TNF-α inhibitors on par with novel biologics for resolution of dactylitis, enthesitis

Tumour necrosis factor-α (TNF-α) inhibitors infliximab, golimumab and adalimumab are as effective as novel biologic agents ustekinumab, secukinumab and ixekizumab in the treatment of dactylitis and enthesitis, results of a systematic review and meta-analysis have shown.

The investigators performed a systematic literature search and a pooled meta-analysis of randomized controlled trials (RCTs) with TNF-α inhibitors, anti–interleukin (IL)-12/23 (ustekinumab) and anti–IL-17 (secukinumab, ixekizumab) using the random-effects model. They also assessed bias using the Cochrane risk-of-bias tool.

Eighteen RCTs including 6,981 patients were eligible for the pooled analysis. Both TNF-α inhibitors and novel biologic agents effectively resolved dactylitis at week 24 (pooled risk ratio [RR] vs placebo, 2.57, 95 percent confidence interval [CI], 1.36–4.84 and RR, 1.88, 95 percent CI, 1.33–2.65, respectively). TNF-α inhibitors (RR, 1.93, 95 percent CI, 1.33–2.79) and novel biologics (RR, 1.95, 95 percent CI, 1.60–2.38) were also effective in the resolution of enthesitis at week 24.

Both biologic categories showed overlapping ranges of American College of Rheumatology 20 responses (TNF-α inhibitors: RR, 2.23, 95 percent CI, 1.60–3.11; pooled IL-12/23 and -17: RR, 2.30, 95 percent CI, 1.94–2.72) and similar quality of life improvement scores, with mean Health Assessment Questionnaire–Disability Index score changes of –0.29 (95 percent CI, –0.39 to –0.19) and –0.26 (95 percent CI, –0.31 to –0.22), respectively.

“Biologic agents with different mechanisms of action showed efficacy in RCTs in the treatment of psoriatic arthritis,” the investigators said.