BALTIMORE—Psoriatic arthritis (PsA) was once dismissed by some as “rheumatoid arthritis with rash.” Despite that attitude, the understanding of PsA, its diagnosis and treatment, and management of comorbidities have come a long way.
At the 18th Annual Advances in the Diagnosis and Treatment of the Rheumatic Diseases, held May 13–14 at the Johns Hopkins School of Medicine, Baltimore, Ana-Maria Orbai, MD, MHS, associate professor of medicine and director of the Psoriatic Arthritis Program at the Johns Hopkins School of Medicine, began the session by discussing the latest medications that have entered the PsA armamentarium.
Risankizumab is an anti-interleukin (IL) 23 monoclonal IgG1 antibody. In January, the U.S. Food & Drug Administration (FDA) approved risankizumab to treat adults with PsA. Unlike some other medications approved to treat PsA and psoriasis, the treatment dose is the same for both conditions. In terms of safety profile, some of the main potential side effects include upper respiratory tract infections, headache, fatigue, injection-site reactions and tinea infections.
The ACR20 and ACR50 response rates to risankizumab are good for the treatment of patients naive to biologics, as well as for patients with prior biologic use, noted Dr. Orbai.
In the KEEPsAKE 1 trial, 964 patients with active PsA who were intolerant to or for whom one or more conventional synthetic disease-modifying anti-rheumatic drug (csDMARD) proved inadequate were randomized to receive 150 mg of risankizumab or placebo at weeks 0, 4 and 16. With a primary end point of an ACR20 response at week 24, the study found a significantly greater proportion of patients receiving risankizumab achieved that end point (57.3% vs. 33.5% for placebo; P<0.001).1 (Note: An ACR20 response is defined as a 20% improvement in the number of tender and number of swollen joints, and a 20% improvement in three of the following five criteria: patient global assessment, physician global assessment, functional ability measure, visual analog pain scale, and erythrocyte sedimentation rate or C-reactive protein level.)
In December 2021, the FDA approved upadacitinib, a Janus kinase (JAK) inhibitor, for the treatment of patients who have had inadequate response to, or are intolerant of, one or more tumor necrosis factor-α (TNF) inhibitors.
Dr. Orbai addressed the FDA boxed warning for JAK inhibitors. This warning notes an increased risk for serious infections, mortality, malignancy, major adverse cardiac events and thrombosis. However, similar to risankizumab, upadacitinib proved beneficial in treating patients naive to biologics or with prior biologic use. Also, data indicate that upadacitinib may slow the radiographic progression of PsA, which is important to prevent joint deformities and impaired function in patients.