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PRO-SPIRIT study examines the real-world efficacy results of disease-modifying antirheumatic drugs for patients with psoriatic arthritis.

The PRO-SPIRIT is a multinational, prospective study investigating the real-world comparative effectiveness of biological or targeted synthetic disease-modifying antirheumatic drugs (DMARDs) in psoriatic arthritis (PsA). In this study, almost one in five patients achieved remission in line with the EULAR recommendations.

While randomized controled trials are the gold standard, real-world evidence provides crucial insights into the comparative effectiveness of these therapies. As Prof. Dennis McGonagle, PhD, University of Leeds, in the United Kingdom, pointed out, there is a lack of real-world studies on advanced therapies in PsA. PRO-SPIRIT aimed to report treatment persistence at 24 months, as well as comparative effectiveness at 3 and 12 months.

The study included 1,192 participants across 175 sites in six countries. The patient’s baseline characteristics and disease activity were similar across treatment groups, except for notable differences in disease duration. The disease duration was longer in patients treated with JAK inhibitors and ixekizumab and shorter in those treated with TNF inhibitors. Patients treated with low dose secukinumab were less experienced with biological or targeted synthetic DMARD.

IL-17A inhibitors showed significantly greater improvements in clinical Disease Activity Index for PsA (cDAPSA), tender joint counts, and swollen joint counts than IL-12/23 and IL-23 inhibitor treatments at 3 months, indicating a faster response. Ixekizumab was as effective as TNF inhibitors and JAK inhibitors in improving cDAPSA scores and joint counts at 3 and 12 months. At 12 months, about 20% of patients achieved DAPSA remission when treated with ixekizumab and TNF inhibitors compared with 12% in patients treated with secukinumab, IL-12/23 inhibitors, and IL-23 inhibitors.

The PRO-SPIRIT findings underscore the value of real-world evidence in complimenting randomized controlled trials and guiding clinical decisions for PsA management. “Almost one in five patients achieved remission with ixekizumab and TNF blockers at months 12, in line with the EULAR recommendations,” Prof. McGonagle concluded.