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Research ArticleAccepted Article

Treatment of Dactylitis and Enthesitis in Psoriatic Arthritis with Biologic Agents: A Systematic Review and Meta-Analysis

Ahmed Mourad and Robert Gniadecki
The Journal of Rheumatology March 2019, jrheum.180797; DOI: https://doi.org/10.3899/jrheum.180797
Ahmed Mourad
From the Faculty of Medicine & Dentistry, University of Alberta 2Division of Dermatology, Department of Medicine, University of Alberta. Funding Support: Medical student research funding was provided by the Dorothy Jean Usher Memorial Summer Research Award. Dr. Gniadecki has received speaker’s honorarium from Mallinckrodt, Janssen, AbbVie, Novartis, and Leo Pharma, is on the advisory board for Mallinckrodt, Janssen, Amgen, AbbVie, Eli Lily, Sanofi, Novartis, and Leo Pharma. Dr. Gniadecki is an investigator in clinical trials for Janssen, Celgene, AbbVie, and Leo Pharma. Address correspondence to Ahmed Mourad, 2-166 Clinical Sciences Building, Division of Dermatology, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada.
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Robert Gniadecki
From the Faculty of Medicine & Dentistry, University of Alberta 2Division of Dermatology, Department of Medicine, University of Alberta. Funding Support: Medical student research funding was provided by the Dorothy Jean Usher Memorial Summer Research Award. Dr. Gniadecki has received speaker’s honorarium from Mallinckrodt, Janssen, AbbVie, Novartis, and Leo Pharma, is on the advisory board for Mallinckrodt, Janssen, Amgen, AbbVie, Eli Lily, Sanofi, Novartis, and Leo Pharma. Dr. Gniadecki is an investigator in clinical trials for Janssen, Celgene, AbbVie, and Leo Pharma. Address correspondence to Ahmed Mourad, 2-166 Clinical Sciences Building, Division of Dermatology, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada.
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Abstract

Objective Biologic agents with different mechanisms of actions (inhibitors of TNF-α, interleukin-12/23 and interleukin-17) showed efficacy in randomized controlled trials in the treatment of psoriatic arthritis. We aimed to conduct a pooled meta-analysis of those agents for dactylitis and enthesitis and compare those with the American College of Rheumatology 20 (ACR20) response, and Health Assessment Questionnaire Disability Index (HAQ-DI) scores.

Methods A systematic literature search was performed and a pooled meta-analysis of randomized controlled trials with anti-TNF-α (infliximab, golimumab, adalimumab), antiinterleukin- 12/23 (ustekinumab) and anti-interleukin-17 (secukinumab, ixekizumab) was conducted using the random-effects model. Bias was assessed using the Cochrane Risk Of Bias tool.

Results Eighteen randomized controlled trials were included in the pooled analysis (n=6981). Both TNF-α inhibitors and novel biologics (ustekinumab, secukinumab, ixekizumab) demonstrated significant resolution of dactylitis at week 24 with pooled risk ratios (RRs) versus placebo of 2.57 (95% CI: 1.36-4.84) and 1.88 (95% CI: 1.33-2.65), respectively. For the resolution of enthesitis at week 24, RR for TNF-α inhibitors was 1.93 (95% CI: 1.33-2.79) vs 1.95 (95% CI: 1.60-2.38) for novel biologics. Both biologic categories showed overlapping ranges of ACR20 responses (TNF-α inhibitors: RR=2.23, 95% CI: 1.60-3.11, pooled interleukin-12/23 and -17: RR=2.30, 95% CI 1.94-2.72) and similar quality of life improvement scores with mean HAQ-DI score changes of -0.29 (95% CI: -0.39, -0.19) and -0.26 (95% CI: -0.31, -0.22), respectively.

Conclusion The pooled analysis demonstrates that anti-TNF-α agents have the same efficacy as novel agents (ustekinumab, secukinumab, and ixekizumab) in dactylitis and enthesitis.

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The Journal of Rheumatology
Vol. 52, Issue 6
1 Jun 2025
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Accepted manuscript
Treatment of Dactylitis and Enthesitis in Psoriatic Arthritis with Biologic Agents: A Systematic Review and Meta-Analysis
Ahmed Mourad, Robert Gniadecki
The Journal of Rheumatology Mar 2019, jrheum.180797; DOI: 10.3899/jrheum.180797

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Accepted manuscript
Treatment of Dactylitis and Enthesitis in Psoriatic Arthritis with Biologic Agents: A Systematic Review and Meta-Analysis
Ahmed Mourad, Robert Gniadecki
The Journal of Rheumatology Mar 2019, jrheum.180797; DOI: 10.3899/jrheum.180797
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