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Yu J, Zhao Q, Wang X, Zhou H, Hu J, Gu L, Hu Y, Zeng F, Zhao F, Yue C, Zhou P, Li G, Li Y, Wu W, Zhou Y, Li J. Pathogenesis, multi-omics research, and clinical treatment of psoriasis. J Autoimmun 2022; 133:102916. [PMID: 36209691 DOI: 10.1016/j.jaut.2022.102916] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/08/2022] [Accepted: 09/12/2022] [Indexed: 11/07/2022]
Abstract
Psoriasis is a common inflammatory skin disease involving interactions between keratinocytes and immune cells that significantly affects the quality of life. It is characterized by hyperproliferation and abnormal differentiation of keratinocytes and excessive infiltration of immune cells in the dermis and epidermis. The immune mechanism underlying this disease has been elucidated in the past few years. Research shows that psoriasis is regulated by the complex interactions among immune cells, such as keratinocytes, dendritic cells, T lymphocytes, neutrophils, macrophages, natural killer cells, mast cells, and other immune cells. An increasing number of signaling pathways have been found to be involved in the pathogenesis of psoriasis, which has prompted the search for new treatment targets. In the past decades, studies on the pathogenesis of psoriasis have focused on the development of targeted and highly effective therapies. In this review, we have discussed the relationship between various types of immune cells and psoriasis and summarized the major signaling pathways involved in the pathogenesis of psoriasis, including the PI3K/AKT/mTOR, JAK-STAT, JNK, and WNT pathways. In addition, we have discussed the results of the latest omics research on psoriasis and the epigenetics of the disease, which provide insights regarding its pathogenesis and therapeutic prospects; we have also summarized its treatment strategies and observations of clinical trials. In this paper, the various aspects of psoriasis are described in detail, and the limitations of the current treatment methods are emphasized. It is necessary to improve and innovate treatment methods from the molecular level of pathogenesis, and further provide new ideas for the treatment and research of psoriasis.
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Affiliation(s)
- Jiadong Yu
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, West China Medical School, Sichuan University, and Collaborative Innovation Center for Biotherapy, 1 Keyuan 4th Road, Gaopeng Street, High Technological Development Zone, Chengdu, Sichuan, 610041, China
| | - Qixiang Zhao
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, West China Medical School, Sichuan University, and Collaborative Innovation Center for Biotherapy, 1 Keyuan 4th Road, Gaopeng Street, High Technological Development Zone, Chengdu, Sichuan, 610041, China
| | - Xiaoyan Wang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, West China Medical School, Sichuan University, and Collaborative Innovation Center for Biotherapy, 1 Keyuan 4th Road, Gaopeng Street, High Technological Development Zone, Chengdu, Sichuan, 610041, China
| | - Hong Zhou
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, West China Medical School, Sichuan University, and Collaborative Innovation Center for Biotherapy, 1 Keyuan 4th Road, Gaopeng Street, High Technological Development Zone, Chengdu, Sichuan, 610041, China
| | - Jing Hu
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, West China Medical School, Sichuan University, and Collaborative Innovation Center for Biotherapy, 1 Keyuan 4th Road, Gaopeng Street, High Technological Development Zone, Chengdu, Sichuan, 610041, China
| | - Linna Gu
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, West China Medical School, Sichuan University, and Collaborative Innovation Center for Biotherapy, 1 Keyuan 4th Road, Gaopeng Street, High Technological Development Zone, Chengdu, Sichuan, 610041, China
| | - Yawen Hu
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, West China Medical School, Sichuan University, and Collaborative Innovation Center for Biotherapy, 1 Keyuan 4th Road, Gaopeng Street, High Technological Development Zone, Chengdu, Sichuan, 610041, China
| | - Fanlian Zeng
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, West China Medical School, Sichuan University, and Collaborative Innovation Center for Biotherapy, 1 Keyuan 4th Road, Gaopeng Street, High Technological Development Zone, Chengdu, Sichuan, 610041, China
| | - Fulei Zhao
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, West China Medical School, Sichuan University, and Collaborative Innovation Center for Biotherapy, 1 Keyuan 4th Road, Gaopeng Street, High Technological Development Zone, Chengdu, Sichuan, 610041, China
| | - Chengcheng Yue
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, West China Medical School, Sichuan University, and Collaborative Innovation Center for Biotherapy, 1 Keyuan 4th Road, Gaopeng Street, High Technological Development Zone, Chengdu, Sichuan, 610041, China
| | - Pei Zhou
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, West China Medical School, Sichuan University, and Collaborative Innovation Center for Biotherapy, 1 Keyuan 4th Road, Gaopeng Street, High Technological Development Zone, Chengdu, Sichuan, 610041, China
| | - Guolin Li
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, West China Medical School, Sichuan University, and Collaborative Innovation Center for Biotherapy, 1 Keyuan 4th Road, Gaopeng Street, High Technological Development Zone, Chengdu, Sichuan, 610041, China
| | - Ya Li
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, West China Medical School, Sichuan University, and Collaborative Innovation Center for Biotherapy, 1 Keyuan 4th Road, Gaopeng Street, High Technological Development Zone, Chengdu, Sichuan, 610041, China
| | - Wenling Wu
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, West China Medical School, Sichuan University, and Collaborative Innovation Center for Biotherapy, 1 Keyuan 4th Road, Gaopeng Street, High Technological Development Zone, Chengdu, Sichuan, 610041, China
| | - Yifan Zhou
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, West China Medical School, Sichuan University, and Collaborative Innovation Center for Biotherapy, 1 Keyuan 4th Road, Gaopeng Street, High Technological Development Zone, Chengdu, Sichuan, 610041, China
| | - Jiong Li
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, West China Medical School, Sichuan University, and Collaborative Innovation Center for Biotherapy, 1 Keyuan 4th Road, Gaopeng Street, High Technological Development Zone, Chengdu, Sichuan, 610041, China.
