TNFi (tumor necrosis inhibitors) and anti-IL-17 therapies are widely used to manage psoriatic arthritis (PsA). In a study that appears in ACR Open Rheumatology, investigators sought to identify characteristics of PsA patients on TNFi or anti IL-17 agents.
Peripheral arthritis and skin were the most common PsA domains observed while axial disease and dactylitis were the least observed. The most common triad of signs was peripheral arthritis, nail psoriasis, and skin psoriasis.
As we would expect, there was an improvement in disease activity across all domains.
Of 1,005 patients, 63% received TNFI and 37% received anti-IL-17 therapies. Patients were collected from a prospective longitudinal observational registry of subjects under the care of a rheumatologist. Patients were treated between 2013-2021. The majority were female and Caucasian. Interestingly, patients with enthesitis and those with axial disease were less likely to remain on therapy. Patients with dactylitis were more likely to continue therapy.
Overall, patients were followed for a relatively short period. It would be useful to see longer duration studies among TNFi and anti-IL-17 patients.
This study is useful in real world practice because it helps support the effectiveness of either therapy in the disease domains of PsA. It would be interesting to see head-to-head data between TNFi and anti-IL-17 therapies. A third of TNFi initiators and a quarter of anti-IL-17 initiators received the medication second line; studies should also be conducted to identify what predisposes patients to respond more to one biologic agent over another.
Sneha Patel, MD, practices rheumatology in Ft. Worth, Texas.