Patients with Psoriatic Arthritis from a Phase 4 Head-To-Head Study Stratified by Nail Involvement

Objectives Nails are a challenging body area to treat in patients (pts) with psoriatic arthritis (PsA).[1] In this analysis, we sought to understand whether baseline (BL) nail involvement is an important indicator of treatment response in pts with PsA from the SPIRIT-H2H ( NCT03151551 ) study. Methods This descriptive post hoc analysis included 565 pts with PsA from SPIRIT-H2H treated with either ixekizumab (IXE), an IL-17A inhibitor, or adalimumab (ADA) with Nail Psoriasis Severity Index (NAPSI)>0 or NAPSI=0 at BL. All pts satisfied the CASPAR classification criteria guidelines for PsA.[2] Parameters assessed included Disease Activity in Psoriatic Arthritis-low disease activity (DAPSA-LDA), Psoriasis Area Severity Index (PASI) 90 and 100, Minimal Disease Activity (MDA; calculated with PASI instead of BSA), swollen (SJC) and tender joint count (TJC), SF-36 Physical (PCS) and Mental (MCS) Component Summary score, and Dermatology Life Quality Index (DLQI). Non-responder imputation was used to handle missing data. Results Of the 565 pts at BL, 368 had nail involvement (NAPSI>0) and 197 had no nail involvement (NAPSI=0). BL characteristics were similar for age and body mass index, with differences based on nail involvement at BL evident for sex, duration of symptoms since PsA onset, SJC and TJC, and PASI score, which were higher in pts with nail involvement. Pts with nail involvement at BL demonstrated higher SJC and TJC improvement vs those without involvement at W12, W24 and W52 following treatment with IXE and ADA compared to patients without nail involvement at BL (Table). IXE achieved rapid response for DAPSA-LDA as early as W12 (59.7%) and maintained this response up to W52 (64.4%). For PASI 90 and MDA, IXE achieved a more rapid and higher response rates compared to ADA in pts with and without nail involvement at BL (Table). In pts with nail involvement, IXE demonstrated improvement in SF-36 MCS and PCS as early as week 12 and maintain up to week 52 compared to ADA (Table). Table. Response rates up to W52 by baseline nail involvement Conclusion IXE and ADA both showed numerically greater SJC and TJC reduction in those with nail disease. Further, IXE and ADA both demonstrated joint improvement in pts with and without nail involvement at BL. In the subset of pts with BL nail involvement, numerically higher proportions of pts treated with IXE compared to ADA achieved DAPSA-LDA, PASI 90, MDA, and SF-36 as early as W12, and sustained up to W52. [1.] Kirkham B. Rheumatol Ther 2023;10(5):1127-46. [2.] Taylor C. Arthritis Rheum 2006;54(8):2665-73.

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