Medicine Matters rheumatology

We know that a lot of patients with psoriatic arthritis continue to complain of symptoms of active disease despite the available therapies. It's been a huge change in the management of psoriatic arthritis over the last two decades. But despite the new advances, we still have a substantial proportion of people who are not obtaining the outcomes that we wish to achieve, and therefore we need further therapeutics and hence one of the reasons for the KEEPsAKE study.

In the study, we looked at risankizumab an IL-23 antibody looking at that versus placebo in the management of active psoriatic arthritis. This was a 24-week analysis that was undertaken, presented here at EULAR, looking at the outcome measures-- the primary outcome measures ACR 20 at week 24, and then the number of secondary outcomes including PROs and functional assessments. And it was pleasing to see that the risankizumab did achieve the primary outcome of a statistically significant difference between risankizumab and placebo at week 24 in relation to the ACR 20 response and all the key secondary outcomes including PROs.

Once the medication is licensed, it will be certainly a significant step forward in the management of psoriatic arthritis. We know that there are a number of different manifestations of the condition, including skin disease, joint disease, and the enthesis, and dactylitis, and as well as all the functional limitations and the patient-reported outcomes that are really meaningful for individual patients.

So once this drug is licensed, it will certainly represent a step forward in the management in all aspects, actually, of the patient's experience of psoriatic arthritis. What was pleasing, which we found in KEEPsAKE 2 study was that whether you'd failed on conventional DMARDs or indeed conventional DMARDs and biologic DMARDs, predominantly anti-TNF therapy, you still gained statistically significant improvement. So really, this drug can be used in a spectrum of patients in those who have either failed conventional synthetic DMARDs or biologic DMARds, and the responses, interestingly, are very similar including those who are on ongoing background conventional DMARDs or those who are not continuing on conventional DMARDs.

One of the main issues, of course, is going to be the longer term data. This was presented here in ULA for 24 weeks, but the study continues on for two years and beyond. That will be the main issue is the efficacy and safety in the long term. However, certainly at this stage is certainly reassuring from the efficacy and the safety perspective that patients respond very well and continue to respond at 24 weeks.