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Vassilopoulos A, Shehadeh F, Benitez G, Kalligeros M, Cunha JS, Cunha CB, Mylonakis E. The incidence of opportunistic infections in patients with psoriatic arthritis treated with biologic and targeted synthetic agents: A systematic review and meta-analysis. Front Pharmacol 2022; 13:992713. [PMID: 36278224 PMCID: PMC9579334 DOI: 10.3389/fphar.2022.992713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Biologic (bDMARD) and targeted synthetic (tsDMARD) disease-modifying anti-rheumatic drugs have broadened the treatment options and are increasingly used for patients with psoriatic arthritis (PsA). These agents block different pro-inflammatory cytokines or specific intracellular signaling pathways that promote inflammation and can place patients at risk of serious infections. We aimed to review the incidence of opportunistic infections (OIs) in patients with PsA who were treated with these agents.Methods: We searched PubMed and EMBASE through 14 April 2022 for randomized clinical trials evaluating bDMARD or tsDMARD in the treatment of PsA. Trials were eligible if they compared the effect of a bDMARD or tsDMARD with placebo and provided safety data. We used the Revised Cochrane risk-of-bias tool to assess the risk of bias among trials, and stratified the studies by mechanism of action (MOA) of the agents studied.Results: We included 47 studies in this analysis. A total of 17,197 patients received at least one dose of an agent of interest. The cumulative incidence of OIs by MOA was as follows: 1) JAK inhibitors: 2.72% (95% CI: 1.05%–5.04%), 2) anti-IL-17: 1.18% (95% CI: 0.60%–1.9%), 3) anti-IL-23: 0.24% (95% CI: 0.04%–0.54%), and 4) anti-TNFs: 0.01% (95% CI: 0.00%–0.21%). Based on their MOA, these agents are known to increase the risk of certain serious infections. The cumulative incidence of herpes zoster infection following treatment with JAK inhibitors (JAKi) was 2.53% (95% CI: 1.03%–4.57%) and the cumulative incidence of opportunistic Candida spp. infections following treatment with anti-IL-17, was 0.97% (95% CI: 0.51%–1.56%).Conclusion: The overall incidence of OIs among patients with PsA who were treated with biologic and targeted synthetic agents is low. However, careful monitoring is warranted for specific OIs such as herpes zoster infection following JAKi treatment, mucocutaneous candidiasis following anti-IL-17 treatment, and Mycobacterium tuberculosis infection following anti-TNF treatment.
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Affiliation(s)
- Athanasios Vassilopoulos
- Infectious Diseases Division, Rhode Island Hospital, Providence, RI, United States
- Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Fadi Shehadeh
- Infectious Diseases Division, Rhode Island Hospital, Providence, RI, United States
- Warren Alpert Medical School of Brown University, Providence, RI, United States
- School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| | - Gregorio Benitez
- Infectious Diseases Division, Rhode Island Hospital, Providence, RI, United States
- Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Markos Kalligeros
- Infectious Diseases Division, Rhode Island Hospital, Providence, RI, United States
- Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Joanne S. Cunha
- Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Cheston B. Cunha
- Infectious Diseases Division, Rhode Island Hospital, Providence, RI, United States
- Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Eleftherios Mylonakis
- Infectious Diseases Division, Rhode Island Hospital, Providence, RI, United States
- Warren Alpert Medical School of Brown University, Providence, RI, United States
- *Correspondence: Eleftherios Mylonakis,
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Saldarriaga-Rivera LM, Bautista-Molano W, Junca-Ramírez A, Fernández-Aldana AR, Fernández-Ávila DG, Jaimes DA, Jáuregui EA, Segura-Charry JS, Romero-Sánchez C, Felipe-Diaz OJ. 2021 clinical practice guidelines for the diagnosis, treatment, and follow-up of patients with peripheral spondyloarthritis. Colombian Association of Rheumatology. REUMATOLOGIA CLINICA 2022; 18:5-14. [PMID: 35033487 DOI: 10.1016/j.reumae.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 09/30/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Peripheral spondyloarthritis is a chronic inflammatory disease in which clinical presentation is related to the presence of arthritis, enthesitis and/or dactylitis. This term is used interchangeably with some of its subtypes such as psoriatic arthritis, reactive arthritis, and undifferentiated spondyloarthritis. OBJECTIVE To develop and formulate a set of specific recommendations based on the best available evidence for the diagnosis, treatment and monitoring of adult patients with peripheral spondyloarthritis. METHODS A working group was established, clinical questions were formulated, outcomes were graded, and a systematic search for evidence was conducted. The guideline panel was multidisciplinary (including patient representatives) and balanced. Following the formal expert consensus method, the GRADE methodology "Grading of Recommendations Assessment, Development and Evaluation" was used to assess the quality of the evidence and generate the recommendations. The Clinical Practice Guideline includes ten recommendations; related to monitoring of disease activity (n = 1) and treatment (n = 9). RESULTS In patients with peripheral spondyloarthritis, the use of methotrexate or sulfasalazine as the first line of treatment is suggested, and local injections of glucocorticoids is recommended conditionally. In patients with failure to cDMARDs, an anti TNFα or an anti IL17A is recommended. In case of failure to bDMARDs, it is suggested to use another bDMARD or JAK inhibitor. In patients with peripheral spondyloarthritis associated to inflammatory bowel disease, it is recommended to start treatment with cDMARDs; in the absence of response, the use of an anti TNFα over an anti-IL-17 or an anti-IL-12-23 is recommended as a second line of treatment. In patients with psoriatic arthritis, the combined use of methotrexate with bDMARD is conditionally recommended for optimization of dosing. To assess disease activity in Psoriatic Arthritis, the use of DAPSA or MDA is suggested for patient monitoring. CONCLUSIONS This set of recommendations provides an updated guide on the diagnosis and treatment of peripheral spondyloarthritis.
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Affiliation(s)
- Lina M Saldarriaga-Rivera
- Hospital Universitario San Jorge, Facultad de Medicina, Universidad Tecnológica de Pereira, Institución Universitaria Visión de las Américas, Clínica Los Rosales, Pereira, Colombia.
