Efficacy and Safety of Pharmacologic Treatment of Psoriatic Arthritis

According to a study published in the Annals of the Rheumatic Diseases, recent evidence on the efficacy and safety of pharmacologic treatments for psoriatic arthritis (PsA) could help improve recommendations for pharmacologic management of PsA.

Researchers conducted a systematic literature review (SLR), examining conventional synthetic (cs), biologic (b), and targeted synthetic disease-modifying antirheumatic drugs (DMARDs). The search covered Medline, EMBASE, and Cochrane CENTRAL databases for articles published from the previous update in 2019 until December 28, 2022. Efficacy data were drawn from clinical trials, whereas safety data also included observational studies. The study focused on adverse events such as infections (e.g., herpes zoster, influenza, tuberculosis), malignancies, major adverse cardiovascular events, venous thromboembolisms, liver disease, laboratory changes, and psychiatric adverse events.

For efficacy, out of 3946 screened articles, 38 (from 30 trials) were analyzed. The csDMARDs investigated included leflunomide and methotrexate. bDMARDs studied were those inhibiting IL-17 (bimekizumab, brodalumab, ixekizumab, izokibep, secukinumab), IL-23 (guselkumab, risankizumab, tildrakizumab), IL-12/23 (ustekinumab), tumor necrosis factor (TNF) (adalimumab, certolizumab-pegol, etanercept, infliximab, golimumab), and Janus kinase (JAK) (brepocitinib, deucravacitinib, tofacitinib, upadacitinib). These compounds were found to be effective in improving PsA symptoms, physical functioning, and quality of life.

For safety, 2055 abstracts were screened and 24 articles were analyzed, including 15 observational studies and 9 long-term trial follow-ups. These studies assessed safety indicators for glucocorticoids and TNF, IL-17, JAK, IL-12/23, and phosphodiesterase-4 inhibitors (apremilast). Safety outcomes were generally consistent with the previous SLR in 2019.

The findings from this SLR informed the 2023 update of the European Alliance of Associations for Rheumatology recommendations for the pharmacologic management of PsA, emphasizing the efficacy of various DMARDs in managing PsA symptoms and the importance of monitoring for potential adverse events.

Reference
Kerschbaumer A, Smolen JS, Ferreira RJO, et al. Efficacy and safety of pharmacological treatment of psoriatic arthritis: a systematic literature research informing the 2023 update of the EULAR recommendations for the management of psoriatic arthritis. Ann Rheum Dis. 2024;83:760-774. doi:10.1136/ard-2024-225534