Last month, the 2017 American College of Rheumatology (ACR) Annual Meeting attracted thousands of attendees, including some of our own NPF-funded researchers. Participants presented and discussed research across the spectrum of rheumatic diseases, including psoriatic arthritis (PsA). Sessions relevant to PsA covered topics such as inflammatory biomarkers, new drugs, patient registries, and the relationship between treatments and the gut microbiome.
Julia Manasson, M.D., of New York University Medical Center, studies the microbial communities living in and on the body – the “microbiome”. Her work, partially funded by an Early Career Research Grant, characterized the effects of biologic therapies on metabolic markers and the gut microbiome in patients with PsA, finding that treatment with interleukin (IL)-17 inhibitors leads to a shift in the gut microbiome. This shift was not seen with tumor necrosis factor inhibitor biologics.
Dafna Gladman, M.D., of Toronto Western Hospital and the University of Toronto, researches predictors for PsA progression and mortality, as well as genetic factors for susceptibility and expression of the disease. Gladman, a recipient of a Psoriatic Disease Research Fellowship, presented an analysis of the changes in selected cardiovascular risk factors in PsA patients who took the biologic Xeljanz (tofacitinib). Gladman’s Phase 3 study reported small, dose-dependent increases in cholesterol and lipid levels in patients treated with tofacitinib, a Janus kinase inhibitor.
Elaine Husni, M.D., MPH, and Unnikrishnan Chandrasekharan, Ph.D., both of the Cleveland Clinic, study cardiovascular disease biomarkers. Husni received a Translational Grant and Chandrasekharan received a Discovery Grant, which funds basic science research. Persistent systemic inflammation is partially responsible for cardiovascular morbidity and mortality. The colleagues found that individuals with PsA have low L-arginine availability, which impairs nitric oxide production. This may contribute to chronic inflammation and atherosclerosis.
Inflammatory biomarker profiling has been fertile ground for drug developers. Belgian pharmaceutical company UCB is the manufacturer of bimekizumab, a dual inhibitor of the cytokines interleukin (IL)-17A and IL-17F. UCB-supported research provided evidence for both the role of IL-17F as a biomarker of PsA inflammation as well as for the anti-inflammatory pharmacological benefit of this dual inhibition by bimekizumab over that of IL-17A or IL-17F alone.
Individuals with psoriatic disease react differently to the various biologics on the market, and patients and health care providers need choices in their treatment. Several new studies on biosimilars, which are drugs modeled after an already FDA-approved biologic, were unveiled at ACR. In data from a Phase 4 study, an infliximab biosimilar (CT-P13, Celltrion) was shown to produce no change in safety or efficacy when patients switched from infliximab to the biosimilar, compared with a group who did not switch from infliximab treatment.
As new biologics come to market, it is important to collect long-term data on individuals who are treating. It is equally as important to monitor comorbidities and compare treatments.
In addition to the psoriasis registry being run in partnership with NPF, Corrona manages a registry for Psoriatic Arthritis and Spondyloarthritis under the direction of Philip Mease, M.D. He used registry data to illustrate the value of screening individuals with psoriasis for PsA. Results showed a correlation between skin and joint symptom severity in individuals with both types of psoriatic disease.
ACR, in collaboration with NPF, will release treatment guidelines for adults with active PsA next year. Designed for rheumatologists, the forthcoming guidelines also will help dermatologists, primary care providers and other health care professionals who care for patients with PsA.
If you are a rheumatologist interested in getting involved in the registry, email firstname.lastname@example.org. If you are a dermatologist who would like additional information on the Corrona Psoriasis Registry, contact email@example.com or call 508-408-5415.
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