Axial PsA therapies fall short of axial SpA surplus due to absent classification criteria
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While there is a cross-section of drugs that are FDA-approved for the treatment of axial spondyloarthritis, clinicians and researchers continue to struggle with axial psoriatic arthritis, according to a presenter at ACR Convergence 2021.
There were two key points for consideration that Atul Deodhar, MD, professor of medicine at Oregon Health & Science University, discussed at the top of his talk. The first was that the boundaries between psoriatic spondyloarthritis or axial psoriatic arthritis, peripheral spondylarthritis and radiographic and non-radiographic axial spondyloarthritis are often unclear and overlapping.
The next point pertained to a slide showing all of the phase 3 trials of biologic therapies and janus kinase inhibitors that have been conducted in radiographic axial SpA, including etanercept (Enbrel, Amgen), infliximab (Remicade, Janssen), adalimumab (Humira, Abbvie), golimumab (Simponi, Janssen), certolizumab (Cimzia, UCB), secukinumab (Cosentyx, Novartis), ixekizumab (Taltz, Eli Lilly & Co.), tofacitinib (Xeljanz, Pfizer) and upadacitinib (Rinvoq, Abbvie).
“The reason I show this slide is to impress upon you that we have lots of good treatments, novel treatments, biologics, JAK inhibitors, to treat ankylosing spondylitis or axial SpA,” he said.
Deodhar also noted that from that list, only tofacitinib and upadacitinib do not yet have FDA approval for this indication. He added that each of these drugs has similar outcomes in terms of ASAS20 criteria.
The list is a bit shorter for drugs to treat non-radiographic axial SpA and includes adalimumab, etanercept, certolizumab, golimumab, ixekizumab and secukinumab. However, Deodhar noted that most of these drugs have yielded strong efficacy as assessed by ASAS40 criteria. “Again, very similar results,” he said. “I do not think we can say one drug is any better than the other.”
Regarding drugs that should be avoided in non-radiographic disease, Deodhar highlighted ustekinumab (Stelara, Janssen) and risankizumab (Skyrizi, Abbvie).
Turning to axial PsA, Deodhar noted that there are fewer options and more challenges. One reason for this is that clinical trials in this condition have been plagued by a number of setbacks, including insufficient information about how individual diagnoses are made. “Classification is very important for enrolling patients into clinical trials,” he said. “No classification criteria were used because none are available – none exist.”
The other issue for axial PsA comes back to Deodhar’s original point about the broad umbrella of these conditions. “We still do not have a good idea of what this disease is,” he said. “We have not really defined it. Once we have defined it, we will have a better idea of whether the therapies that work in axSpA will also work in axial PsA.”
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Deodhar A. Abstract 6S403. Presented at: ACR Convergence 2021; November 5-9, 2021 (virtual meeting).
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