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Biologic To Treat Enthesitis and Dactylitis

A systematic review has shown that tumor necrosis factor inhibitors (TNFi) are equaled in efficacy by other biologic agents (ustekinumab, secukinumab, and ixekizumab) in psoriatic arthritis (PsA) patients with dactylitis and enthesitis.

The literature review analyzed data from 18 randomized controlled trials (RCTs) with TNFi (infliximab, golimumab, adalimumab); anti-interleukin-12/23 (ustekinumab); and anti-interleukin-17 (secukinumab, ixekizumab). The analyses included 6,981 patients.

The ability of the biologic to yield significant resolution of dactylitis at week 24 revealed the following risk ratios (RRs) versus placebo:

  • TNFi: RR 2.57 (95% CI 1.36-4.84)
  • Novel biologics: RR 1.88 (95% CI 1.33-2.65)

Resolution of enthesitis at week 24 was:

  • TNFi: RR 1.93 (95% CI 1.33-2.79)
  • Novel biologics: RR 1.95 (95% CI: 1.60-2.38)

Both the TNFi and novel biologic had overlapping ranges of ACR20 responses:

  • TNFi: RR 2.23 (95% CI 1.60-3.11)
  • Anti-IL-12/23 and IL-17 agents: RR 2.30 (95% CI 1.94-2.72)

Pooled analysis demonstrated that agents targeting TNFi, IL-17, and IL-12/23 have equivalent efficacy in managing dactylitis and enthesitis in PsA patients.

Jack Cush, MD, is the director of clinical rheumatology at the Baylor Research Institute and a professor of medicine and rheumatology at Baylor University Medical Center in Dallas. He is the executive editor of A version of this article first appeared on RheumNow, a news, information, and commentary site dedicated to the field of rheumatology. Register to receive their free rheumatology newsletter.