Psoriatic Arthritis Supported by Pharmacologic Treatment Strategies

According to a study published in Clinical Therapeutics, there are many approved therapeutic options for patients with psoriatic arthritis (PsA) with additional emerging treatment options in the pipeline.

Researchers aimed to provide up-to-date information on therapeutic strategies for PsA by adopting a domain-based approach to support treatment decisions. The review focused on various disease domains related to PsA, including peripheral arthritis, enthesitis, axial disease, dactylitis, skin, and nail disease. It also covered "related conditions" such as uveitis, Crohn's disease, and ulcerative colitis. The researchers conducted a comprehensive search across PubMed, EMBASE, international guidelines, and recent congress abstracts to gather relevant data.

Currently, there are multiple approved treatment options for PsA, offering a broad range of choices. These include tumor necrosis factor (TNF) inhibitors, interleukin-17 (IL-17) inhibitors, IL-12/23 inhibitors, IL-23 inhibitors, Janus kinase inhibitors, the phosphodiesterase 4 inhibitor apremilast, and the T-cell modulator abatacept. However, the review highlighted that no single treatment option demonstrated clear superiority in terms of efficacy for peripheral arthritis and dactylitis compared to others. For enthesitis, some limited evidence suggested that the IL-17 inhibitor ixekizumab and the IL-12/23 inhibitor ustekinumab may be more effective than TNF inhibitors.

Treatment for axial PsA mostly draws from axial spondyloarthritis, and more research is required to address the specific subgroup of PsA patients with axial involvement. A randomized controlled trial indicated that the IL-17 inhibitor secukinumab showed superiority over placebo in terms of clinical and radiologic outcomes in axial PsA. In psoriatic skin involvement, head-to-head trials in both PsA and skin psoriasis favored IL-17, IL-23, and IL-12/23 inhibitors over TNF inhibitors. When managing PsA with concurrent uveitis, the existing data suggest that monoclonal TNF inhibitor antibodies should be the preferred choice. For patients with PsA and coexisting inflammatory bowel disease, treatment decisions need to consider the specific type of inflammatory bowel disease (Crohn's disease or ulcerative colitis). IL-17 inhibitors should be avoided in both cases.

“Individualized treatment decisions for each patient, depending on the leading disease phenotype, underlying comorbidities, and patient preferences, should be made based on shared decision-making,” the authors concluded.

Reference
Ayan G, Ribeiro A, Macit B, Proft F. Pharmacologic treatment strategies in psoriatic arthritis. Clin Ther. Published online July 14, 2023. doi:10.1016/j.clinthera.2023.05.010