Ustekinumab at the ACR 2012 in Washington

I restrict this blogpost to Ustekinumab. Link for EULAR 2012: http://rheumatologe.blogspot.de/2012/07/ustekinumab-and-other-options-in.html.Ustekinumab (Stelara) is a human monoclonal antibody against IL-12 and IL-23. Adverse events include an increased risk of infections (tuberculosis and others) and cancer.

A. Kavanaugh and colleagues presented: "Ustekinumab Improves Arthritis-Related and Skin-Related Quality of Life in Patients with Active Psoriatic Arthritis: Patient Reported Outcomes From Randomized and Double Blinded Phase III Psummit I Trial" (Abstract No. 569). Conclusion: "Ustekinumab improves general as well as arthritis and skin-related quality of life, and reduces the impact of disease on work productivity in patients with active PsA." There is not much on arthritis in this part of the study.

Ch. T. Ritchlin and colleagues presented: "Ustekinumab in Active Psoriatic Arthritis Including Patients Previously Treated with Anti-TNF Agents: Results of a Phase 3, Multicenter, Double-Blind, Placebo-Controlled Study" (Abstract No. 2557). The conclusion looked like this: "UST reduced signs & symptoms, improved physical fxn, enthesitis & improved plaque PsO. Safety profiles were similar between UST & PBO." - Welcome to twitter! (UST, PsO &b PBO) The presentation of results is very eloquent, whereas it is very laconic on the DAS28 response.

Another study (actually all are the same) by A. Kavanaugh and colleagues: " Ustekinumab in Patients with Active Psoriatic Arthritis: Results of the Phase 3, Multicenter, Double-Blind, Placebo-Controlled Psummit I Study" (Abstract No. 2562). Here we have DAS28-CRP responses: 34.5% for placebo, 65.9% for 45 mg, and 67.6% for 90 mg. Conclusion: "In pts with active PsA, UST significantly reduced the signs and symptoms of arthritis, improved physical function, enthesitis and dactylitis, and improved plaque psoriasis vs PBO-treated pts at wk24. Safety profiles were similar between UST-and PBO-treated pts."

And there has been the late breaking poster (Abstract No. L4): Continued Improvement of Signs and Symptoms in Patients with Active Psoriatic Arthritis: Week 52 Results of a Phase 3, Multicenter, Double-Blind,Placebo-Controlled Study." Here we have DAS28-CRP responses: none for placebo, as these patients changed to ustekinumab, 72,7% for 45 mg, and 74,6% for 90 mg. Conclusion has been much the same like above.

Do we have the solution of our problems in psoriatic arthritis? I fear we haven't, but we get a new option to treat at least some of our patients better than before.