Advanced therapies show promising results in PsA real-world study

The PRO-SPIRIT study provided compelling real-world evidence on the effectiveness of biological and targeted synthetic DMARDs for psoriatic arthritis (PsA). The results indicate that almost 20% of patients achieved remission, aligning with EULAR recommendations.

While randomised-controlled trials are the gold standard, real-world evidence provides crucial insights into the comparative effectiveness of therapies. As Prof. Dennis McGonagle (University of Leeds, UK) pointed out, there is a lack of real-world studies on advanced therapies in PsA [1]. The multinational, prospective PRO-SPIRIT study aimed to explore the real-world comparative effectiveness of biological or targeted synthetic DMARDs in PsA. Prof. McGonagle reported on treatment effectiveness at 3 and 12 months.

The study included 1,192 participants across 175 sites in 6 countries. The patients’ baseline characteristics and disease activity were similar across treatment groups, except for notable differences in disease duration. Disease duration was longer in participants treated with JAK inhibitors and ixekizumab and shorter in those treated with TNF inhibitors. Participants treated with the 150 mg secukinumab regimen were less bio-experienced with biological or targeted synthetic DMARDs.

IL-17A inhibitors showed significantly greater improvements in clinical Disease Activity Index for PsA (cDAPSA), tender joint counts, and swollen joint counts than IL-12/23 and IL-23 inhibitors at 3 months, indicating a faster response. Ixekizumab was as effective as TNF and JAK inhibitors in improving cDAPSA scores and tender/swollen joint counts at both 3 and 12 months (see Figure). At 12 months, about 20% of the participants achieved cDAPSA remission when treated with ixekizumab and TNF inhibitors compared with 12% of the participants treated with secukinumab, IL-12/23 inhibitors, and IL-23 inhibitors; at 12 months the IL-23 pathway inhibitors were catching up.

Figure: Change from baseline in the clinical Disease Activity for PsA (cDAPSA) [2]



BL, baseline; cDAPSA, clinical disease activity for psoriatic arthritis; IL-I, interleukin inhibitor; IXE, ixekizumab; JAKi, Janus kinase inhibitor; SEC, secukinumab; TNFi, tumour necrosis factor inhibitor.

The PRO-SPIRIT findings underscore the value of real-world evidence in complementing randomised-controlled trials and guiding clinical decisions for PsA management. “Almost 1 in 5 patients achieved remission with ixekizumab and TNF blockers at 12 months, corroborating the EULAR recommendations,” Prof. McGonagle concluded [1,2].

1. Tillet W, et al. Early and maintained comparative effectiveness of five different classes of advanced therapies in a large multinational cohort of real-world PsA patients. LBA0002. EULAR 2024 Congress, 12–15 June, Vienna, Austria.
2. Gossec L, et al. Ann Rheum Dis 2020;79:700-12.

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Posted on 29 July 202429 July 2024