Home Psoriasis Philip Mease, MD, on Which Patients With Psoriatic Arthritis Are Most Likely...

Philip Mease, MD, on Which Patients With Psoriatic Arthritis Are Most Likely to Achieve Optimal Outcomes With Apremilast

248
0

Apremilast is familiar to just about anyone with psoriatic arthritis (PsA), not to mention the clinicians who care for them. Still, it is just one option in a fairly crowded field.

So when might apremilast be a stronger potential option than the alternatives? That’s the question a recent study, published in Arthritis Care & Research, set out to address.

Researchers analyzed data from 1,493 patients from three separate studies; participants were randomized to receive ≥1 dose of placebo (n=496), apremilast 30 mg BID (n=497), or apremilast 20 mg BID (n=500). Following probability analysis, 46.9% of people with moderate disease activity who received 30 mg BID of apremilast achieved either remission or low disease activity after 52 weeks — well above the 24.9% of people who reached the same goals after beginning the study with high disease activity.

Philip Mease, MD, is a rheumatologist with the University of Washington School of Medicine and served as first author of the study. He recently discussed the findings with MedPage Today.

This study evaluated the effects of apremilast on two different treatment targets. What were the specific questions you were hoping to address?

Mease: Because apremilast is one of many therapies available for treating PsA, a need exists to identify subgroups of patients who are most likely to achieve optimal outcomes with apremilast treatment to help guide clinical practice. To address this, it is important to determine which patients are more likely to achieve treatment targets of remission or low disease activity with apremilast.

The study had two layers. The first was to look at the ability of apremilast to achieve desirable treatment targets of low disease activity or remission after 52 weeks as measured by the Clinical Disease Activity for Psoriatic Arthritis (cDAPSA) score. We also used a 16-week threshold to detect earlier activity.

The second layer was to demonstrate the utility of cDAPSA, a relatively easy-to-use measurement tool for PsA, which could be practically used by clinicians trying to follow a treat-to-target approach.

How would you summarize your key findings?

Mease: The key findings for the first question were that nearly half of the study population that was in moderate disease activity and roughly a quarter of the study in high disease activity were able to achieve either low disease activity or remission state at week 52.

If a patient demonstrated at least a 30% improvement in cDAPSA score by week 16, they had a high probability of remaining in these desirable states through week 52.

The cDAPSA proved to be a reliable and practical measure. Although the instrument focuses on joint response, improvements in score were highly correlated with improvements in PsA’s non-arthritis domains, including enthesitis, dactylitis, and skin disease.

You and your colleagues wrote that the new data could provide a “framework of reference” for treating people with PsA. How would you describe that framework?

Mease: A high percentage of patients treated with apremilast are able to achieve and maintain desirable treatment targets of low disease activity or remission. This is especially good to know given the good safety profile of the drug. Patients can feel reassured about using a relatively safe drug and also have a reasonably high expectation of achieving meaningful improvement.

If a patient sees at least a 30% improvement in cDAPSA score by week 16, we can inform them that they can expect that improvement to continue the longer they are on the drug.

On the other hand, if the patient is not demonstrating improvement by week 16, it is legitimate to consider alternative therapies.

You can read the abstract of this study here and expert commentary on the clinical implications here.

Disclosures

Mease reported receiving research grants from AbbVie, Amgen, Bristol-Myers Squibb, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, and UCB (less than $10,000 each); consulting fees from Novartis, AbbVie, Amgen, Bristol-Myers Squibb, Celgene Corporation, Corrona, Eli Lilly, Galapagos, Genentech, Gilead, Janssen, Merck, Pfizer, Sun Pharmaceutical, and UCB (greater than $10,000 each); and speaking fees from AbbVie, Amgen, Bristol-Myers Squibb, Celgene Corporation, Genentech, Janssen, Novartis, Pfizer, and UCB (less than $10,000 each).

https://www.medpagetoday.com/acrr/psoriaticarthritis/86639

This site uses Akismet to reduce spam. Learn how your comment data is processed.