Berman Julia, Furer Victoria, Berman Mark, Isakov Ofer, Zisman Devy, Haddad Amir, Elkayam Ori
Department of Medicine 'T', Sourasky Medical Center, Tel Aviv, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Biologics. 2021 Nov 18;15:463-470. doi: 10.2147/BTT.S326792. eCollection 2021.
To assess the clinical response to ixekizumab following secukinumab failure in patients with psoriatic arthritis.
A retrospective multi-center observational study included psoriatic arthritis (PsA) patients with a history of treatment with secukinumab, further treated with ixekizumab. Primary endpoint was primary response to treatment (drug survival > 6 months); secondary endpoints were changes in disease activity indices from initiation of ixekizumab to 6 and 12 months later and overall drug survival.
Of 23 PsA patients, 86% (n = 20) received more than two TNF inhibitors (TNFi). Median secukinumab treatment time was 15 months (IQR 10-21.5 months). Subsequently, 19 patients (83%) had a primary response to ixekizumab. Overall treatment duration during follow-up period for primary responders was 14 months (IQR 10-20.5). Reasons for ixekizumab cessation were worsening psoriasis (27%), peripheral arthritis (27%), both (47%), worsening of axial disease (13%), and adverse events (6%). Articular disease indices including Disease Activity Index for Psoriatic Arthritis (DAPSA), tender joints count (TJC) and Simplified Disease Activity Index (SDAI) were significantly lower at 6 and 12 months (DAPSA 1.5-2 levels reduction; p = 0.018 and 1-1.5 levels reduction; p = 0.031, respectively; TJC -2.16 [-4.0, -0.3]; p = 0.025 and -1.69 [-3.09, -0.28]; p = 0.022, respectively; SDAI -10.13 [-16.4, -3.8], p = 0.003 and -12.2 [-17.1, -7.2], p = 0.0002, respectively). PASI75 at 6 and 12 months was achieved by 63% and 57%, respectively, and PASI100 at 6 and 12 months by 31% and 21%, respectively.
Patients with resistant PsA, including inadequate response to secukinumab, demonstrated a good response to ixekizumab, albeit limited on time. Within class switch from secukinumab to ixekizumab may be a plausible therapeutic option in PsA patients following secukinumab failure.
评估银屑病关节炎患者在司库奇尤单抗治疗失败后接受依奇珠单抗治疗的临床反应。
一项回顾性多中心观察性研究纳入了有司库奇尤单抗治疗史并进一步接受依奇珠单抗治疗的银屑病关节炎（PsA）患者。主要终点是对治疗的主要反应（药物存活>6个月）；次要终点是从开始使用依奇珠单抗到6个月和12个月后疾病活动指数的变化以及总体药物存活情况。
23例PsA患者中，86%（n = 20）接受过两种以上的肿瘤坏死因子抑制剂（TNFi）治疗。司库奇尤单抗的中位治疗时间为15个月（四分位间距10 - 21.5个月）。随后，19例患者（83%）对依奇珠单抗有主要反应。主要反应者在随访期间的总体治疗持续时间为14个月（四分位间距10 - 20.5）。停用依奇珠单抗的原因包括银屑病恶化（27%）、外周关节炎（27%）、两者均有（47%）、轴性疾病恶化（13%）和不良事件（6%）。包括银屑病关节炎疾病活动指数（DAPSA）、压痛关节计数（TJC）和简化疾病活动指数（SDAI）在内的关节疾病指数在6个月和12个月时显著降低（DAPSA分别降低1.5 - 2级；p = 0.018和降低1 - 1.5级；p = 0.031；TJC分别为-2.16 [-4.0, -0.3]；p = 0.025和-1.69 [-3.09, -0.28]；p = 0.图22；SDAI分别为-10.13 [-16.4, -3.8]，p = 0.003和-12.2 [-17.1, -7.2]，p = 0.0002）。6个月和12个月时分别有63%和57%的患者达到PASI75，6个月和12个月时分别有31%和21%的患者达到PASI100。
对司库奇尤单抗耐药的PsA患者，包括对司库奇尤单抗反应不足的患者，对依奇珠单抗表现出良好反应，尽管时间有限。在司库奇尤单抗治疗失败的PsA患者中，从司库奇尤单抗转换为依奇珠单抗可能是一种合理的治疗选择。