| | - Wilson Bautista-Molano
- Hospital Universitario Fundación Santa Fe de Bogotá, Universidad El Bosque, Bogotá, Colombia
| | | | | | - Daniel G Fernández-Ávila
- Hospital Universitario San Ignacio, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Diego A Jaimes
- Universidad de la Sabana, Clínicos IPS, Bogotá, Colombia
| | - Edwin A Jáuregui
- Servicio de Reumatología, Riesgo de Fractura S.A. Cayre IPS, Bogotá, Colombia
| | - Juan S Segura-Charry
- Servicio de Reumatología, Clínica Medilaser, Neiva, Colombia, Clínicos IPS, Bogotá, Colombia
| | | | - Oscar J Felipe-Diaz
- Servicio de Reumatología, Clínica Medilaser, Neiva, Colombia, Clínicos IPS, Bogotá, Colombia; Servicio de Reumatología, Medicarte S.A. Clínica Las Vegas, Bogotá, Colombia
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Carneiro S, Palominos PE, Anti SMA, Assad RL, Gonçalves RSG, Chiereghin A, Lyrio AM, Ximenes AC, Saad CG, Gonçalves CR, Kohem CL, Marques CDL, Schainberg CG, de Souza Meirelles E, Resende GG, Pieruccetti LB, Keiserman MW, Yazbek MA, Sampaio-Barros PD, da Cruz Lage R, Bonfiglioli R, Oliveira TL, Azevedo VF, Bianchi WA, Bernardo WM, Dos Santos Simões R, de Medeiros Pinheiro M, Campanholo CB. Brazilian Society of Rheumatology 2020 guidelines for psoriatic arthritis. Adv Rheumatol 2021; 61:69. [PMID: 34819174 DOI: 10.1186/s42358-021-00219-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/28/2021] [Indexed: 12/29/2022] Open
Abstract
Psoriatic arthritis (PsA) is a chronic and systemic immune disease characterized by inflammation of peripheral and/or axial joints and entheses in patients with psoriasis (PsO). Extra-articular and extracutaneous manifestations and numerous comorbidities can also be present. These recommendations replace the previous version published in May 2013. A systematic review of the literature retrieved 191 articles that were used to formulate 12 recommendations in response to 12 clinical questions, divided into 4 sections: diagnosis, non-pharmacological treatment, conventional drug therapy and biologic therapy. These guidelines provide evidence-based information on the clinical management for PsA patients. For each recommendation, the level of evidence (highest available), degree of strength (Oxford) and degree of expert agreement (interrater reliability) are reported.
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Affiliation(s)
- Sueli Carneiro
- Universidade Federal do Rio de Janeiro (UFRJ), Rua Farme de Amoedo, 140/601. Ipanema, Rio de Janeiro, RJ, CEP 22420-020, Brazil.
| | | | | | | | | | | | - Andre Marun Lyrio
- Pontifícia Universidade Católica de Campinas (PUC), Campinas, Brazil
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Meier K, Schloegl A, Poddubnyy D, Ghoreschi K. Skin manifestations in spondyloarthritis. Ther Adv Musculoskelet Dis 2020; 12:1759720X20975915. [PMID: 33343725 PMCID: PMC7727049 DOI: 10.1177/1759720x20975915] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/03/2020] [Indexed: 12/30/2022] Open
Abstract
Spondyloarthritides (SpA) like psoriatic arthritis, axial spondyloarthritis/ankylosing spondylitis, reactive arthritis and inflammatory bowel disease (IBD)-associated SpA can present with characteristic skin manifestations. These SpA-associated skin disorders may precede joint involvement, reflect a loss of efficacy of a current systemic treatment or can even be treatment associated. Cutaneous manifestations in SpA not only add additional morbidity with physical impact but also impose a psychosocial burden on affected patients. Psoriasis (PsO) - the main skin disease in SpA - has a variety of clinical presentations, including plaque-type PsO, inverse PsO, guttate PsO, erythrodermic PsO, nail PsO and pustular types. SpA associated with IBD presents with neutrophilic and granulomatous skin disorders, including pyoderma gangrenosum, hidradenitis suppurativa and cutaneous Crohn's disease. Reactive arthritides has a favourable prognosis and may feature keratoderma blenorrhagicum or balanitis circinatum as typical skin manifestations. Immunologically, SpA-associated skin diseases share interleukin (IL)-17 and IL-23 dysregulation but show distinctive genetic and immunological profiles. Therefore, they vary in their treatment responses to targeted therapies with biologicals or small molecules. In this review, we highlight the clinical presentation of skin manifestations in SpA and discuss therapeutic approaches in this interdisciplinary field.
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Affiliation(s)
- Katharina Meier
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | | | - Denis Poddubnyy
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Kamran Ghoreschi
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
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Noviani M, Feletar M, Nash P, Leung YY. Choosing the right treatment for patients with psoriatic arthritis. Ther Adv Musculoskelet Dis 2020; 12:1759720X20962623. [PMID: 33133245 PMCID: PMC7576918 DOI: 10.1177/1759720x20962623] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/02/2020] [Indexed: 12/12/2022] Open
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory condition with articular and extra-articular manifestations: peripheral arthritis, axial disease, enthesitis, dactylitis, psoriasis, inflammatory bowel disease and uveitis. Anti-tumour necrosis factors (anti-TNFs) have demonstrated clinical efficacies exceeding those of conventional disease-modifying antirheumatic drugs (DMARDs). New understanding in pathogenic pathways have led to novel therapeutic targets. The current treatment paradigms emphasize early diagnosis and treatment, and treating towards remission and low disease activity status, particularly in long-standing disease. This review addresses the evidence of current treatment options for each of the domains of PsA. We present a simple guide that weighs on clinical efficacies for each PsA domain to aid clinicians in choosing the most appropriate treatment for patients. We highlight the unmet need for biomarkers of treatment response, and future perspectives with precision medicine in PsA.
