Taltz Treatment Can Result in Complete Resolution of Enthesitis and Dactylitis
by Dr. C.H. Weaver M.D. 2/8/2019
A recent analyses of Taltz treated psoriatic arthritis (PsA) patients with enthesitis or dactylitis shows this approach to yield significant improvements in both.
Individuals with PsA often have enthesitis and dactylitis which can be painful and inhibit normal joint function. Dactylitis also referred to as “sausage digit” is inflammation of an entire digit (a finger or toe) and can be painful. The word dactyl comes from the Greek word "daktylos" meaning "finger". The places where tendons and ligaments connect to bones are called entheses. Inflammation of these areas is called enthesitis and can cause new bone tissue to form limiting mobility.
Interleukin-17 (IL-17) inhibitors
Interleukin-17 is a protein produced by immune cells that functions as a messenger between cells playing an important role in inflammation and the symptoms associated with PsA. Antibodies that target the IL-17 pathways are used for the treatment of several conditions in which the IL-17 pathway has a role, including, psoriasis and psoriatic arthritis, IL-17 therapies available for the treatment of PsA include.
- Cosentyx (secukinumab) is an anti-IL-17 monoclonal antibody that blocks the effects of IL-17 leading to an improvement in IL-17 associated symptoms.
- Taltz (ixekisumab) is an anti-IL-17 monoclonal antibody that blocks the effects of IL-17.
The SPIRIT-P1 and SPIRIT-P2 clinical trials evaluated two doses of Taltz compared to a placebo in 679 individuals with PsA. As part of the trial enthesitis was assessed using the Leeds Enthesitis Index [LEI] and dactylitis assessed using the Leeds Dactylitis Index-Basic [LDI-B].
Evaluation performed 24 weeks after initial of treatment found that there was a total resolution of enthesitis in 39% of individuals. Overall 78% experienced complete resolution of dactylitis. In addition, significant improvements in function and quality of life were reported in patient experiencing resolution of enthesitis whereas dactylitis resolution was associated with more limited improvements.
SAT0321 Ixekizumab treatment significantly improves enthesitis and dactylitis in patients with active psoriatic arthritis: results from the spirit trials
Background Psoriatic arthritis (PsA) is a chronic inflammatory disease with heterogeneous musculoskeletal manifestations including enthesitis and dactylitis. Ixekizumab (IXE), an interleukin-17A antagonist, is approved in the USA for the treatment of PsA including patients with pre-existing enthesitis or dactylitis. Objectives To investigate the impact of IXE treatment on the resolution of enthesitis or dactylitis and whether such improvements were associated with improved function and health-related quality of life (HRQoL). Methods Patients with active PsA who were biologic-naïve (SPIRIT-P1; [NCT01695239]) or with prior inadequate response to tumour necrosis factor inhibitor(s) (SPIRIT-P2; [NCT02349295]) were randomised to placebo (PBO) or 80 mg IXE every 4 weeks (IXEQ4W) or 2 weeks (IXEQ2W), after a 160 mg starting dose. All patients who were inadequate responders at Week 16 received rescue therapy (changes in background therapy). Leeds Enthesitis Index (LEI), Leeds Dactylitis Index-Basic (LDI-B), Health Assessment Questionnaire Disability Index (HAQ-DI), and EuroQoL-5D Visual Analogue Scale (EQ-5D VAS) were measured at Week 24. Missing data or data from inadequate responders were considered non-response or imputed with last observation carried forward for categorical and continuous measures, respectively. Statistical comparisons between PBO and IXE treatment groups were performed with a logistic regression model using Wald’s test with treatment and study as factors. In post hoc-analyses, associations between enthesitis and dactylitis with HAQ-DI and EQ-5D VAS are based on an ANCOVA model adjusting for study and Disease Activity of Psoriatic Arthritis (DAPSA). Results In the integrated SPIRIT-P1 and -P2 dataset (n=679), 403 patients (59% of total) had baseline enthesitis (LEI >0) with a mean 2.9 LEI score, and 155 patients (23% of total) had baseline dactylitis (LDI-B >0) with a mean 56.4 LDI-B score. Relative to PBO, IXE treatment resulted in significantly higher resolution of enthesitis (SPIRIT-P1) and dactylitis (SPIRIT-P1 and -P2) after 24 weeks.1,2 In the integrated SPIRIT-P1 and –P2 dataset, both IXEQ4W and IXEQ2W had significantly higher enthesitis and dactylitis resolution than PBO treatment at Week 24 (Table). In ad-hoc analysis, IXE treatment had significantly higher resolution of enthesitis compared to PBO at the entheseal points comprising the LEI score (Table). For all PBO- and IXE-treated patients at Week 24, least squares mean (SE) HAQ-DI changes from baseline were −0.44 (0.05) and −0.25 (0.03; p<0.01) for patients who did and did not resolve enthesitis, and −0.41 (0.06) and −0.31 (0.07; p=0.34) for patients who did and did not resolve dactylitis. Corresponding EQ-5D VAS improvements were 12.3 (2.2) and 5.8 (1.5; p=0.02) for patients who did and did not resolve enthesitis, and 10.8 (2.8) and 9.8 (3.5; p=0.83) for patients who did and did not resolve dactylitis. View this table: Abstract SAT0321 – Table 1 Enthesitis and Dactylitis Resolution from the Integrated SPIRIT-P1 and SPIRIT-P2 Dataset (Week 24) Conclusions Treatment with IXE resulted in significant improvement in enthesitis and dactylitis in patients with pre-existing enthesitis or dactylitis. Resolution of enthesitis symptoms was associated with improvements in patients’ function and HRQoL. References  Mease, et al. ARD2017;76(1):79.  Nash, et al. Lancet2017;389(10085):2317. Disclosure of Interest D. Gladman Grant/research support from: Abbvie, Amgen, Celgene, Janssen, Novartis, Pfizer, UCB, Consultant for: Abbvie, Amgen, BMS, Celgene, Eli Lilly and Company, Janssen, Novartis, Pfizer, UCB, A.-M. Orbai Grant/research support from: Abbvie, Celgene, Eli Lilly, Horizon, Janssen, Novartis, Pfizer, Consultant for: Eli Lilly, Janssen, Novartis, Pfizer, UCB, G. Gallo Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, J. Birt Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, S. Rathmann Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, H. Marzo-Ortega Grant/research support from: Janssen, Speakers bureau: Abbvie, Celgene, Janssen, MSD, Novartis, Pfizer and UCB : /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT01695239&atom=%2Fannrheumdis%2F77%2FSuppl_2%2F1025.1.atom : /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT02349295&atom=%2Fannrheumdis%2F77%2FSuppl_2%2F1025.1.atom