Abstract：
OBJECTIVE: To assess the frequency of simultaneous distal interphalangeal (DIP) joint disease and adjacent nail psoriasis (finger unit) among patients with psoriatic arthritis (PsA) and compare the efficacy of the interleukin (IL)-17A antagonist ixekizumab (IXE) and the tumour necrosis factor (TNF)-α inhibitor adalimumab (ADA).
METHODS: This post hoc analysis evaluated the simultaneous occurrence of DIP joint involvement (tenderness and/or swelling) and adjacent nail psoriasis among patients with PsA from the SPIRIT-H2H (NCT03151551) trial comparing IXE to ADA. Among patients with simultaneous DIP joint involvement and adjacent nail psoriasis in ≥ 1 digit at baseline, treatment effects were assessed through week 52 for each affected finger unit; \'finger unit\' defines the connected DIP joint and adjacent nail of an individual digit.
RESULTS: A total of 354 patients had simultaneous DIP joint involvement and adjacent nail psoriasis in ≥ 1 finger unit at baseline. Among them, 1309 (IXE = 639, ADA = 670) finger units had baseline DIP joint tenderness and/or swelling and adjacent nail psoriasis. Proportions of affected finger units achieving complete resolution were significantly higher with IXE vs ADA as early as week 12 (38.8% vs 28.4%, p< 0.0001) and at all post-baseline assessments through week 52 (64.9% vs 57.5%, p= 0.0055).
CONCLUSIONS: In this study cohort, patients with DIP joint involvement almost always had adjacent nail psoriasis. Greater resolution of DIP joint tenderness, swelling, and adjacent nail psoriasis was achieved at all timepoints over 52 weeks through targeting IL-17A with IXE than TNF-α with ADA, which is noteworthy given prior comparable musculoskeletal outcomes for both drug classes.
METHODS: This post hoc analysis evaluated the simultaneous occurrence of DIP joint involvement (tenderness and/or swelling) and adjacent nail psoriasis among patients with PsA from the SPIRIT-H2H (NCT03151551) trial comparing IXE to ADA. Among patients with simultaneous DIP joint involvement and adjacent nail psoriasis in ≥ 1 digit at baseline, treatment effects were assessed through week 52 for each affected finger unit; \'finger unit\' defines the connected DIP joint and adjacent nail of an individual digit.
RESULTS: A total of 354 patients had simultaneous DIP joint involvement and adjacent nail psoriasis in ≥ 1 finger unit at baseline. Among them, 1309 (IXE = 639, ADA = 670) finger units had baseline DIP joint tenderness and/or swelling and adjacent nail psoriasis. Proportions of affected finger units achieving complete resolution were significantly higher with IXE vs ADA as early as week 12 (38.8% vs 28.4%, p< 0.0001) and at all post-baseline assessments through week 52 (64.9% vs 57.5%, p= 0.0055).
CONCLUSIONS: In this study cohort, patients with DIP joint involvement almost always had adjacent nail psoriasis. Greater resolution of DIP joint tenderness, swelling, and adjacent nail psoriasis was achieved at all timepoints over 52 weeks through targeting IL-17A with IXE than TNF-α with ADA, which is noteworthy given prior comparable musculoskeletal outcomes for both drug classes.
摘要：
目的：评估银屑病关节炎（PsA）患者同时发生远端指间（DIP）关节病和邻近指甲牛皮癣（指单位）的频率，并比较白介素（IL）-17A拮抗剂ixekizumab（IXE）和肿瘤坏死因子（TNF）-α抑制剂阿达木单抗（ADA）的疗效。
方法：该事后分析评估了来自SPIRIT-H2H（NCT03151551）试验的比较IXE与ADA的PsA患者中DIP关节受累（压痛和/或肿胀）和相邻指甲牛皮癣的同时发生。在基线时同时发生DIP关节受累和邻近指甲银屑病≥1位的患者中，在第52周评估每个受影响的手指单元的治疗效果;“手指单元”定义了单个手指的连接的DIP关节和相邻指甲。
结果：总共354例患者在基线时同时发生DIP关节受累和邻近的指甲银屑病，时间≥1指单位。其中,1309(IXE=639,ADA=670)手指单位具有基线DIP关节压痛和/或肿胀以及邻近的指甲牛皮癣。早在第12周，IXE和ADA的受影响的手指单位达到完全分辨率的比例明显更高（38.8%vs28.4%，p<0.0001），并且在第52周的所有基线后评估中（64.9％vs57.5％，p=0.0055）。
结论：在本研究队列中，DIP关节受累的患者几乎总是患有邻近的指甲银屑病.DIP关节压痛的分辨率更大，肿胀,和邻近的指甲牛皮癣在52周的所有时间点通过靶向IL-17A与IXE比TNF-α与ADA，考虑到两种药物的先前可比的肌肉骨骼结局，这是值得注意的。
方法：该事后分析评估了来自SPIRIT-H2H（NCT03151551）试验的比较IXE与ADA的PsA患者中DIP关节受累（压痛和/或肿胀）和相邻指甲牛皮癣的同时发生。在基线时同时发生DIP关节受累和邻近指甲银屑病≥1位的患者中，在第52周评估每个受影响的手指单元的治疗效果;“手指单元”定义了单个手指的连接的DIP关节和相邻指甲。
结果：总共354例患者在基线时同时发生DIP关节受累和邻近的指甲银屑病，时间≥1指单位。其中,1309(IXE=639,ADA=670)手指单位具有基线DIP关节压痛和/或肿胀以及邻近的指甲牛皮癣。早在第12周，IXE和ADA的受影响的手指单位达到完全分辨率的比例明显更高（38.8%vs28.4%，p<0.0001），并且在第52周的所有基线后评估中（64.9％vs57.5％，p=0.0055）。
结论：在本研究队列中，DIP关节受累的患者几乎总是患有邻近的指甲银屑病.DIP关节压痛的分辨率更大，肿胀,和邻近的指甲牛皮癣在52周的所有时间点通过靶向IL-17A与IXE比TNF-α与ADA，考虑到两种药物的先前可比的肌肉骨骼结局，这是值得注意的。