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Affiliation(s)
- Maria Noviani
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | | | - Peter Nash
- School of Medicine, Griffith University, Brisbane, Queensland, Australia
| | - Ying Ying Leung
- Department of Rheumatology and Immunology, Singapore General Hospital, level 4, Academia, 20 College Road, Outram Road, Singapore 169608, Singapore Duke-NUS Medical School, Singapore
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Bungey G, Chang-Douglass S, Hsu MA, Cappelleri JC, Young P, Woolcott J. Costs and Health Outcomes Associated with Tofacitinib Treatment for Active Psoriatic Arthritis in the United States. J Manag Care Spec Pharm 2020; 26:1027-1038. [PMID: 32308099 PMCID: PMC10391130 DOI: 10.18553/jmcp.2020.19319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Psoriatic arthritis (PsA) is a chronic progressive inflammatory condition associated with significant direct and indirect costs. Tofacitinib is an oral Janus kinase inhibitor for the treatment of PsA. Economic evaluations, alongside clinical data, help inform papers and formulary decisions in the United States. OBJECTIVE To evaluate outcomes and costs of including tofacitinib in treatment strategies for PsA from a third-party U.S. payer perspective, using a health economic model. METHODS A decision tree model was developed to evaluate treatment sequences (up to 4 lines of advanced PsA therapy) with or without tofacitinib. Patients included in the model had active PsA and a previous inadequate response (IR) to conventional synthetic disease-modifying antirheumatic drug (csDMARD) or tumor necrosis factor inhibitor (TNFi) therapy. The analysis time horizon was 2 years; decision points for continuing/switching treatments occurred quarterly, based on clinical response (assessed using the primary rheumatoid measure of efficacy, American College of Rheumatology [ACR]20 response only) and adverse drug reactions (ADRs). Costs included those related to ADRs and drug acquisition, monitoring, and administration. Other endpoints of PsA, such as assessment of enthesitis and dactylitis, were not integrated into the model. RESULTS Treatment strategies including tofacitinib were associated with cost savings versus strategies without tofacitinib across all modeled scenarios, with an estimated 2-year cost saving of up to $8,454,858, based on 1 million insurants. Similarly, costs per member per month and per ACR20 responder were lower for sequences including tofacitinib versus sequences without. These savings arose because of lower ADR and drug acquisition/administration costs for sequences including tofacitinib. Deterministic sensitivity analyses showed these results to be robust. CONCLUSIONS This analysis suggests that including tofacitinib in the treatment of active PsA in csDMARD-IR or TNFi-IR patients is a cost-saving alternative to sequences without tofacitinib, potentially reducing costs for PsA advanced therapies by up to $8.4 million over 2 years for payers insuring 1 million individuals. DISCLOSURES This work was sponsored by Pfizer Inc. Bungey is an employee of Decision Resources Group, which received financial support from Pfizer Inc to develop the treatment-cost model used in the development of this manuscript. Chang-Douglass was an employee of Decision Resources Group at the time of the analysis. During development of this publication, Chang-Douglass started a role at the National Institute for Health and Care Excellence (NICE). The publication only reflects her views and does not reflect the views of NICE. Hsu, Cappelleri, Young, and Woolcott are employees of Pfizer Inc and own stock or stock options in Pfizer Inc. The data reported in this manuscript have been previously presented at the American College of Rheumatology Annual Scientific Meeting; October 19-24, 2018; Chicago, IL, and the AMCP Annual Meeting and Expo; March 25-28, 2019; San Diego, CA.
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Abstract
Psoriasis is a multisystemic, inflammatory skin condition that can affect many areas of the body, but most commonly the extensor surfaces of the elbows and knees, and sometimes the intergluteal and umbilical area. It has a prevalence of 2–4% in western adults, and 20–30% of psoriasis patients will develop psoriatic arthritis (PsA). PsA is an inflammatory musculoskeletal disease associated with cutaneous psoriasis. It affects men and women almost equally with a peak age at onset of 40 and 50 years. It is a diverse disease that affects multiple organ systems includes peripheral and axial joints, entheses, skin, and nails. PsA is associated with comorbidities such as osteoporosis, uveitis, subclinical bowel inflammation, and cardiovascular disease. Given this heterogeneity, its diagnosis has been difficult. Here we present an updated review of its classification criteria CASPAR (classification criteria for PsA), use of screening tools to aid in early diagnosis, recent findings on pathogenesis, and new therapeutic approaches including new biologic medications.
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Affiliation(s)
- Vanessa Ocampo D
- University of Toronto, Psoriatic Arthritis Program, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Dafna Gladman
- University of Toronto, Psoriatic Arthritis Program, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada.,Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada
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Palsson O, Love TJ, Gunnarsdottir AI, Gunnarsson PS, Runarsdottir EE, Krogh NS, Gudbjornsson B. Patients with psoriatic arthritis who are not eligible for randomised controlled trials for TNF inhibitors have treatment response and drug survival similar to those who are eligible. RMD Open 2019; 5:e000984. [PMID: 31413869 PMCID: PMC6667974 DOI: 10.1136/rmdopen-2019-000984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/05/2019] [Accepted: 06/23/2019] [Indexed: 01/21/2023] Open
Abstract
Objectives To determine in a retrospective cohort whether patients with psoriatic arthritis (PsA) who would not have fulfilled the inclusion criteria for randomised controlled trials (RCTs) for the TNF inhibitor (TNFi) chosen for their treatment (excl) have similar benefits and drug survival as those patients who would have (incl). Methods All patients with rheumatic disorders who are treated with biological disease-modifying antirheumatic drugs in Iceland are registered in ICEBIO. On 1 February 2016, 329 individuals with PsA were registered in ICEBIO, of whom 231 had data available for their first start of TNFi and could be evaluated according to the inclusion criteria of the respective RCTs. Disease activity was collected at baseline using Visual Analogue Scale (pain, fatigue and global (patient and physician) assessments), swollen joint count (SJC) and tender joint count (TJC), Disease Activity Score 28-joint count C reactive protein (DAS28-CRP) and Health Assessment Questionnaire (HAQ). Treatment response was measured at 6 and 18 months according to American College of Rheumatology response criteria, DAS28-CRP and Disease Activity Score in Psoriatic Arthritis for 28 joints. Drug survival rate was also analysed. Results The demographics of these two groups were similar at baseline, although the incl group had higher SJC (5.5 vs 3.8) and subsequently higher DAS28-CRP (4.6 vs 4.2). While a larger change in disease activity was observed in the incl group with respect to HAQ and SJC, both groups had similar disease activity at follow-up. Drug survival was similar in both groups. Conclusions Patients with PsA who would not have fulfilled the inclusion criteria in RCTs reach similar disease activity scores at follow-up of 6 and 18 months and have similar drug survival as those patients who would have been included in RCTs.
