From November 10-14, 2022, various stakeholders within the rheumatology sphere connected at the American College of Rheumatology’s (ACR) Convergence 2022. During ACR Convergence, described as the world’s premier rheumatology experience, researchers shared insights into patient support, clinical practices, trends, and data.  

The Janssen Pharmaceutical Companies of Johnson & Johnson (“Janssen”) shared 37 abstracts during ACR Convergence 2022. The company, which seeks to help inform treatment decisions for people living with psoriatic arthritis (PsA), shared data which demonstrated the company’s progress within rheumatological research. 

Recently, Patient Worthy sat down with Dr. Soumya Chakravarty to discuss what psoriatic arthritis is, the common symptoms of active PsA, TREMFYA® (guselkumab) and research findings, and the most rewarding part of working in a research setting. 

About Dr. Soumya Chakravarty, MD, PhD, FACP, FACR

Dr. Soumya Chakravarty, MD, PhD, FACP, FACR received both his MD and PhD in Microbiology & Immunology from the Albert Einstein College of Medicine of Yeshiva University. He earned his diplomates in Internal Medicine and Rheumatology from the American Board of Internal Medicine and is a Fellow of both the American College of Physicians and the American College of Rheumatology.

Currently, Dr. Chakravarty works as the Senior Director, Strategic Lead — Rheumatology Therapeutic Area at the Janssen Pharmaceutical Companies of Johnson & Johnson. He shares:

 “At Janssen, our mission of relentlessly advancing care for our patients with immune-mediated diseases includes the roughly 1.5 million people living with psoriatic arthritis and the 4 million people living with psoriasis. I’m proud to say that we take a patient-centric approach. Because of the chronic and debilitating nature of immune-mediated diseases, we are really working to bring personalized treatment options to patients and find new ways to support them on their journey.”

You may learn more about Dr. Chakravarty’s research here. 

What is Psoriatic Arthritis (PsA)?  

Psoriatic arthritis is a type of inflammatory arthritis that occurs in some individuals living with psoriasis. This chronic immune-mediated disease affects multiple parts of the body, including the skin, but often attacks the joints and the areas where ligaments and tendons connect to bone. Around 40% of people diagnosed with PsA have a family history of either psoriasis or arthritis. Additionally, many cases of PsA may occur following an infection or trigger which “jump starts” the immune system. PsA is more common in those between ages 30-50, though it can affect people outside of this age range. 

PsA Symptoms

Many people first develop psoriasis and are later diagnosed with PsA. However, in some cases, the arthritic effects can occur before the psoriasis. Symptoms and characteristics of psoriatic arthritis can (but do not always) include: 

•     Red patches of skin with silvery “scales” 
•     Reduced range of motion
•     Morning stiffness and tiredness 
•     Joint pain, tenderness, or stiffness 
•     Dactylitis (inflammation of the tissue around joints) 
•     Enthesitis (inflammation of where the tendon or ligament meets the bone) 
•     Swollen fingers and toes
•     Tenderness, pain, and swelling around tendons
•     Generalized fatigue
•     Eye redness and pain (such as uveitis) 
•     Nail changes such as pitting or separating from the nail bed 

Dr. Chakravarty shares:

 “I’ve found that fatigue is right after pain in terms of what patients will report as being the most bothersome symptoms. However, it is also crucial to recognize that the decreased physical function and quality-of-life can lead to mental health issues for patients. As providers, we need to acknowledge that patients can experience both the physical and mental health challenges. Recognizing that and looking for this in patients can help improve quality-of-life.”

Treatment Options 

Currently, no cure exists for psoriatic arthritis. Medicines are designed to control symptoms and prevent joint damage. Potential therapeutic options include NSAIDs, disease-modifying antirheumatic drugs (DMARDs), steroid injections, joint replacement surgery, and biologic therapies.

