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At the American College of Rheumatology (ACR) virtual meeting, positive results were announced from a (Tremfya), a selective interleukin (IL)-23 inhibitor, in patients with active psoriatic arthritis.

In this first of four exclusive episodes, 番茄社区 brought together three expert leaders in the field, all from the Cleveland Clinic -- moderator M. Elaine Husni, MD, MPH, is joined by Leonard Calabrese, DO, and Anthony Fernandez, MD, PhD -- for a virtual roundtable discussion about the results from the .

Following is a transcript of their remarks:

Husni: Welcome. Thanks for joining us on this virtual roundtable for ACR Convergence 2021. Today I'm really honored to have my good friends and colleagues here, Lenny and Tony. I have asked them to provide their opinions regarding some exciting abstracts at this year's Convergence meeting around psoriatic arthritis, but before we begin, could I have each of you just introduce yourselves.

Calabrese: Hi, I'm Len Calabrese; I'm a professor of medicine here at Cleveland Clinic and I run the R.J. Fasenmyer Center for Clinical Immunology.

Fernandez: My name is Tony Fernandez; I'm a dermatologist and dermatopathologist here at the Cleveland Clinic and serve as director of medical dermatology.

Husni: Excellent, welcome. I'm really excited, we're going to really take a deep dive into some of these really exciting abstracts. The first one I picked is sort of an update on IL-23. So we had guselkumab, which is for us, Tony, is one of the abstracts on this IL-23 that we're most familiar with. But as you know, tildrakizumab (Ilumya) as well as risankizumab (Skyrizi) now have some early data showing some promise in psoriatic arthritis.

But the guselkumab abstract I want to spend a little more time on, it's 700 psoriatic arthritis patients, biologically naive, who were followed out for 2 years, and I think what makes this abstract different is that there was some sort of what we call lower rates of radiographic progression. So we haven't had radiographic outcomes, just sort of skin and joint outcomes. So I wanted to ask the both of you, does this change your practice knowing this extra data?

Len, what do you think?

Calabrese: Well, I'm particularly attracted to this target as a rheumatologist who sees patients with joint disease and varying degrees of skin disease. Not only because of its efficacy, but because of its safety signal thus far. And this is very reassuring for this population of patients. We are comparing it to other classes of biologics, including TNF [tumor necrosis factor] inhibitors which carry weighty product labels and 20 years of experience where we know what to expect. But I think that's what this has to offer; it really changes the risk-benefit ratio.

Husni: I agree. It's really nice to see some of that other psoriatic arthritis outcomes. So I wanted to tag on your safety thing that you just said. So Tony, you have a lot longer runway with IL-23 -- do you find any safety issues to date?

Fernandez: No. I mean, the IL-23 class of medications quickly gained a foothold in dermatology practice for treating psoriasis patients. And I think it's maintained that to some degree because these medications have really an excellent safety profile, and long-term studies to date have not shown any new signals beyond what had been seen in the clinical trial, so we've been very happy to have these available for our patients.

Husni: Right. So personally I do find that IL-23 works probably better for the skin than the joints. I mean we still are lagging behind you in terms of being able to reach a PASI [Psoriasis Area and Severity Index] 100 or you know having to reach ACR20 [20% improvement on the criteria of the ACR] is good, ACR50 and 70, not always where I want to be in some of my patients.

But I do think this abstract 1336 on guselkumab and having some radiographic data is, as Len said, promising and definitely a good player in the field.

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