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Optimising Psoriatic Arthritis Therapy with Immunological Methods to Increase Standard Evaluation


PsA develops in ~15% of people with psoriasis affecting around 150,000 people in the UK. For patients who do not respond to standard arthritis drugs, two different types of biologic drugs are available (called TNF or IL-17 blockers). In patients given one of these, only about 50% will find the drug relieves their symptoms, however importantly 50% will find no relief. Trying each drug takes time and then patients have to wait to see if another drugs works. Doctors do not currently know how to predict in advance which patient will respond best to each drug. A recent small study in Japan suggested that choosing the biologic drug based on patients' blood Th17 cells could give better results than the doctors' choice. However they only tested this in 28 people so we need to run a large study. 


Psoriatic arthritis (PsA) is a type of arthritis that develops in some people with the skin condition psoriasis. It causes joints to become swollen and painful. PsA is a long-term condition that can get progressively worse. Our aim is to test whether we can predict, using blood tests, if people with PsA will respond to a type of drugs (called a biologic) leading to a reduction in inflamed joints and pain. First, we will test if high levels of a type of blood cells called Th17 cells predicts response to biologic drugs. Secondly, does combining this blood result with other blood tests or an individual's pattern of arthritis improve the prediction? We will use statistical tests to estimate how effective the tests are to select the best biologic drug for each person. This approach could ensure that patients receive their best drug first, ensuring their disease is controlled quickly improving quality of life. 

Study design 

This study will be run at about 15 hospital in the UK. Patients with PsA about to start their first biologic will be invited to join the study by their Rheumatology team when they attend for their routine hospital appointment. They will have a blood sample taken to measure their Th17 cells. The patients with high and low levels will be allocated equally to receive either TNF or IL-17 blockers. We will measure how well they respond to the drug after 6 months and test whether the initial blood result could have predicted their response. We will also combine this test with other blood results and the clinical pattern of a patient's arthritis to see if this improves our ability to predict the best drug for each patient. If the test is able to predict the response, we will use statistical tests to estimate how effective it would be if this blood test was used to choose therapy in routine NHS care. If successful this could save money for the NHS if patients were given the best drug for them first and most importantly would improve patients' quality of life earlier. PPI Patients involved in research as part of the British PsA consortium patient communication group reviewed the project and advised on the study design. Patients will continue to advise throughout the project, including reviewing study information for patients, recruitment methods and questionnaires used, interpreting the results alongside the study team and aiding dissemination of results to patient organisations.


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