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Affiliation(s)
- Olafur Palsson
- Centre for Rheumatology Research, Landspitali University Hospital, Reykjavik, Iceland
| | - Thorvardur Jon Love
- Department of Science and Research, Landspitali University Hospital, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Anna Ingibjorg Gunnarsdottir
- Faculty of Pharmaceutical Sciences, University of Iceland, Reykjavik, Iceland
- Hospital Pharmacy, Landspitali University Hospital, Reykjavik, Iceland
| | - Petur Sigurdur Gunnarsson
- Faculty of Pharmaceutical Sciences, University of Iceland, Reykjavik, Iceland
- Hospital Pharmacy, Landspitali University Hospital, Reykjavik, Iceland
| | | | | | - Bjorn Gudbjornsson
- Centre for Rheumatology Research, Landspitali University Hospital, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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Preliminary validation of the Simplified Psoriatic Arthritis Radiographic Score (SPARS). Skeletal Radiol 2019; 48:1033-1041. [PMID: 30535825 DOI: 10.1007/s00256-018-3124-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 10/30/2018] [Accepted: 11/26/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To develop and validate in a preliminary way a novel radiographic scoring system for psoriatic arthritis (PsA), called Simplified Psoriatic Arthritis Radiographic Score (SPARS). MATERIALS AND METHODS Radiographs of hands and feet were obtained from consecutive PsA patients and assessed by two readers. For each joint (30 joints in the hands, ten joints in the feet), the combination of the erosions, joint narrowing space (JNS) and bony proliferation (BP) has been assessed, giving a value of 1 for erosions presence, 1 for JNS presence, and 1 for BP presence (SPARS score range, 0-120). Reliability was assessed by calculating the intraclass correlation coefficient (ICC) and smallest detectable difference (SDD) of the readings. To determine the convergent validity, SPARS was compared to the modified Sharp/van der Heijde Score (mSvdHS) and to the Ratingen scoring system (PARS). RESULTS One-hundred and five hands and feet radiographs have been assessed. The inter- and intra-rater reliability were excellent (inter-rater reliability 0.934, and intra-rater reliability for both readers 0.845 and 0.876). The SDD for the average SPARS scores of the two readers was 8.0. SPARS correlated strongly with mSvdHS (r = 0.926; p < 0.0001), and PARS (r = 0.904; p < 0.0001). The mean time to score each of the mSvdHS, PARS, and SPARS was 14.4, 10.1, and 4.5 min, respectively. CONCLUSIONS The SPARS properties are close to those of the mSvdHS and PARS and is quicker to calculate.
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Sharif K, Gendelman O, Langevitz P, Reitblat T, Watad A, Shoenfeld Y, Azuri J, Amital H, Bragazzi NL, Shovman O. Efficacy and survival of golimumab with and without methotrexate in patients with psoriatic arthritis: A retrospective study from daily clinical practice. Best Pract Res Clin Rheumatol 2019; 32:692-700. [PMID: 31203927 DOI: 10.1016/j.berh.2019.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Golimumab is a recombinant human monoclonal antibody targeted against tumour necrosis factor-alpha (TNF-α). Golimumab is effective in the management of patients with active psoriatic arthritis (PsA). The aim of this study is to evaluate the clinical efficacy and survival of golimumab monotherapy versus co-administration with methotrexate (MTX) in patients with PsA in the clinical practice. This retrospective observational trial included patients with PsA. Efficacy was assessed by disease activity scores - DAS28, BASDAI, physician global assessment of disease (PGA) and CRP. Golimumab survival rate was estimated using the Kaplan-Meier analysis and univariate and multivariate Cox regression models. Forty-one patients with PsA were recruited; 26 patients were treated with golimumab, whereas 15 patients received combination therapy with MTX. The treatment resulted in significantly improved clinical measures of disease activity in comparison with baseline, including DAS28 CRP (4.1 vs 2.6, p ≤ 0.0001) and BASDAI (5.6 vs 3.8, p ≤ 0.001). Overall, 29 (71%) patients continued golimumab treatment (18 patients on monotherapy and 11 on combination therapy). The difference in the duration of golimumab survival between the combination therapy and monotherapy groups was not statistically significant (12.5 vs 12 months, p = 0.2). Similar efficacy profiles and survival rates were documented in patients with PsA regardless of the co-administration of methotrexate.
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Affiliation(s)
- Kassem Sharif
- Zabludowitz Center for Autoimmune Diseases, Sheba Medical Center, Ramat Gan, Israel; Department of Internal Medicine 'B', Sheba Medical Center, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omer Gendelman
- Zabludowitz Center for Autoimmune Diseases, Sheba Medical Center, Ramat Gan, Israel; Department of Internal Medicine 'B', Sheba Medical Center, Ramat Gan, Israel; Rheumatology Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Pnina Langevitz
- Rheumatology Unit, Sheba Medical Center, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Maccabi Healthcare Service, Tel Aviv, Israel
| | - Tatiana Reitblat
- Rheumatology Unit, Barzilai Medical Center, Ben Gurion University of the Negev, Ashkelon, Israel
| | - Abdulla Watad
- Zabludowitz Center for Autoimmune Diseases, Sheba Medical Center, Ramat Gan, Israel; Department of Internal Medicine 'B', Sheba Medical Center, Ramat Gan, Israel; Rheumatology Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Yehuda Shoenfeld
- Zabludowitz Center for Autoimmune Diseases, Sheba Medical Center, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Incumbent of Laura Schwarz-Kioo Chair for Research of Autoimmune Diseases, Tel Aviv University, Tel Aviv, Israel
| | - Josef Azuri
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Maccabi Healthcare Service, Tel Aviv, Israel
| | - Howard Amital
- Zabludowitz Center for Autoimmune Diseases, Sheba Medical Center, Ramat Gan, Israel; Department of Internal Medicine 'B', Sheba Medical Center, Ramat Gan, Israel; Rheumatology Unit, Sheba Medical Center, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nicola Luigi Bragazzi
- School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Ora Shovman
- Zabludowitz Center for Autoimmune Diseases, Sheba Medical Center, Ramat Gan, Israel; Department of Internal Medicine 'B', Sheba Medical Center, Ramat Gan, Israel; Rheumatology Unit, Sheba Medical Center, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Maccabi Healthcare Service, Tel Aviv, Israel.
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12
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de Winter JJ, Paramarta JE, de Jong HM, van de Sande MG, Baeten DL. Peripheral disease contributes significantly to the level of disease activity in axial spondyloarthritis. RMD Open 2019; 5:e000802. [PMID: 30713720 PMCID: PMC6340525 DOI: 10.1136/rmdopen-2018-000802] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 10/02/2018] [Accepted: 10/24/2018] [Indexed: 01/21/2023] Open
Abstract
Objective Spondyloarthritis (SpA) can encompass axial, peripheral and extra-articular disease manifestations. Patients are classified as axial or peripheral SpA depending on the presence or absence of current back pain, independently of the other disease manifestations. Therefore, we aimed to assess the percentage of patients with axial SpA with peripheral disease and how this peripheral disease contributes to the overall disease activity. Methods Prevalence and disease activity of peripheral disease manifestations were assessed in a real-life observational cohort of 314 patients with the clinical diagnosis of SpA and fulfilling the Assessment of SpondyloArthritis international Society (ASAS) criteria. Results Of the 314 patients fulfilling the ASAS criteria, 230 fulfilled the axial and 84 the peripheral SpA criteria. Of the 230 patients with axial SpA, 49% had purely axial disease without peripheral disease manifestations whereas 51% had combined axial (back pain) and peripheral (arthritis, enthesitis and/or dactylitis) disease. The latter group had the highest disease activity in comparison with pure axial SpA as well as with peripheral SpA. Conclusion Half of the patients classified as axial SpA according to the ASAS criteria also have peripheral disease manifestations such as arthritis, enthesitis and/or dactylitis. These peripheral disease manifestations contribute significantly to overall disease activity.
