such patients.
AIM: to investigate the efficacy and safety of IL-17 inhibitors in axial lesions in patients with skin psoriasis.
MATERIALS AND METHODS: A prospective non-interventional comparative multicenter study was conducted in parallel groups of patients with smooth skin psoriasis (n=87). To study the effectiveness of the developed method of therapy, the formation of comparison groups is provided. 3 variants of therapy were analyzed: IL-17A inhibitors (n=21; group 1, main); methotrexate (n=35; group 2, comparison); standard desensitizing therapy was used in group 3 (n=31; control). The distribution into groups was carried out taking into account the severity, prevalence of the skin process (according to PASI, BSA), the quality of life of the patient (according to DLQI), the patient's wishes and the patient's ability to purchase genetically engineered biological drugs.
RESULTS: According to our results, the use of IL-17A inhibitors shows high efficiency: by week 52, 100% of patients reached the level of PASI 75, 90.5% ― PASI 90 and 85.7% ― PASI 100, NAPSI 100 (Nail Psoriasis Severity Index) was observed in 71.4% patients. All patients reported a reduction of pain at 12, 24 and 52 weeks with a mean BASDAI of 5.9 (SD=2.3), 4.1 (SD=1.3), and 2.7 (SD=0.9), respectively. It was found that 90.5% of patients achieved ACR 20 by the end of the study at week 52. The majority of patients (85.7%) achieved remission or low DAPSA disease activity after 24 weeks of therapy. The mean ASDAS at 12, 24, 52 weeks was 3.07 (0.9), 2.2 (1.0), and 2.3 (0.9), respectively.
CONCLUSIONS: Thus, in patients with skin psoriasis and axial lesions, it is recommended to make the earlier prescription of biologic treatment from the group of IL-17 inhibitors in order to prevent the development of severe forms of psoriatic arthritis and human disability.
Keywords
Full Text
##article.viewOnOriginalSite##About the authors
Natalia O. Pereverzina
Central State Medical Academy of Department of Presidential Affairs
Author for correspondence.
Email: natalia.pereverzina@gmail.com
ORCID iD: 0000-0003-1563-9475
SPIN-code: 8923-7850
MD
Russian Federation, 19/1A Marshal Timoshenko street, 121359 MoscowLarisa S. Kruglova
Central State Medical Academy of Department of Presidential Affairs
Email: kruglovals@mail.ru
ORCID iD: 0000-0002-5044-5265
SPIN-code: 1107-4372
MD, Dr. Sci. (Med.), Associate Professor
Russian Federation, 19/1A Marshal Timoshenko street, 121359 MoscowTatiana V. Korotaeva
V.A. Nasonova Research Institute of Rheumatology
Email: tatianakorotaeva@googlemail.com
ORCID iD: 0000-0003-0579-1131
SPIN-code: 9855-5954
MD, Dr. Sci. (Med.)
Russian Federation, MoscowReferences
- Veale DJ, Fearon U. The pathogenesis of psoriatic arthritis. Lancet. 2018;391(10136):2273–2284. doi: 10.1016/S0140-6736(18)30830-4
- Mishina OS, Korotaeva TV, Starodubov VI, Nasonov EL. Incidence of psoriatic arthritis in Russia: Trends at the present stage and prospects. Rheumatol Sci Pract. 2015;53(3):251–257. (In Russ). doi: 10.14412/1995-4484-2015-251-257
- Korotaeva TV, Korsakova YL, Loginova EY, et al. Psoriatic arthritis. Clinical guidelines for diagnosis and treatment. Modern Rheumatol J. 2018;12(2):22–35. (In Russ). doi: 10/14412/1996-7012-2018-2-22-35
- Pereverzina N, Kruglova LS, Korotaeva TV, Lila AA. POS1102 the prevalence of inflammatory back pain in patients with skin psoriasis without psoriatic arthritis. data from dermatological real-world setting. Ann Rheumatic Dis. 2022;81(Suppl 1):879.1–879. doi: 10.1136/annrheumdis-2022-eular.5046
- Kruglova LS, Bakulev AL, Korotaeva TV, et al. Psoriasis. Moscow: GEOTAR-Media; 2022. 328 р. (In Russ).
