Patients With Psoriasis, PsA Benefit From IL Inhibitors Despite Past TNF Inhibitor Use

Patients with psoriasis or psoriatic arthritis (PsA) can benefit from interleukin (IL)-17 and IL-12/23 inhibitor therapy even if they were previously intolerant or had inadequate response to tumor necrosis factor (TNF) inhibitors, suggests study findings published in Clinical and Experimental Dermatology.

Researchers investigated the issue by conducting a systematic review of 7 randomized controlled trials spanning 3398 patients with PsA, 1330 of whom were intolerant or responded inadequately to TNF inhibitors. All 7 studies were considered at low risk of bias.

For IL-17A inhibitors, gains in Psoriasis Area and Severity Index (PASI) responses (PASI 75/90), American College of Rheumatology (ACR) response (ACR 20/50/70), and full resolution of dactylitis/enthesitis were significantly higher compared with placebo.

Nevertheless, lower proportions of patients with previous use of TNF inhibitors achieved the endpoints compared with patients who had never used TNF inhibitors—although differences with TNF inhibitor use were significant only for ACR response and full resolution of enthesitis, according to study authors.

For IL-12/23 inhibitors, studies only reported ACR 20 response. Significantly more patients with previous TNF inhibitor use achieved ACR 20 response with IL-12/23 inhibitors compared with placebo, and differences in treatment efficacy in patients with and without previous TNF inhibitor use were not significant.

“IL-17A and IL-12/23 inhibitors were still efficient for PsA or psoriasis patients who were TNF inhibitor-failed or intolerant,” concluded Yan Xie of Sichuan University and Yang Liu of Tsinghua University in China. “However, the efficacy was lower than that in TNF inhibitor-naïve patients. And more studies are warranted to elucidate relevant problems.”

Reference:
Xie Y, Liu Y. Would previous use of TNF inhibitors affect the therapeutic effect of IL-17 or IL-12/23 inhibitors on psoriasis and psoriatic arthritis: results from a systematic review. Clin Exp Dermatol. Published online April 24, 2022. doi:10.1111/ced.15237