Hand, whole-body MRI register joint, enthesis improvements from apremilast in PsA
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Key takeaways:
- Hand and whole-body MRI scores registered improvements at weeks 24 and 48 with apremilast for PsA.
- PsAMRIS and MRI-WIPE are “sensitive to treatment response” in patients with PsA.
Hand and whole body MRI can objectively measure improvements in joint and enthesis inflammation resulting from apremilast treatment for psoriatic arthritis, according to data published in The Lancet Rheumatology.
“Apremilast is an oral phosphodiesterase 4 inhibitor that is approved for treatment of psoriatic arthritis,” Mikkel Østergaard, MD, professor of rheumatology at the University of Copenhagen, in Denmark, and colleagues wrote.
“However, the effects of apremilast on imaging outcomes are not yet characterized,” they added. “Furthermore, the effects of apremilast on objective assessments of enthesitis and structural disease progression have not yet been documented.”
To evaluate the effects of apremilast (Otelza, Amgen) treatment on MRI outcomes in patients with PsA, Østergaard and colleagues conducted a phase 4, single-arm, open-label study, called MOSAIC, across 29 sites in 10 countries. The researchers analyzed MRI using the Psoriatic Arthritis Magnetic Resonance Imaging Scoring System (PsAMRIS) for the hand, and the MRI Whole-Body Scoring System for Inflammation in Peripheral Joints and Enthesis in Inflammatory Arthritis (MRI-WIPE) for joints and entheses across the whole body.
The study included 122 adults with active PsA (mean age, 46.6 years; mean disease duration, 1.9 years). The primary endpoint was change in a composite inflammation score including bone marrow edema, synovitis and tenosynovitis, from baseline to week 24, as assessed by PsAMRIS.
Overall, 66% of study participants completed 48 weeks of treatment. From baseline to week 24, the PsAMRIS-assessed composite inflammation score demonstrated a least squares mean change of –2.32 (95% CI, –4.73 to 0.09), according to the researchers. Later, at week 48, the least square means change from baseline increased to –2.91 (95% CI, –5.45 to –0.37).
Meanwhile, in a score of total peripheral inflammation as assessed by MRI-WIPE, the researchers noted statistically significant least square means changes of –3.49 (95% CI, –5.46 to –1.52) from baseline to week 24, and –4.06 (95% CI, –6.39 to –1.72) at week 48.
Regarding safety, more than three-quarters of participants (n = 95) demonstrated at least one treatment-emergent adverse event (TEAE), according to the researchers. Six patients had serious TEAEs, but none were attributed to apremilast.
“We found that patients with psoriatic arthritis who were treated with apremilast had improvements in objective MRI assessments of inflammation after 24 and 48 weeks of treatment based on MRI of the hand and whole body,” Østergaard and colleagues wrote.
“Our results offer important insights into the effect of apremilast on psoriatic arthritis and the value of PsAMRIS and MRI-WIPE as objective measures in psoriatic arthritis, including in the detection of inflammation and structural disease progression, supporting their potential use as tools sensitive to treatment response in patients with psoriatic arthritis,” they added. “Future MRI studies should investigate the effect of different therapies on peripheral and axial inflammation in patients with psoriatic arthritis.”
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