- Koreshkova KM, Khismatullina ZR. Quality of life in patients with psoriatic arthritis. Vestnik Dermatologii Venerologii. 2021;97(3):56–65. doi: 10.25208/vdv1213
- Jadon D, Sengupta R, Nightingale A. Axial disease in psoriatic arthritis study: defining the clinical and radiographic phenotype of psoriatic spondyloarthritis. Ann Rheum Dis. 2017;76(4):701–707. doi: 10.1136/annrheumdis-2016-209853
- Haroon M, Gallagher P, FitzGerald O. Diagnostic delay of more than 6 months contributes to poor radiographic and functional outcome in psoriatic arthritis. Ann Rheum Dis. 2015;74 (6):1045–1050. doi: 10.1136/ annrheumdis-2013-204858
- Burgers L, Raza K, van der Helm, van Mil AH. Window of opportunity in rheumatoid arthritis--definitions and supporting evidence: from old to new perspectives. RMD Open. 2019;5(1):e000870. doi: 10.1136/rmdopen-2018-000870
- Van Steenbergen H, da Silva JA, Huizinga TW. Preventing progression from arthralgia to arthritis: Targeting the right patients. Nat Rev Rheumatol. 2018;14(1):32–41. doi: 10.1038/nrrheum.2017.185
- Gottlieb AB, Merola JF. Axial psoriatic arthritis: An update for dermatologists. J Am Acad Dermatol. 2020;84:92–101. doi: 10.1016/j.jaad.2020.05.089
- Tillett W, Charlton R, Nightingale A, et al. Interval between onset of psoriasis and psoriatic arthritis comparing the UK Clinical Practice Research Datalink with a hospital-based cohort. Rheumatology (Oxford). 2017;56(12):2109–2113. doi: 10.1093/rheumatology/kex323
- Kruglova LS. Pereverzina NO. Efficiency of early prescription of IL-17 in therapy of axial lesions in psoriatic arthritis. Farmateka. 2021;28(14):22–26. (In Russ). doi: 10.18565/pharmateca.2021.14.22-26
- Coates LC, Kavanaugh A, Mease PJ, et al. Group for research and assessment of psoriasis and psoriatic arthritis 2015 treatment recommendations for psoriatic arthritis. Arthritis Rheumatol. 2016;68(5):1060–1071. doi: 10.1002/art.39573
- Abdulganieva DI, Bakulev AL, Belousova EА, et al. Draft interdisciplinary guidelines for diagnosis, methods for estimation of the degree of activity, for evaluation of therapeutic efficacy, and for use of biological agents in patients with concomitant immunoinflammatory diseases (psoriasis, psoriatic arthritis, Crohn’s disease). Modern Rheumatol J. 2018;12(3):4–18. (In Russ). doi: 10.14412/1996-7012-2018-3-4-18
- Kruglova LS, Hotko AA, Petriy MA. Early appointment of biological therapy of psoriasis. Medical Alphabet. 2019;1(7):25–28. (In Russ).
- Faustini F, Simon D, Oliveira I, et al. Subclinical joint inflammation in patients with psoriasis without concomitant psoriatic arthritis: A cross-sectional and longitudinal analysis. Ann Rheum Dis. 2016;75(12):2068–2074. doi: 10.1136/annrheumdis-2015-208821
- Pantano I, Mauro D, Romano F, et al. Real-life efficacy of guselkumab in patients with early psoriatic arthritis. Rheumatol (Oxford). 2022;61(3):1217–1221. doi: 10.1093/rheumatology/keab509
- Kruglova LS, Lvov AN, Pushkina AV. Risks and predictors of the development of psoriatic arthritis in psoriasis and issues of the early administration of genetically engineered biological products. Klinicheskaya Dermatologiya Venerologiya. 2020;19(3):289–296. (In Russ). doi: klinderma202019031289
- Haibel H, Fendler C, Listing J, et al. Efficacy of oral prednisolone in active ankylosing spondylitis: Results of a double-blind, randomised, placebo-controlled short-term trial. Ann Rheum Dis. 2014;73(1):243–246. doi: 10.1136/annrheumdis-2012-203055
- Chen J, Veras MM, Liu C, Lin J. Methotrexate for ankylosing spondylitis. Cochrane Database Syst Rev. 2013;(2):CD004524. doi: 10.1002/14651858.CD004524.pub4
- Van der Heijde D, Ramiro S, Landewé R, et al. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis. 2017;76(6):978–991. doi: 10.1136/annrheumdis-2016-210770
Supplementary files
![](/img/style/loading.gif)