Interleukin Inhibitors Effective Among TNFi-Exposed Patients With PsA

Interleukin (IL)-17A and IL-12/23 inhibitors remained efficient in the treatment of psoriatic arthritis (PsA) or psoriasis among patients who had been exposed to tumor necrosis factor inhibitor (TNFi) agents, researchers found in a systematic review of randomized controlled trials.

The team reviewed Psoriasis Area and Severity Index (PASI) responses (PASI75/90); the American College of Rheumatology (ACR) response criteria (ACR20/50/70); and full resolution of dactylitis/enthesitis to assess the effectiveness of treatment with interleukin inhibitors. In 7 studies, 1330 out of 3398 patients with PsA were found to have been intolerant of anti-TNF agents or had inadequate response.

IL-17A inhibitors achieved study endpoints at a significantly higher rate than placebo, the research team noted. Although the proportions of patients who achieved endpoints were lower among TNFi-experienced patients that in TNFi-naïve patients, the differences between these groups were statistically significant only for ACR responses and complete resolution of enthesitis. Among patients treated with IL-12/23 inhibitors—for whom only ACR20 responses were reported— differences in treatment efficacy between TNFi-experienced patients and TFNi-naïve patients was not significant and both were significantly superior to placebo.

The authors concluded, “IL-17A and IL-12/23 inhibitors were still efficient for PsA or psoriasis patients who were TNFi-failed or intolerant. However, the efficacy was lower than that in TNFi-naïve patients. And more studies are warranted to elucidate relevant problems.”

—Rebecca Mashaw

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