Biologics and Advanced Therapies in the Management of Psoriatic Arthritis - Episode 12

Impact of IL-23 Inhibitors on Pain and Fatigue in PsA

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Anthony M. Turkiewicz, MD: Hillary, going back to the BASDAI [Bath Ankylosing Spondylitis Disease Activity Index] from the DISCOVERY trials, how should that be interpreted? Is there relevance in your clinical practice?

Hillary E. Norton, MD: This is a different approach because we’re not using some of the direct investigator-driven assessments of spondylitis. BASDAI is a patient survey, and we’re asking questions about fatigue, about spine pain, joint pain, enthesitis, and duration and severity of morning stiffness. This is something that’s been validated, and we commonly use this in our clinics even when we’re not doing clinical trials. The numbers looked good. I mean, this is an interesting way of doing things, particularly when we looked at the BASDAI 50; that’s a more stringent outcome measure. We’re looking at a 50% improvement, and about twice as many of the patients getting guselkumab had achieved that BASDAI 50. This is intriguing. This is not a complete look at sacroiliitis or axial involvement by any means, but this gives us some reassurance when we have patients with that domain of activity, and we can address that.

Anthony M. Turkiewicz, MD: That’s helpful. John, just a quick comment. It seems as if we’re bringing up the fatigue scores, and yes, this is unique in these studies. This was in the label. Specifically for pain and fatigue and with the recognition of rheumatologists’ experience with IL-23s in the clinic outside clinical trials may be somewhat limiting because of the recent approval for PsA [psoriatic arthritis]. Specifically for fatigue and maybe for pain as well, how do the clinical trial outcomes for pain and fatigue relate to your experience so far with using IL-23 inhibitors in your patients with PsA? Is there a correlation from what you saw in the trials vs what you see in the clinic?

John Tesser, MD: You laid the groundwork here. This drug was approved for PsA only in early July.The amount of experience that I’ve had has been relatively limited. I was an investigator in the trials, and therefore I can comment about the open-label phase where I knew the patients were getting the drug and how they were feeling and rating these elements, and they were doing very well. It’s going to take another amount of time if we’re going to be able to comment about these issues in terms of the population that we’re seeing clinically. Hillary, have you had more of an opportunity to see patients on the drug?

Hillary E. Norton, MD: Yes. I have a number of patients on the drug, and the thing that really struck me first was the skin clearance. My first patient who took this drug was a young man in his 30s, and he had had psoriasis his entire life. He never remembered not having psoriasis, and he had been on several agents. When I told him I thought we could get his skin cleared, he didn’t really believe me. He came back, and on his first visit his skin was clear and he was just amazed. That was my first experience with it, the rapid skin clearance. Since then we’ve had good results with joints as well. I’m liking the safety, particularly during this time, when patients are really even more concerned about infection than ever. This is very timely for us to have this option.

Transcript Edited for Clarity