Treating Enthesitis in Psoriatic Arthritis Patients: Filgotinib



Philip J. Mease, MD: The EQUATOR-2 trial was a study of filgotinib, which is a relatively JAK1-specific JAK inhibitor, in patients with psoriatic arthritis. That study has been reported out previously and was published in The Lancet. It showed high rates of response in terms of ACR [American College of Rheumatology] scores on enthesitis and dactylitis and improvement of physical function, all the things we want to see in the psoriatic arthritis trial. This was a study looking more specifically at the end point of enthesitis. What we saw was that by the end of the original study, at week 16, we had seen resolution of enthesitis in 52% of patients, compared with 26% on placebo, using an end point known as the Leeds Enthesitis Index. We also saw 35% of patients on filgotinib vs 23% on placebo using a Canadian enthesitis measure called the SPARCC [Spondyloarthritis Research Consortium of Canada] score.

As we tracked patients out to week 52, two-thirds of patients achieved complete resolution of enthesitis using both scoring methodologies. What does this tell us? Because it took a little bit longer than the 16-week mark to achieve the full benefit, the enthesitis domain is a little tougher to treat. It’s less vascular. There is more biomechanical pressure and microinjury going on. So it’s not that unusual to see only the partial benefit, in this case, of about half the patients achieving full resolution. That is good at week 16, but we have even better results as we go out over time. It’s telling us to be patient in your patient who’s in front of you who has, say, a troublesome Achilles tendon insertion site that’s providing problems with work or exercise. Whether it’s with this drug or with other drugs, we’ve seen this longer time to complete resolution.

Transcript Edited for Clarity

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