 “The undertreatment, overall, of patients with psoriatic arthritis remains a continued unmet need. Without early recognition, diagnosis, and treatment, the disease progresses both from a clinical standpoint but also a health-related quality-of-life standpoint and can interfere with a person’s basic daily activities. I think we really need to recognize these components through awareness and work hand-in-hand with patients through shared decision-making to address these aspects.”

One of the ways that Janssen has worked to improve PsA outcomes is through the development of TREMFYA, the first IL-23 inhibitor approved in the U.S. to treat both adults with moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy and adults with active PsA. IL-23 is an inflammatory cytokine that drives the process of inflammation downstream. Dr. Chakravarty says:

 “One of the ways we embody this shared decision-making is to equip patients and physicians with data that shows how our products benefit the patients. At ACR Convergence, we shared new data on the effects of TREMFYA on active psoriatic arthritis.” 

Findings Presented at ACR Convergence 2022

Although ACR Convergence 2022 has passed, it is important to continue discussing the findings presented – and to advocate for continued research and awareness in order to best serve those affected. 

Psoriatic arthritis is a heterogeneous disease that does not always present the same in patients; each patient is unique in how the disease manifests. Many patients have skin involvement, and some have skin involvement plus arthritis and axial disease. Because of underdiagnosis and underreporting, the true impact of PsA is still unknown. As Dr. Chakravarty shares:

 Because of this heterogeneity and because of these challenges, it is important for us to generate data across these various domains. The first analysis we shared at ACR Convergence was looking at specific responses to TREMFYA relating to skin response and enthesitis (inflammation where the tendon or ligament meets the bone). These can be debilitating and can adversely affect one’s ability to function from a physical standpoint.

With TREMFYA, we saw early improvements in clinical endpoints as early as week eight after starting treatment. We were able to correlate that with long-term, durable, maintainable clinical outcomes such as improvement in health-related quality-of-life and an outcome measure that we call FACIT-F, a questionnaire to measure self-reported tiredness, weakness, and difficulty conducting usual activities due to fatigue.” 

Health Equity Initiatives

Janssen also shared an update on the company’s Race to Health Equity commitments. To support care coordination for people of color with psoriatic disease, the Janssen Immunology team unveiled a new solution as part of their Determi-Nation initiative helping to close the health equity gap. 

 “We are determined to close this gap in response to the underdiagnosis, undertreatment, and under-research of psoriatic disease in patients of color. Through pulling together patients, patient advocates, providers, thought leaders, and partners, we have formed a community and developed initiatives to make a change.”

One solution encompasses a pilot program in partnership with SUNY Downstate Health Sciences University. Through the program, medical students will serve as patient navigators, working with patients of color to help navigate the healthcare system. Dr. Chakravarty explains that medical students are excited to take part and develop the knowledge on how to best help those with psoriatic disease. 

Another solution, Dr. Chakravarty shares, is “Beyond the Textbook:”

 “With Beyond the Textbook, we set out to create a psoriatic disease atlas for healthcare providers that better explains how psoriatic disease presents in people of color. Current educational tools for HCPs are quite homogenous in terms of Caucasian patients. So, this was an opportunity to create a resource for rheumatologists, dermatologists, and other care providers and coordinators to expand the understanding and help them build trust with patients of color.”

“Building this trust involves making sure that patients are involved from the get-go. We want to know: what are their challenges? What are the actual problems patients face that we can articulate and identify? What solutions can we develop together based on those problems?”

The key to building this sense of trust, he explains, is a focus on partnership, which is the foundation of Determi-Nation and Janssen’s broader commitment to developing innovative therapies to address unmet patient needs. 

Ultimately, there is work that still needs to be done: studying TREMFYA’s effects on the inhibition of structural damage; understanding how the drug works with respect to safety and efficacy in axial PsA and TNF-inhibitor refractory PsA; determining ways to best meet patient needs.

But whatever comes next, Dr. Chakravarty knows one thing: that Janssen will continue working tirelessly to ensure that both patients and providers are equipped with the tools and knowledge to make informed treatment decisions.