Table 3.

Dactylitis outcomes in randomized controlled trials of PsA

Drug class	Compound	Dactylitis measure	Efficacy at week 24
TNFα inhibitor	Adalimumab [53]	Scale of 0–3 for each digit of hands and feet (exploratory endpoint)	Mean improvement in dactylitis from baseline  Improvement with adalimumab greater than placebo; statistical significance was not reached (values not presented)
	Infliximab [54]	Presence/absence of dactylitis (endpoint not specified)	Percentage of patients with dactylitis  Infliximab (12%), placebo (34%); p < 0.001
	Golimumab [55]	Scale of 0–3 for each digit of hands and feet (exploratory endpoint)	Median percentage change from baseline  Golimumab 50 mg (100%), golimumab 100 mg (100%), placebo (42%); p = 0.09 vs. placebo and p < 0.001 vs. placebo, respectively
	Golimumab (intravenous) [56]	Scale of 0–3 for each digit of hands and feet (secondary endpoint at week 14)	Mean change from baseline  Golimumab 2 mg/kg (− 8.2), placebo (− 5.0); p < 0.001
	Etanercept [57]	Scale of 0–3 for each digit of hands and feet (secondary endpoint)	Mean percentage change from baseline  Etanercept 50 mg BIW/QW (84.5%), etanercept 50 mg QW/QW (84.8%)
	Certolizumab pegol [58]	LDI (secondary endpoint)	Mean change from baseline  Certolizumab pegol 200 mg (− 40.7), certolizumab pegol 400 mg (− 53.5), placebo (− 22.0); p = 0.002 vs. placebo and p < 0.001 vs. placebo, respectively
IL-12/23 inhibitor	Ustekinumab [102]	Scale of 0–3 for each digit of hands and feet (exploratory endpoint)	Median percentage change from baseline  Ustekinumab 45 mg (approximately − 75%; p = 0.0003 vs. placebo) and ustekinumab 90 mg (approximately − 70%; p = 0.0003 vs. placebo)
IL-23 inhibitor	Guselkumaba [103]	Scale of 0–3 for each digit of hands and feet (secondary endpoint)	Median percentage change from baseline  Guselkumab (− 100%), placebo (− 33%); p < 0.001 vs. placebo
IL-17A inhibitor	Ixekizumab [104]	LDI (secondary endpoint)	Percentage of patients who achieved complete resolution of dactylitis  Ixekizumab Q4W (75%), ixekizumab Q2W (50%), placebo (21%); p = 0.002 vs. placebo and p = 0.06 vs. placebo, respectively
	Secukinumab [105]	Scale of 1 (presence) or 0 (absence) for each digit of hands and feet (secondary endpoint)	Percentage of patients who achieved complete resolution of dactylitis  Secukinumab 300 mg (56.5%), secukinumab 150 mg (50.0%), placebo (14.8%); p = 0.0021 vs. placebo and p = 0.0056 vs. placebo, respectively
Small-molecule PDE4 inhibitor	Apremilast [106]	Scale of 1 (presence) or 0 (absence) for each digit of hands and feet (secondary endpoint at week 16)	Percentage of patients achieving complete resolution of dactylitis  Apremilast 20 mg (50.9%), apremilast 30 mg (47.7%), placebo (40.9%); statistical significance was not reached
T-cell inhibitor	Abatacept [89]	LDI (prespecified exploratory endpoint)	Percentage of patients achieving complete resolution of dactylitis  Abatacept (44.3%), placebo (34.0%); statistical significance was not reached
Small-molecule JAK inhibitor	Tofacitinib [90]	Dactylitis severity score (secondary endpoint)	Mean change from baseline  Tofacitinib 5 mg (− 6.0), tofacitinib 10 mg (− 6.0)

Efficacy results are presented at week 24 for consistency, and studies with secondary endpoints at other timepoints are indicated in the ‘Dactylitis measure’ column. All agents are approved for PsA unless otherwise noted. The score range for the dactylitis severity score is 0–20. LDI is determined by the number of tender and swollen digits with a circumference ≥ 10% higher than the contralateral digit according to the LDI basic score

BIW twice weekly, IL interleukin, JAK Janus kinase, LDI Leeds Dactylitis Index, PDE4 phosphodiesterase-4, PsA psoriatic arthritis, QW once weekly, Q4W every 4 weeks, Q2W every 2 weeks, TNF tumor necrosis factor

^aExperimental compound in PsA, approved for moderate-to-severe psoriasis