AB0787 EFFECTIVENESS OF IL-17 INHIBITORS REVEALED BY MINIMAL DISEASE ACTIVITY (MDA) ACHIEVEMENT OF PSORIATIC ARTHRITIS PATIENTS
Authors: M. Kato, H. Shimada, S. Nakashima, M. Mahmoud Fahmy Mansour, R. Wakiya, T. Miyagi, K. Sugihara, Y. Ushio, T. Kameda, H. Dobashi
Journal: Annals of the Rheumatic Diseases (2020)

Background: Recently, several type of biologics such as TNF inhibitors, IL-17 inhibitors, IL-12/23 (p40) inhibitors and IL-23 (p19) inhibitors are approved for PsA. Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2015 Treatment Recommendation suggests the treat-to-target strategy for PsA 1) , however, this recommendation does not indicate how to determine which biologics to use. Recent reports revealed that IL-17 inhibitors were as effective as TNF inhibitors 2) . On the other hand, based on the Tight Control of Psoriatic Arthritis (TICOPA) study, present treatment strategies for PsA aim to reach on minimal disease activity (MDA) 3) . Objectives: We investigate the effectiveness of IL-17 inhibitors focusing on MDA achievement which were administered for the Psoriatic Arthritis (PsA) patients in our institution. Methods: We examined 46 patients whom were diagnosed and treated in our institution. We analyzed DAS28-CRP as the evaluation of arthritis and Minimal Disease Activity (MDA) achievement as that of overall disease activity. Results: Biologics were administered in 30 cases (65.2%) of all 46 cases. In 30 cases, 19 cases (63.3%) initiated TNF inhibitors (TNFi) and 7 cases (23.3%) were IL-17 inhibitors (naïve group). In 9 cases, TNFi were switched into Il-17 inhibitors (switch group), 7 cases continued TNFi (TNFi group). Patients characteristics in the cases which could collect the data were shown in Table 1. As for arthritis, DAS28-CRP has significantly improved at fourth weeks in naïve and TNFi group. In switch group, DAS28-CRP has not demonstrated significant improvement, however, IL-17 inhibitors were effective for the cases to which they were initiated for arthritis. As for MDA, 71% and 78% have also achieved MDA at twentieth weeks in both naïve and switch groups. In the TNFi group, 67% have not achieved MDA at twentieth weeks because of no improvement of rash (Figure 1). In switch group, all cases to which IL-17 inhibitors were initiated for either arthritis or rash have achieved MDA, however, 40% of cases which were introduced for both arthritis and rash have not achieved MDA. Table 1. Comparison of clinical characteristics at baseline in 3 groups. Il-17 naïve group (n=7 ) IL-17 switch group (n=9 ) TNF group (n=7 ) p value Age, year 60.7 ± 18.9 53.8 ± 15.4 50.7 ± 13.6 N.S Disease duration, year 20.3 ± 25.8 17.4 ± 9.5 9.9 ± 12.4 N.S Male, n (%) 3 (43) 6 (67) 5 (71) N.S MTX, n (%) 2 (29) 4 (44) 5 (71) N.S CRP(mg/dl) 0.41 ± 0.50 1.87 ± 3.13 1.07 ± 1.77 N.S Swollen joint count 6.7 ± 7.3 3.6 ± 4.2 6.2 ± 6.9 N.S Tender joint count 6.6 ± 7.0 2.2 ± 2.6 6.9 ± 9.0 N.S Patient pain VAS 55.7 ± 22.3 47.1 ± 34.9 35.4 ± 13.6 N.S BSA (%) 12.5± 17.3 7.7 ± 14.8 7.4 ± 7.2 N.S Biologics, n Secukinumab: 2 Ixekizumab: 5 secukinumab: 3 Ixekizumab: 5 Brodalumab: 1 Infliximab: 3 Adalimumab:3 Etanercept:1 TNF: Tumor Necrosis Factor, MTX: Methotrexate, VAS: visual analog scale, BSA: body surface area, N.S: not significant Conclusion: In our study, IL-17 inhibitors could bring high rate of MDA achievement for both naïve and switch from TNFi. We suggest that TNFi should be switched into IL-17 inhibitors rapidly in the case of ineffective for TNFi. References: [1]Coates LC, Kavanaugh A, Mease PJ, et al. Arthritis Rheumatol. 2016;68:1060-71. [2]Miyagawa I, Nakayamada S, Tanaka Y. Curr Rheumatol Rep. 2019 20;21:21. [3]Coates LC, Moverley AR, McParland L, et al. Lancet. 2015 19;386:2489-98. Disclosure of Interests: None declared