Biologic of choice after secukinumab failure in psoriatic arthritis patient: Ixekizumab or interleukin-23 inhibitors – A retrospective study

Abstract

Aim of the work

This study aimed to compare the clinical response to ixekizumab versus interleukin-23 inhibitors (IL23i) in psoriatic arthritis (PsA) patients who failed secukinumab treatment.

Patients and methods

A retrospective multi-center study included active PsA patients who experienced treatment failure with secukinumab and were subsequently treated with either ixekizumab or IL23i. Baseline demographics, including disease duration, domains involved and duration of secukinumab therapy were recorded. The disease activity in PsA (DAPSA) score and body surface area (BSA) were used to assess the effectiveness of the biologics in PsA.

Results

The mean age of the 25 patients was 49.4 ± 12.4 years, 15 females and 10 males with secukinumab failure were enrolled. 14 (56 %) patients switched to IL23i and 11 (44 %) to ixekizumab. The median duration of secukinumab exposure was 85.7 ± 56.2 weeks. The primary reason for switching was worsening joint and skin symptoms (52 %). Complete resolution of dactylitis (7/7) and enthesitis (5/5) was achieved with ixekizumab or IL23i. Patients with primary secukinumab failure showed PsA improvements regardless the treatment switch. Multivariate analysis identified comedication with conventional synthetic DMARDs and baseline DAPSA as predictors for achieving treatment targets in the ixekizumab group.

Conclusion

This study found that after secukinumab failure, the response to ixekizumab and IL23i was comparable, regardless of the type of therapeutic failure. By comparing these alternatives, it offers valuable insights into the evolving landscape of PsA management. Further prospective studies with larger sample sizes are needed to validate these findings and guide the selection of the optimal biologic therapy.