Pharmacological Treatment of Psoriatic Arthritis: A Systematic Literature Research for the 2019 Update of the EULAR Recommendations for the Management of Psoriatic Arthritis

Andreas Kerschbaumer (1) , Josef S Smolen (1) , Maxime Dougados (2) , Maarten De Wit , Jette Primdahl , Iain Mcinnes (3) , Désirée van Der Heijde (4) , Xenofon Baraliakos (5) , Louise Falzon , Laure Gossec (6, 7)

1 Medizinische Universität Wien = Medical University of Vienna
2 Hôpital Cochin [AP-HP]
3 University of Glasgow
4 LUMC - Leiden University Medical Center
5 RUB - Ruhr University Bochum = Ruhr-Universität Bochum
6 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
7 CHU Pitié-Salpêtrière [AP-HP]

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\textendash 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\textendash 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\textendash 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.

Mots clés: DMARDs (biologic); DMARDs (synthetic); anti-TNF; psoriatic arthritis

Domaines: Sciences du Vivant [q-bio]

Andreas Kerschbaumer, Josef S Smolen, Maxime Dougados, Maarten De Wit, Jette Primdahl, et al.. Pharmacological Treatment of Psoriatic Arthritis: A Systematic Literature Research for the 2019 Update of the EULAR Recommendations for the Management of Psoriatic Arthritis. Annals of the Rheumatic Diseases, 2020, 79 (6), pp.778--786. ⟨10.1136/annrheumdis-2020-217163⟩. ⟨hal-03894171⟩