Effects of ustekinumab versus tumor necrosis factor inhibition on enthesitis: Results from the enthesial clearance in psoriatic arthritis (ECLIPSA) study

Guilhon de Araujo E, Englbrecht M, Höpken S, Finzel S, Kampylafka E, Kleyer A, Bayat S, Schoenau V, Hueber A, Rech J, Schett G (2018)

Publication Type: Journal article

Publication year: 2018

Journal

Seminars in Arthritis and Rheumatism WB Saunders

DOI: 10.1016/j.semarthrit.2018.05.011

Abstract

OBJECTIVES: To date, all studies addressing on anti-inflammatory drugs in PsA have been carried out in psoriatic arthritis (PsA) patients with polyarticular disease. Specific studies on enthesitis are missing. IL-23 is considered to play a central role in the development of enthesitis. We therefore speculated that therapeutic inhibition of IL-12/IL-23 is particularly effective in enthesitis-driven PsA patients. METHODS: Enthesial CLearance In PSoriatic Arthritis (ECLIPSA) is a prospective randomized-controlled open-label study. Patients with PsA with active enthesitis were randomized 1:1 to receive either ustekinumab (UST; arm 1) or tumor necrosis factor inhibitors (TNFi; arm 2). Primary endpoint was complete clearance of enthesitis, defined by Spondyloarthritis Research Consortium of Canada (SPARCC) index equal to zero at 24weeks. RESULTS: 51 patients (UST = 25; TNFi = 26) were screened, 47 enrolled (UST = 23; TNFi = 24) and 46 completed the study. Mean ± SD SPARCC index at baseline was 4.8 ± 2.6 in the UST group and 3.5 ± 2.3 in the TNFi group with no significant difference. After 24 weeks, 73.9% of UST patients and 41.7% of TNFi patients reached the primary endpoint (SPARCC = 0) indicating clearance from enthesitis (p = 0.018). UST achieved superior responses as compared to TNFi with respect to enthesitis (p = 0.007) and psoriatic skin disease (p = 0.030) but not for arthritis (p = 0.95). CONCLUSION: These results indicate that p40-IL-12/IL-23 inhibition is superior to TNFi in the clearance of enthesitis. Future stratified therapeutic approaches in PsA patients may therefore consider the presence or absence of enthesitis as a discriminator of response between different cytokine blocking modalities.

Authors with CRIS profile

Elizabeth Guilhon de Araujo Professur für Rheumatologie und Klinische Immunologie Matthias Englbrecht Lehrstuhl für Innere Medizin III Sabrina Höpken Lehrstuhl für Innere Medizin III Stephanie Finzel Lehrstuhl für Innere Medizin III Arnd Kleyer Department of Medicine 3 – Rheumatology and Immunology Sara Bayat Lehrstuhl für Innere Medizin III Axel Hueber Department of Medicine 3 – Rheumatology and Immunology Hans Jürgen Rech Department of Medicine 3 – Rheumatology and Immunology Georg Schett Lehrstuhl für Innere Medizin III

How to cite

APA:

Guilhon de Araujo, E., Englbrecht, M., Höpken, S., Finzel, S., Kampylafka, E., Kleyer, A.,... Schett, G. (2018). Effects of ustekinumab versus tumor necrosis factor inhibition on enthesitis: Results from the enthesial clearance in psoriatic arthritis (ECLIPSA) study. Seminars in Arthritis and Rheumatism. https://doi.org/10.1016/j.semarthrit.2018.05.011

MLA:

Guilhon de Araujo, Elizabeth, et al. "Effects of ustekinumab versus tumor necrosis factor inhibition on enthesitis: Results from the enthesial clearance in psoriatic arthritis (ECLIPSA) study." Seminars in Arthritis and Rheumatism (2018).

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