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Affiliation(s)
- Janneke J de Winter
- Amsterdam Rheumatology and Immunology Center, Department of Clinical Immunology and Rheumatology, Amsterdam UMC University of Amsterdam, Amsterdam, The Netherlands
| | - Jacqueline E Paramarta
- Amsterdam Rheumatology and Immunology Center, Department of Clinical Immunology and Rheumatology, Amsterdam UMC University of Amsterdam, Amsterdam, The Netherlands
| | - Henriëtte M de Jong
- Amsterdam Rheumatology and Immunology Center, Department of Clinical Immunology and Rheumatology, Amsterdam UMC University of Amsterdam, Amsterdam, The Netherlands
| | - Marleen G van de Sande
- Amsterdam Rheumatology and Immunology Center, Department of Clinical Immunology and Rheumatology, Amsterdam UMC University of Amsterdam, Amsterdam, The Netherlands
| | - Dominique L Baeten
- Amsterdam Rheumatology and Immunology Center, Department of Clinical Immunology and Rheumatology, Amsterdam UMC University of Amsterdam, Amsterdam, The Netherlands
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Affiliation(s)
- Thorvardur Jon Love
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Research, Landspitali University Hospital, Reykjavik, Iceland
| | - Arthur Kavanaugh
- Department of Medicine, Division of Rheumatology, Allergy, Immunology, The University of California, San Diego, CA, USA
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Nash P, Behrens F, Orbai AM, Rathmann SS, Adams DH, Benichou O, Deodhar A. Ixekizumab is efficacious when used alone or when added to conventional synthetic disease-modifying antirheumatic drugs (cDMARDs) in patients with active psoriatic arthritis and previous inadequate response or intolerance to tumour necrosis factor inhibitors. RMD Open 2018; 4:e000692. [PMID: 30233812 PMCID: PMC6135452 DOI: 10.1136/rmdopen-2018-000692] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 06/29/2018] [Accepted: 07/06/2018] [Indexed: 01/12/2023] Open
Abstract
Objective To conduct subset analyses of SPIRIT-P2 (NCT02349295) to investigate the efficacy and safety of ixekizumab versus placebo in three subgroups of patients with active psoriatic arthritis (PsA) according to the concomitant conventional synthetic disease-modifying antirheumatic drug (cDMARD) received: any background cDMARDs (including methotrexate), background methotrexate only, or none. Methods Patients were randomised to receive placebo, ixekizumab 80 mg every 4 weeks (IXEQ4W) or every 2 weeks (IXEQ2W). Efficacy and safety were assessed when patients were subdivided according to cDMARD use at baseline. Efficacy was evaluated versus placebo at week 24 by the American College of Rheumatology criteria (ACR20/50), achievement of minimal disease activity (MDA) state, Disease Activity Index for PsA (DAPSA), 28-joint Disease Activity Score using C-reactive protein (DAS28-CRP), Health Assessment Questionnaire-Disability Index and the 36-item Short-Form health survey physical functioning domain. Results Regardless of background cDMARD status, ACR20, ACR50 and MDA response rates were significantly higher than placebo with IXEQ4W or IXEQ2W treatment. Similarly, significant improvements were observed relative to placebo for DAS28-CRP and DAPSA across subgroups. Physical function also significantly improved relative to placebo with IXEQ4W treatment regardless of background cDMARD status and with IXEQ2W alone. Percentages of reported treatment-emergent adverse events (AEs), serious AEs (including serious infections) and discontinuations due to AEs in each subgroup were comparable to the overall SPIRIT-P2 population. Conclusion Ixekizumab was efficacious in patients with active PsA and previous tumour necrosis factor inhibitor (TNFi) inadequate response or TNFi intolerance treated with ixekizumab alone or when added to cDMARDs with subgroup safety profiles that were consistent with that observed in the overall SPIRIT-P2 population.
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Affiliation(s)
- Peter Nash
- Department of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Frank Behrens
- Center for Innovative Diagnostics and Therapy in Rheumatology/Immunology (CIRI), Goethe University Frankfurt and Fraunhofer IME Project Group Translational Medicine and Pharmacology TMP, Frankfurt, Germany
| | - Ana-Maria Orbai
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | | | | | - Atul Deodhar
- Division of Arthritis and Rheumatic Diseases, Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA
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15
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Gladman DD, Kavanaugh A, Gómez-Reino JJ, Wollenhaupt J, Cutolo M, Schett G, Lespessailles E, Guerette B, Delev N, Teng L, Edwards CJ, Birbara CA, Mease PJ. Therapeutic benefit of apremilast on enthesitis and dactylitis in patients with psoriatic arthritis: a pooled analysis of the PALACE 1-3 studies. RMD Open 2018; 4:e000669. [PMID: 30018799 PMCID: PMC6045740 DOI: 10.1136/rmdopen-2018-000669] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/30/2018] [Accepted: 05/25/2018] [Indexed: 01/11/2023] Open
Abstract
Objective The Psoriatic Arthritis Long-term Assessment of Clinical Efficacy (PALACE) clinical trial programme findings demonstrated that apremilast, an oral phosphodiesterase 4 inhibitor, is effective for treating psoriatic arthritis (PsA). Enthesitis and dactylitis are difficult-to-treat features of PsA leading to disability and affecting quality of life. PALACE 1, 2 and 3 data were pooled to assess the efficacy of apremilast on enthesitis and dactylitis outcomes in patients with these conditions at baseline. Methods Patients with enthesitis (n=945) or dactylitis (n=633) at baseline were analysed after receiving double-blind treatment with placebo, apremilast 30 mg two times per day or apremilast 20 mg two times per day up to 52 weeks and continuing up to 5 years. Data were analysed through 156 weeks. Enthesitis was evaluated by Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) and dactylitis via dactylitis count. Results At week 24, patients receiving apremilast 30 mg two times per day demonstrated a significantly greater mean change in enthesitis (−1.3 vs −0.9; p<0.05) and dactylitis (−1.8 vs −1.3; p<0.01) vs placebo. Patients in the 30 mg dose group showed significantly greater mean (−23.6% vs −7.0%; p<0.05) and median (−50.0% vs −21.1%; p<0.05) per cent changes in MASES; mean and median per cent changes in dactylitis count were numerically, but not significantly, different for either apremilast dose in patients with dactylitis. In the patient population remaining on apremilast, observed mean and median improvements in both conditions were sustained through 156 weeks. Conclusion Apremilast is effective for the treatment of active PsA, including improvements in enthesitis and dactylitis up to 3 years. Trial registration numbers NCT01172938, NCT01212757 and NCT01212770.
