Dr. Joseph Merola discusses new and promising investigational treatment options for psoriasis patients with psoriatic arthritis.
Joseph F. Merola, MD, MMSc, Associate Professor, Harvard Medical School; Vice Chair of Clinical Trials and Innovation; Director, Center for Skin and Related Musculoskeletal Diseases, Departments of Dermatology and Medicine, Division of Rheumatology, Brigham and Women’s Hospital, Boston.
“Dermatologists really can’t choose the right therapy for psoriasis without first knowing whether a patient has psoriatic arthritis or not,” said Joseph F. Merola, MD, MMSc, who presented “What’s New in Psoriatic Arthritis,” at this year’s Masterclasses in Dermatology.
Dr. Merola reviewed the many approaches for treating patients who have psoriatic arthritis, including a few in the pipeline. But first, he said, dermatologists should take a domain-based approach to treatment.
“We have to understand whether our patient has psoriatic arthritis as well as the ‘flavor’ of disease: peripheral arthritis, axial (or spine) disease, enthesitis, dactylitis, and/or skin and nail disease.”
Rheumatologists have historically treated with anti-tumor necrosis factor (TNF) therapy. Now there’s head-to-head data on other therapies, opening the door to potentially better options, said Dr. Merola.
“For example, we have head-to-head data with interleukin (IL)-17 agents, largely highlighting that the mechanism works as well as our gold standard anti-TNF medication for psoriatic arthritis but with improved outcomes with regard to skin and nail disease, and similar to improved safety profiles.”
There is newer data from the SELECT-PsA 1 and SELECT-PsA 2 trials looking at where the Janus kinase (JAK) inhibitor upadacitinib (RINVOQ, Abbvie) fits into the psoriatic arthritis algorithm, said Dr. Merola. It is particularly helpful for the dermatologist to be aware of the psoriasis skin efficacy data, as well as the benchmark active comparator of adalimumab data that is present in the SELECT-PsA 1 study.1
New phase 2 data looking at deucravacitinib (SOTYKTU, Bristol Myers Squibb), a TYK2 inhibitor that is approved for psoriasis, supports that it may well be an option for psoriatic arthritis patients in the near future,2 said Dr. Merola.
“We looked at long-term efficacy data from some of our IL-23 inhibitors, specifically risankizumab and guselkumab, that is showing not only good efficacy in psoriatic arthritis but also really good, sustained efficacy after one and two years with regard to some important endpoints like American College of Rheumatology 50 (ACR 50) and even MDA, which is a stringent marker of minimal disease activity in psoriatic arthritis.”
Data on bimekizumab, an IL-17 A/F inhibitor, is showing robust efficacy in psoriatic arthritis, as well as some of the highest efficacy data to date in psoriasis, said Dr. Merola.
“Bimekizumab likely will be added to our armamentarium in 2023 for psoriasis in the U.S., and a bit further down the road for psoriatic arthritis.”
Counseling on the “ideal” treatment for the psoriatic disease patient still relies on practicing good medicine and on communication, said Dr. Merola
“In order to treat our patients with psoriatic arthritis well, we have to think about what domain of disease is involved; consider how to align with a patient’s given comorbidities of disease (or risk thereof); and have a shared decision-making moment with our patients around their treatment goals, preferences for topical versus oral versus injectable, etc.”
“We have so many opportunities to have a rewarding therapeutic interaction with our patients and improve their lives in 2023.”
References:
- McInnes IB, Anderson JK, Magrey M, et al. Trial of Upadacitinib and Adalimumab for Psoriatic Arthritis. N Engl J Med. 2021;384(13):1227-1239. doi:10.1056/NEJMoa2022516.
- Mease PJ, Deodhar AA, van der Heijde D, et al. Efficacy and safety of selective TYK2 inhibitor, deucravacitinib, in a phase II trial in psoriatic arthritis. Ann Rheum Dis. 2022 Jun;81(6):815-822. doi: 10.1136/annrheumdis-2021-221664. Epub 2022 Mar 3. PMID: 35241426; PMCID: PMC9120409
Disclosures: Dr. Merola is a consultant and/or investigator for Amgen, Bristol-Myers Squibb, Abbvie, Dermavant, Eli Lilly, Incyte, Novartis, Janssen, UCB, Sanofi-Regeneron, Sun Pharma, Biogen, Pfizer and Leo Pharma.