Future of PsA Therapy Combination Strategies and New Endpoints

EP: 1.Sustained Safety of Tildrakizumab for Psoriatic Arthritis

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EP: 2.Future of PsA Therapy Combination Strategies and New Endpoints

Sustained long-term safety data for tildrakizumab strengthens the positioning of IL-23 inhibitors as a preferred choice, especially for patients with comorbidities or a history of infection, and suggests their potential use in combination therapies for psoriatic arthritis.

Copy: The data presented at the American College of Rheumatology Convergence regarding the IL-23 inhibitor tildrakizumab in treating active psoriatic arthritis received expert analysis from Christopher Ritchlin, MD, MPH, professor and chief of the Division of Allergy, Immunology and Rheumatology at the University of Rochester Medical Center. Ritchlin, an expert in the field who was not involved in conducting this specific study, analyzed the sustained safety and durability demonstrated by the findings, offering insight into their impact on treatment strategy.

The long-term safety data for tildrakizumab provides significant implications for the market positioning and therapeutic sequencing of biologics used to treat psoriatic arthritis (PsA). The safety advantage of the anti-IL-23 class is a major factor, making these agents particularly informative for patients who are at a higher risk of developing infections, such as those with diabetes or those who have experienced infectious complications with other biologic therapies. For these vulnerable patient populations, IL-23 antibodies represent a very important addition to the available treatment arsenal.

Another key advantage of IL-23 inhibitors is their versatility for combination therapy, notably with anti-tumor necrosis factor (TNF) agents. This area of research is rapidly expanding, with studies already completed, such as the AFFINITY-1 trial combining guselkumab with golimumab. Furthermore, an ongoing study is evaluating the combination of another anti-IL-23, deucravacitinib, with an anti-TNF agent for PsA. This suggests that combining tildrakizumab with other biologics is a likely future therapeutic strategy.

To fully understand tildrakizumab's long-term role in PsA, additional endpoints in clinical trials are crucial. Radiographic progression is very important not only to rheumatologists but also to dermatologists, as evidenced by recent studies like the APEX trial with guselkumab. Additionally, quality of life scores are essential. Given that IL-23 is hypothesized to be a major driver of enthesitis, more complete enthesitis data is needed, ideally within the confines of a phase 3 trial. Finally, the reduction of pain is another vital area where IL-23 inhibitors have shown promise, and more specific data on pain reduction with tildrakizumab in PsA patients would significantly enhance its clinical profile.