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Affiliation(s)
- Dafna D Gladman
- Division of Rheumatology, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Arthur Kavanaugh
- Department of Rheumatology, University of California School of Medicine at San Diego, La Jolla, California, USA
| | - Juan J Gómez-Reino
- Fundación Ramón Domínguez, Hospital Clínico Universitario, Santiago, Spain
| | - Jürgen Wollenhaupt
- Department of Rheumatology and Clinical Immunology, Schön Klinik Hamburg Eilbek, Hamburg, Germany
| | - Maurizio Cutolo
- Research Laboratory and Division of Rheumatology, Department Internal Medicine, University of Genova, Genova, Italy
| | - Georg Schett
- Medizinishche Klinik 3, Rheumatologie und Immunologie, Friedrich-Alexander-Universität Erlangen-Nürnberg und Universitätsklinikum Erlangen, Erlangen, Germany
| | - Eric Lespessailles
- Rheumatology Department, University Orléans and Regional Hospital of Orléans, Orléans, France
| | | | | | - Lichen Teng
- Celgene Corporation, Summit, New Jersey, USA
| | - Christopher J Edwards
- Musculoskeletal Research Unit, NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Charles A Birbara
- Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Philip J Mease
- Swedish Medical Center and University of Washington School of Medicine, Seattle, Washington, USA
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Krüger K, Burmester GR, Wassenberg S, Bohl-Bühler M, Thomas MH. Effectiveness and safety of golimumab in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis under real-life clinical conditions: non-interventional GO-NICE study in Germany. BMJ Open 2018; 8:e021082. [PMID: 29903793 PMCID: PMC6009562 DOI: 10.1136/bmjopen-2017-021082] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE The Non Interventional Evaluation with Golumimab (GO-NICE) study aimed to document patient and treatment characteristics as well as clinical effectiveness and safety in adult patients newly treated with the tumour necrosis factor inhibitor golimumab (GLM). DESIGN Prospective non-interventional study with 24-month observation per patient. SETTING 158 office-based and clinical-based physicians in Germany. INTERVENTION GLM administered in the 50 mg dose subcutaneously in monthly intervals under real-life conditions. RESULTS Of the 1613 included patients, 1458 patients were eligible for final analysis: 474 patients with rheumatoid arthritis (RA, 54.9±13.4 years, 72.8% women, 64.7% biologic-naïve), 501 with psoriatic arthritis (PsA, 50.5±12.1 years, 54.1% women, 56.5% biologic-naïve) and 483 with ankylosing spondylitis (AS, 43.6±12.3 years, 66.5% men, 61.0% biologic-naïve). 664 patients completed follow-up (2-year retention rate 45.5%). Disease Activity Score 28-joint count erythrocyte sedimentation rate (DAS28-ESR) decreased from 5.0 to 2.9 after 24 months (p<0.0001) in patients with RA, and Bath Ankylosing Spondylitis Disease Index score decreased from 5.1 to 2.4 (p<0.0001) in patients with AS. Response rate calculated in patients with PsA by modified Psoriatic Arthritis Response Criteria was 67.9% after 24 months. Most adverse events were of mild or moderate nature, and no new safety signals were detected. According to the physicians' clinical assessments, treatment with GLM was successful (no adverse drug reaction and a clear or moderate therapeutic effect in an individual patient) in 55.0%-56.6% of patients with RA, PsA and AS, respectively, at month 3, increasing from 74.5% to 76.1% at month 24. CONCLUSIONS GLM subcutaneously once monthly led to substantial improvements in clinical effectiveness in patients with various inflammatory rheumatic diseases who could be followed up in a real-life setting in Germany. The treatment was well tolerated, and the safety profile of GLM was consistent with that observed in the previous randomised controlled trials. TRIAL REGISTRATION NUMBER NCT01313858.
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Affiliation(s)
- Klaus Krüger
- Rheumatologisches Praxiszentrum, Munich, Germany
| | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin, Berlin, Germany
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Balsa A, Lula S, Marshall L, Szczypa P, Aikman L. The comparative immunogenicity of biologic therapy and its clinical relevance in psoriatic arthritis: a systematic review of the literature. Expert Opin Biol Ther 2018. [PMID: 29533116 DOI: 10.1080/14712598.2018.1450385] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Biologic agents have demonstrated efficacy in treating patients with psoriatic arthritis (PsA). Biologic agents also have an intrinsic capacity to induce an immune response in patients that could result in unwanted adverse events and/or treatment failure. AREAS COVERED In this systematic literature review, the authors document the incidence of immune responses, primarily anti-drug antibodies (ADA), to the biologic therapeutic agents currently in clinical practice for the treatment of PsA. The authors discuss the importance of these responses with respect to clinical practice. EXPERT OPINION Our evaluation of the published literature shows that the immune responses to the various biologic therapeutic agents currently being used to treat PsA are similar to those observed for these agents in other rheumatic diseases. Moreover, similar to observations in other rheumatic diseases, the incidence of ADA formation to biologic agents in patients with PsA is often decreased when patients are given concomitant treatment with disease-modifying anti-rheumatic drugs. These data strongly suggest that the immune response is a characteristic of the biologic agent. Using therapeutic drug monitoring may be an approach to assess the immune response to the agent and to mitigate the potential impact on efficacy and safety, and consequently optimize treatment.
