Pharmacological treatment of psoriatic arthritis: a systematic literature research for the 2019 update of the EULAR recommendations for the management of psoriatic arthritis.

Abstract

OBJECTIVE:

To perform an update of a review of the efficacy and safety of disease-modifying antirheumatic drugs (DMARDs) in psoriatic arthritis (PsA).

METHODS:

This is a systematic literature research of 2015-2018 publications on all DMARDs in patients with PsA, searching Medline, Embase and the Cochrane Library. Efficacy was assessed in randomised controlled trials. For safety, cohort studies, case-control studies and long-term extensions (LTEs) were analysed.

RESULTS:

56 publications (efficacy: n=33; safety n=23) were analysed. The articles were on tumour necrosis factor (TNF) inhibitors (n=6; golimumab, etanercept and biosimilars), interleukin (IL)-17A inhibitors (n=10; ixekizumab, secukinumab), IL-23-p19 inhibitors (n=2; guselkumab, risankizumab), clazakizumab (IL-6 inhibitor), abatacept (CD80/86 inhibitor) and ABT-122 (anti-TNF/IL-17A), respectively. One study compared ustekinumab (IL-12/23i) with TNF inhibitor therapy in patients with entheseal disease. Three articles investigated DMARD tapering. Trials on targeted synthetic DMARDs investigated apremilast (phosphodiesterase-4 inhibitor) and Janus kinase inhibitors (JAKi; tofacitinib, filgotinib). Biosimilar comparison with bio-originator showed non-inferiority. Safety was evaluated in 13 LTEs, 9 cohort studies and 1 case-control study investigating malignancies, infections, infusion reactions, multiple sclerosis and major cardiovascular events, as well as efficacy and safety of vaccination. No new safety signals were identified; however, warnings on the risk of venous thromboembolic events including pulmonary embolism when using JAKi were issued by regulators based on other studies.

CONCLUSION:

Many drugs in PsA are available and have demonstrated efficacy against placebo. Efficacy varies across PsA manifestations. Safety must also be taken into account. This review informed the development of the European League Against Rheumatism 2019 updated PsA management recommendations.

• Authors: Andreas Kerschbaumer, Josef S Smolen, Maxime Dougados, Maarten de Wit, Jette Primdahl, Iain McInnes, Désirée van der Heijde, Xenofon Baraliakos, Louise Falzon, Laure Gossec
• Journal: Annals of the rheumatic diseases (Ann Rheum Dis) Vol. 79 Issue 6 Pg. 778-786 (06 2020) ISSN: 1468-2060 [Electronic] England
• PMID: 32381564 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Systematic Review)
• Copyright: © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.

Chemical References

• Antirheumatic Agents
• Biological Products
• IL17A protein, human
• Interleukin-17
• Interleukin-23 Subunit p19
• Synthetic Drugs
• Tumor Necrosis Factor-alpha

Topics

• Antirheumatic Agents (adverse effects, therapeutic use)
• Arthritis, Psoriatic (drug therapy)
• Biological Products (adverse effects, therapeutic use)
• Humans
• Interleukin-17 (antagonists & inhibitors)
• Interleukin-23 Subunit p19 (antagonists & inhibitors)
• Molecular Targeted Therapy
• Synthetic Drugs (therapeutic use)
• Tumor Necrosis Factor-alpha (antagonists & inhibitors)