Ustekinumab effective long term treatment for active Psoriatic Arthritis: SUSTAIN Study data

Psoriatic arthritis (PsA) is a chronic, progressive disease that places a significant burden on patients and healthcare systems. The SUSTAIN study collected real world evidence on long-term effectiveness, impact on quality of life, and safety of ustekinumab treatment for PsA.

SUSTAIN (Sustainability of effectiveness, safety and patient-reported outcomes for UStekinumab in the Treatment of Active psoriatic arthritis IN a real-life cohort) was a prospective, non-interventional study conducted in Germany. Patients with active PsA received ustekinumab for 160 weeks in routine clinical care, with assessments at baseline, week 4, and every 12 weeks thereafter. This analysis focuses on patients who remained in SUSTAIN until week 160.

Key findings of the study were:

• Of 337 patients enrolled, 129 were documented at week 160, of which 123 (95.3%) had received previous PsA medication, including biologics.

• The 45 mg dose was given to 89 (69.5%) patients, while the 90 mg dose was given to 39 (30.5%) patients; data were missing for 1 patient.

• The mean weight-adjusted ustekinumab dose was 0.7 (SD 0.2) mg/kg body weight.

• Concurrent MTX was taken by 69 (53.5%) patients, while an alternative DMARD was taken by 9 (7.0%) patients

• Decreases from baseline to week 4 were observed for tender joint count (TJC, 8.0 to 5.8) and swollen joint count (SJC, 4.5 to 3.1); these decreases continued to week 28 and were maintained to week 160 (1.0 and 0.4, respectively).

• Skin assessments in patients with PsA and psoriasis revealed improvement at week 4, which continued to week 2 with a sustained effect until week 160.

• Similar patterns of response were observed for patient assessed pain, sleep quality, and health scores.

• Improvements in TJC, SJC, Psoriasis Area and Severity Index, and affected body surface area were observed irrespective of the number of prior biologic therapies used.

• Minimal disease activity was achieved by 36 (31.9%) patients at week 28, and by 38 (33.6%) at week 52.

• Ustekinumab-related adverse events (AEs) and serious AEs were reported in 61 (47.3%) and 4 (3.1%) patients, respectively.

• At week 160, 100% of patients assessed ustekinumab tolerability as good or very good.

The authors concluded that – "This analysis of the SUSTAIN study demonstrates that, in routine clinical practice, ustekinumab can provide rapid and sustained (long term) treatment efficacy for up to 160 weeks (3 years), as well as high tolerability, in patients with active PsA who respond to ustekinumab treatment. Of note, ustekinumab was efficacious irrespective of prior biologic use. As the primary aim of any physician treating PsA is to prescribe a well-tolerated therapy, with fast onset and sustained efficacy that also improves QoL, we propose that ustekinumab offers a valuable therapeutic option."

Further reading:

Ustekinumab Is Rapid-Acting and Is an Effective Long Term Treatment for Patients with Active Psoriatic Arthritis: Real-World Evidence from the Non interventional SUSTAIN Study

Jorg Wendler, Nils Damann et al

Rheumatology Therapy (2022) 9:1435–1450

https://doi.org/10.1007/s40744-022-00484-3