Among patients with psoriatic arthritis (PsA) who present with dactylitis and enthesitis, risankizumab was effective in resolving these conditions, according to research presented at the American College of Rheumatology (ACR) Convergence meeting in Philadelphia.

Saakshi Khattri, MD, MBBS, presented the poster on the results of the KEEPsAKE 1 and 2 trials of risankizumab, an interleukin (IL)-23/p19 subunit inhibitor, among patients with PsA who had shown inadequate response to or intolerance of conventional disease-modifying antirheumatic drugs or biologic therapies.

Dr Khattri is a board-certified dermatologist, internist, and rheumatologist at Mt Sinai, where she serves an associate professor and director of the Center for Connective Tissue Diseases.

“Dactylitis and enthesitis are common clinical manifestations of active psoriatic arthritis and are associated with impaired joint function and reduced quality of life,” she explained. Because enthesitis and dactylitis are linked to the immunopathogenesis of PsA, but not to rheumatoid arthritis, the impact of IL-23 inhibition in these domains is of special interest.

In this study, the researchers evaluated whether risankizumab led to complete resolution of enthesitis or of dactylitis, or to composite resolution of both manifestations in patients with active PsA.

In the KEEPsAKE 1 and KEEPsAKE 2 trials, Dr Khattri explained, “Patients received risankizumab 150 mg or placebo at weeks 0, 4, and 16. At week 24, patients randomized to placebo received a blinded dose of risankizumab. All patients received open-label risankizumab at week 28 and every 12 weeks thereafter.”

Patients with enthesitis as measured by the Leeds Enthesitis Index (LEI> 0), dactylitis as determined by the Leeds Dactylitis Index (LDI> 0), or both (LEI and LDI > 0) at baseline were included the analysis. The investigators evaluated the proportion of patients achieving complete resolution of enthesitis (LEI = 0), complete resolution of dactylitis (LDI = 0), and complete resolution of both (LEI and LDI = 0) at weeks 24 and 52, as well as the median time to resolution.

“A total of 1407 patients were evaluated across a pooled analysis of both studies,” Dr Khattri said. “Approximately 63%, 28%, and 20% of patients had enthesitis, dactylitis, and both at baseline, respectively.  At week 24, the response rates for resolution of enthesitis were 48.4% among patients receiving risankizumab vs 34.8% for placebo; for dactylitis 68.1% of patients achieved resolution compared to 51.0% of patients receiving placebo; and for both manifestations, resolution with risankizumab reached 42.2% vs 28.6% for placebo. At week 52, 55% of patients treated with risankizumab achieved enthesitis resolution (LEI = 0), 76.1% achieved dactylitis resolution (LDI = 0), and 52.3% achieved resolution of both enthesitis and dactylitis (LEI and LDI = 0).

“Treatment with risankizumab resulted in a shorter time to first resolution of enthesitis  to placebo,” Dr Khattri reported. “Median time to resolution was 22.9 weeks for risankizumab and 24.1 weeks for placebo. Similar results were observed in resolution of dactylitis, with a median time to resolution of 12.3 weeks for risankizumab and 16.1 week for placebo.”
 

After receiving risankizumab for the open-label extension from weeks 24 to 52, the group originally randomized to placebo achieved rates of resolution virtually equal to those of the original risankizumab group.

“Improvements in these clinically relevant PsA domains were maintained through week 52 with continued risankizumab treatment,” she said. “These results confirm a central role of the IL-23 pathway in these distinct psoriatic arthritis manifestations.”

Reference:
Kwatra S, Khattri S, Amin A, Poster 2126. Impact of risankizumab on enthesitis and dactylitis: Integrated analysis of the phase 3, randomized, double-dlind KEEPsAKE 1 and 2 trials. Presented at: American College of Rheumatology Convergence. November 14, 2022.