Treatment of Dactylitis and Enthesitis in Psoriatic Arthritis with Biologic Agents: A Systematic Review and Meta-Analysis.

OBJECTIVE:

Biologic agents with different mechanisms of actions (inhibitors of TNF-α, interleukin-12/23 and interleukin-17) showed efficacy in randomized controlled trials in the treatment of psoriatic arthritis. We aimed to conduct a pooled meta-analysis of those agents for dactylitis and enthesitis and compare those with the American College of Rheumatology 20 (ACR20) response, and Health Assessment Questionnaire Disability Index (HAQ-DI) scores.

METHODS:

A systematic literature search was performed and a pooled meta-analysis of randomized controlled trials with anti-TNF-α (infliximab, golimumab, adalimumab), antiinterleukin- 12/23 (ustekinumab) and anti-interleukin-17 (secukinumab, ixekizumab) was conducted using the random-effects model. Bias was assessed using the Cochrane Risk Of Bias tool.

RESULTS:

Eighteen randomized controlled trials were included in the pooled analysis (n=6981). Both TNF-α inhibitors and novel biologics (ustekinumab, secukinumab, ixekizumab) demonstrated significant resolution of dactylitis at week 24 with pooled risk ratios (RRs) versus placebo of 2.57 (95% CI.: 1.36-4.84) and 1.88 (95% CI.: 1.33-2.65), respectively. For the resolution of enthesitis at week 24, RR for TNF-α inhibitors was 1.93 (95% CI.: 1.33-2.79) vs 1.95 (95% CI.: 1.60-2.38) for novel biologics. Both biologic categories showed overlapping ranges of ACR20 responses (TNF-α inhibitors: RR=2.23, 95% CI.: 1.60-3.11, pooled interleukin-12/23 and -17: RR=2.30, 95% CI 1.94-2.72) and similar quality of life improvement scores with mean HAQ-DI score changes of -0.29 (95% CI.: -0.39, -0.19) and -0.26 (95% CI.: -0.31, -0.22), respectively.

CONCLUSION:

The pooled analysis demonstrates that anti-TNF-α agents have the same efficacy as novel agents (ustekinumab, secukinumab, and ixekizumab) in dactylitis and enthesitis.