Dactylitis, enthesitis resolution linked to less pain, fatigue in guselkumab-treated PsA
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Key takeaways:
- Patients who achieved enthesitis resolution were more likely to have improvements in pain and physical function.
- Those with dactylitis resolution also demonstrated improvement in fatigue.
Patients with psoriatic arthritis who use guselkumab are more likely to experience meaningful improvements in fatigue and pain if they achieve resolution of enthesitis or dactylitis, according to data published in Clinical Rheumatology.
“Both enthesitis and dactylitis are associated with more severe disease and are often difficult to treat, thereby producing significant disease burden for PsA patients and challenges to clinicians treating patients with these manifestations,” Proton Rahman, MD, FRCPC, of Memorial University of Newfoundland, in Canada, and colleagues wrote.
“In patients with active disease enrolled in DISCOVER-1 (both biologic-naïve and -experienced patients) and DISCOVER-2 (biologic-naïve patients), significant improvements in the signs and symptoms of PsA were noted at week 24 following treatment with guselkumab 100 mg administered either every 4 weeks (Q4W) or at weeks 0 and 4 and then every 8 weeks (Q8W) compared with placebo,” they added. “Durable efficacy was observed across multiple PsA domains, including enthesitis and dactylitis, through week 52 and week 100.”
To investigate links between enthesitis and dactylitis resolution and improvements in patient reported outcomes in biologic-naïve patients with PsA treated with guselkumab (Tremfya, Janssen), Rahman and colleagues conducted a post hoc analysis of data from DISCOVER-2. According to the researchers, DISCOVER-2 was a phase 3, multicenter, randomized, double-blind, placebo-controlled study of the efficacy and safety of guselkumab in biologic-naïve patients with active PsA.
The researchers measured enthesitis and dactylitis using the Leeds Enthesitis Index and Dactylitis Severity Score. Meanwhile, patient-reported outcomes were assessed via the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue), a 100-point visual analogue scale for pain, the Health Assessment Questionnaire-Disability Index (HAQ-DI) for physical function, and a 36-item Short-Form Health Survey (SF-36) for health-related quality of life.
Minimal pain was defined as an absolute score of 15 or less on the pain scale, normalized physical function was defined as an HAQ-DI score of 0.5 or less, and response on the SF-36 was defined as an improvement of five or more points. Links between enthesitis or dactylitis resolution and outcomes were analyzed using a Chi-square test.
At weeks 24, 52 and 100, patients with enthesitis resolution were more likely than those without to achieve minimal pain (P < .001), normalized physical function based on the HAQ-DI (P < .001), and a response on the physical component summary of the SF-36 (P < .05), according to the researchers. In addition, patients who achieved dactylitis resolution were more likely to demonstrate FACIT-Fatigue response at weeks 24 and 52 (P for both .03), as well as minimal pain at week 24 and normalized HAQ-DI at week 52 (P for both .03).
“These results indicate that [enthesitis resolution] and [dactylitis resolution] with guselkumab treatment may also lower the overall burden of disease as measured by meaningful responses in fatigue, pain, function and [health-related quality of life] in PsA patients,” Rahman and colleagues wrote.
“While improvement in [patient-reported outcomes (PROs)] would be expected to accompany resolution of these important aspects of disease, the distinct effects of the two manifestations on specific patient outcomes are noteworthy,” they added. “Future studies will provide insight into potential mechanisms impacting PROs and determining treatment choices by PsA phenotype.”
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