Efficacy Of New Treatments On Dactylitis Of Psoriatic Arthritis: Update Of Systematic Literature Review

Background Dactylitis is a frequent disabling feature of psoriatic arthritis (PsA). Therapeutic strategy on dactylitis is not really codified. Objectives The objective of the study was to evaluate efficacy on dactylitis of differents treatments actually available in PsA. Methods We performed a literature review from June 2014 to October 2017 based on Pubmed, using the search terms “psoriatic arthritis” and “treatment” with only clinical trials. 89 articles were identified (English-language reports only). Thus, we selected only randomised, double-blind placebo-controlled trials in which analysis of dactylitis was exposed: 11 articles were selected for full review. Results Significant improvement of dactylitis (p For secukinumab, results are different: McInnes et al. (FUTURE 2) found no significant efficacy with 47% of dactylitis resolution at 24 weeks for secukinumab vs 11% for placebo (p=0.9195). At the opposite, Kavanaugh et al. (FUTURE 2) demonstrated secukinumab efficacy on anti-TNF-naive (300 mg and 150 mg dosages) and anti-TNF-exposed patients (only 300 mg). For Mc Innes et al. , clazakizumab permitted great decreases in the mean number of dactylitis from baseline to weeks 16 and 24 but no statistical data are available in the report. Similarly, in a recent publication, promising results were found for tofacitinib and abatacept, but no statistical data are available. At the opposite, no significant efficacy was demonstrated in a randomised controlled trial with brodalumab. Calculating of effect size was possible and available only in one study: secukinumab’s effect size was 4.35 in McInnes study (FUTURE 2). Calculation of Odds Ratio (with of residual dactylitis between treatment and placebo groups was possible on part of studies with significant results for clazakizumab (200 mg dosing) and secukinumab in patients TNF exposed (figure 1). Conclusions Dactylitis was always used as secondary outcome criteria with heterogeneous results. So conclusions need to be cautious. This invalidating clinical manifestation need to be evaluated as a primary outcome in the future. Disclosure of Interest None declared