medwireNews: Ustekinumab and tumor necrosis factor (TNF) inhibitors lead to similar rates of low disease activity (LDA) when given as first- to third-line therapies in people with psoriatic arthritis (PsA), show results of a European observational study.
“Treatment decisions can be challenging in PsA because of the variety of available drugs, and although efficacy and safety have been demonstrated in [randomized clinical trials], real-world data comparing biologics are limited,” write Josef Smolen (Medical University of Vienna, Austria) and co-authors in the Annals of the Rheumatic Diseases.
To address this, Smolen and team conducted the PsABio study, which prospectively followed 868 people with PsA, from 92 sites in eight European countries, who were initiating treatment with ustekinumab (n=426) or a TNF inhibitor (n=442).
At baseline, disease activity was high in both groups, with mean clinical (c)DAPSA scores of 31.0 points among the people starting ustekinumab and 29.8 points among those starting a TNF inhibitor.
At 6 months, the mean cDAPSA scores had fallen by 13.7 and 14.5 points, respectively, and the proportions achieving the primary outcome of LDA (DAPSA ≤13 points) were a corresponding 49.2% and 54.1%.
In addition, cDAPSA remission (≤4 points) occurred in 17.5% of participants who received ustekinumab and 21.9% of those who received a TNF inhibitor, with a respective 27.0% and 31.9% achieving minimal disease activity (MDA), defined as meeting five of seven individual DAPSA domain cutoffs.
The researchers note that participants in the ustekinumab group were older, had longer disease duration, and were more often on their third line of therapy than those in the TNF inhibitor group. They were also more likely to have more severe skin involvement, comorbidities, and chronic widespread pain.
However, when these differences were accounted for by propensity scoring, the team found no significant difference between the two treatments in the likelihood of achieving LDA or MDA at 6 months.
Safety outcomes were also similar between the two groups, with adverse events (AEs) of any grade occurring in 17.9% of patients in the ustekinumab group and 20.9% of those in the TNF inhibitor group. Serious AEs occurred in 3.5% and 1.6%, respectively.
Smolen et al conclude: “PsABio demonstrated that approximately half of all patients but also half of those patients in whom previous therapies had an insufficient response and who received [ustekinumab] or TNF [inhibition] as second- or third-line treatments, can achieve cDAPSA LDA, with many also reaching MDA or remission.”
They add that long-term follow-up data will be published in due course.
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