Itch as major mediator of effect of tofacitinib on health‐related quality of life in psoriatic arthritis: A mediation analysis

Peter C. Taylor, Andrew G. Bushmakin, Joseph C. Cappelleri, Pamela Young, Rebecca Germino, Joseph F. Merola, Gil Yosipovitch

Research output: Contribution to journalArticlepeer-review

Abstract

Patients with psoriatic arthritis (PsA) experience impaired health‐related quality of life (HRQoL). Tofacitinib is an oral Janus kinase inhibitor for the treatment of PsA, which has been associated with improvements in dermatologic endpoints in patients with PsA. To assess the extent to which tofacitinib affects patient HRQoL via improvements in dermatologic symptoms, including itch, data were pooled from patients with PsA who received tofacitinib in phase III studies (NCT01866668 and NCT01882439). Mediation modeling assessed the indirect effects (via Itch Severity Item [ISI] and Physician’s Global Assessment of Psoriasis [PGA‐PsO]) and direct effects (via all other factors) of tofacitinib treatment on dermatology‐specific HRQoL (measured by Dermatology Life Quality Index [DLQI]). In the initial model, the treatment effect on DLQI was largely mediated by itch (ISI; p < 0.0001) and PGA‐PsO (p < 0.01). The model was re‐specified to assess the indirect effects only of itch and PGA‐PsO on DLQI. Here, 17.7% of the treatment effect on DLQI was attributable to PGA‐PsO (p = 0.0006), and 82.3% to itch (p < 0.0001). Tofacitinib‐dependent improvements in DLQI were primarily mediated by itch relief, in addition to improvements in PGA‐PsO.

Original languageEnglish (US)
Article number4081
JournalJournal of Clinical Medicine
Volume10
Issue number18
DOIs
StatePublished - Sep 2021

Keywords

  • Itch
  • Mediation modeling
  • Psoriatic arthritis
  • Quality of life

ASJC Scopus subject areas

  • Medicine(all)

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