PracticeUpdate Conference Series World Congress of Dermatology 2019

" Psoriatic arthritis should be considered in all patients with cutaneous psoriasis. I really feel strongly about this. It’s not just the moderate- to-severe [cases]. I’ve had patients come to joint replacement where the only psoriasis I could find was a little on the scalp. "

Another IL-17 inhibitor, bimekizumab, has been shown in a phase II study to pro- duce an ACR20 at 24 weeks in 80% of patients. Dr. Gottlieb compared this with ACR20 rates of 60% with ixekizumab and 57.4% with adalimumab, both of which are currently FDA-approved in the United States for use in psoriatic arthritis. Even more impressive, bimekizumab produced an ACR50 in 70% of patients at week 12. The results of phase III trials are needed before approval of bimekizumab can be considered. “If they confirm the results, that would be moving the bar higher for clinical efficacy in psoriatic arthritis. So, this is one to watch,” said Dr. Gottlieb. A study presented in 2019 at the annual meeting of the European League Against Rheumatism (EULAR) compared ixekizumab and adalimumab head-to- head for psoriatic arthritis in a phase IV, open-label, assessor-blinded study in about 560 patients. The primary endpoint was the proportion of patients achieving both ACR50 and a Psoriasis

Area Severity Index (PASI) 100 at week 24. Ixekizumab was the better performer, with 36% of patients achieving this combined endpoint, compared with 28% of patients taking adalimumab. Ixekizumab was noninferior to adalimumab with respect to ACR50 but superior with respect to PASI 100 (60% vs 40%). Dr. Gottlieb highlighted that improve- ments in skin symptoms are important, as her own research demonstrates that quality of life scores are much higher in patients with psoriatic arthritis when both

their arthritis and their skin symptoms are well-controlled. An upcoming new class of drugs for the treatment of psoriatic arthritis is the IL-23 inhibitor class. In a phase II trial, gusel- kumab resulted in significant control of signs and symptoms of disease in 58% of patients. Results of phase III trials will be available soon. Risankizumab may have less potential, with a phase II study showing 62% achieving ACR20, but with no dose response and no significant improvement in quality of life.

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WCD 2019 • PRACTICEUPDATE CONFERENCE SERIES