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Affiliation(s)
- Alejandro Balsa
- a Department of Rheumatology , Hospital Universitario La Paz, IdiPAZ , Madrid , Spain
| | - Sadiq Lula
- b Market Access Solutions , Envision Pharma Group , London , UK
| | - Lisa Marshall
- c Global Therapeutic Area, Rheumatology, Immunology & Inflammation , Pfizer , Collegeville , PA , USA
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Bakirci Ureyen S, Ivory C, Kalyoncu U, Karsh J, Aydin SZ. What does evidence-based medicine tell us about treatments for different subtypes of psoriatic arthritis? A systematic literature review on randomized controlled trials. Rheumatol Adv Pract 2018; 2:rkx019. [PMID: 31431950 PMCID: PMC6649907 DOI: 10.1093/rap/rkx019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 01/04/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE PsA is a heterogeneous disease with various subtypes of joint manifestations, which can affect the homogeneity of randomized controlled trials (RCTs). The aim of this systematic literature review was to evaluate the inclusion criteria, demographics and outcomes of RCTs to see whether the whole spectrum of PsA was represented. METHODS Medline, EMBASE and Cochrane databases were screened for RCTs on the efficacy of any treatment for PsA up to 4 October 2016 to investigate the inclusion criteria, demographics, outcomes and efficacy. RESULTS Two thousand and sixty-eight abstracts were identified at screening; 76 articles and 52 conference proceedings were included in the final analysis. The main inclusion criteria always included the number of active joints and never axial symptoms, enthesitis nor dactylitis. Only 10 studies provided information about subtypes, of which symmetrical polyarthritis was the main subtype. Mean (s.d.) tender and swollen joints were between 7.8 and 35.8 (1.8-22.1) and between 5.2 and 25.2 (1.5-16.2), respectively. All studies had responses in joint counts as their primary outcome. Responses in enthesitis and dactylitis were usually secondary or tertiary outcomes. Response in BASDAI was among the outcomes in four studies. The comparison of efficacy in polyarticular vs oligoarticular disease was given in three studies, whereas no information was available for DIP joint disease or arthritis mutilans. CONCLUSION There is evidence in the literature to guide clinicians on how to treat PsA patients with polyarticular disease, but there is a gap in knowledge about the other subtypes. PROTOCOL REGISTRATION The study protocol is registered at PROSPERO (CRD42017053907).
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Affiliation(s)
| | - Catherine Ivory
- University of Ottawa, Faculty of Medicine, Rheumatology, Ottawa, ON, Canada
| | - Umut Kalyoncu
- Faculty of Medicine, Rheumatology, Hacettepe University, Ankara, Turkey
| | - Jacob Karsh
- University of Ottawa, Faculty of Medicine, Rheumatology, Ottawa, ON, Canada
| | - Sibel Zehra Aydin
- University of Ottawa, Faculty of Medicine, Rheumatology, Ottawa, ON, Canada
- Faculty of Medicine, Ottawa Hospital Research Institute, Rheumatology, University of Ottawa, Ottawa, ON, Canada
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Coates LC, Kishimoto M, Gottlieb A, Shuler CL, Lin CY, Lee CH, Mease PJ. Ixekizumab efficacy and safety with and without concomitant conventional disease-modifying antirheumatic drugs (cDMARDs) in biologic DMARD (bDMARD)-naïve patients with active psoriatic arthritis (PsA): results from SPIRIT-P1. RMD Open 2017; 3:e000567. [PMID: 29299340 PMCID: PMC5743900 DOI: 10.1136/rmdopen-2017-000567] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/16/2017] [Accepted: 11/05/2017] [Indexed: 11/09/2022] Open
Abstract
Objective To evaluate the efficacy and safety of ixekizumab alone or with concomitant conventional disease-modifying antirheumatic drugs (cDMARDs) versus placebo in patients with active psoriatic arthritis (PsA) as part of a SPIRIT-P1 subgroup analysis (NCT01695239). Methods Patients were stratified by cDMARD use (concomitant cDMARDs use (including methotrexate) or none (past or naïve use)) and randomly assigned to treatment groups (ixekizumab 80 mg every 4 weeks (IXEQ4W) or every 2 weeks (IXEQ2W) or placebo). Efficacy was evaluated versus placebo at week 24 by the American College of Rheumatology criteria (ACR20/50/70), modified total Sharp score and Health Assessment Questionnaire-Disability Index (HAQ-DI). Safety was assessed according to cDMARD status. Results Regardless of concomitant cDMARD usage, ACR20, ACR50 and ACR70 response rates were significantly higher versus placebo with IXEQ4W and IXEQ2W. The proportion of patients achieving HAQ-DI minimal clinically important difference was significantly higher versus placebo with IXEQ4W with concomitant cDMARD use and IXEQ2W, regardless of concomitant cDMARD use. Treatment-emergent adverse events (AE) were more frequent versus placebo for either ixekizumab-dosing regimen, regardless of concomitant cDMARD use. Serious AEs were not higher versus placebo, regardless of concomitant cDMARD use. Conclusion Ixekizumab treatment improved measures of disease activity and physical function in patients with active PsA relative to placebo, when used with or without concomitant cDMARD therapy.
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Affiliation(s)
- Laura C Coates
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | - Alice Gottlieb
- Department of Dermatology, New York Medical College at Metropolitan Hospital, New York, New York, USA
| | | | - Chen-Yen Lin
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | - Philip J Mease
- Department of Rheumatology, Swedish Medical Center and University of Washington, Seattle, Washington, USA
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Takeuchi T, Harigai M, Tanaka Y, Yamanaka H, Ishiguro N, Yamamoto K, Miyasaka N, Koike T, Ukyo Y, Ishii Y, Yoshinari T, Baker D. Clinical efficacy, radiographic, and safety results of golimumab monotherapy in Japanese patients with active rheumatoid arthritis despite prior therapy with disease-modifying antirheumatic drugs: Final results of the GO-MONO trial through week 120. Mod Rheumatol 2017; 28:770-779. [PMID: 29219638 DOI: 10.1080/14397595.2017.1404731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Evaluate the safety and efficacy of golimumab through week 120 in Japanese patients with active rheumatoid arthritis (RA) previously treated with DMARDs. METHODS Japanese patients with active RA despite prior DMARDs were randomized to placebo (Group 1, n = 105), golimumab 50 mg (Group 2, n = 101), or golimumab 100 mg (Group 3, n = 102). At week 16, Group 1 patients crossed over to golimumab 50mg; after week 52, a one-time golimumab dose reduction from 100 to 50 mg was permitted. Assessments included ACR20/50/70 responses and good/moderate DAS28-ESR responses. Radiographic progression was assessed with the van der Heijde-modified Sharp (vdH-S) score. Safety and efficacy were assessed through week 120. RESULTS ACR20 response rates at week 52 in Group 1, Group 2, and Group 3 were 70.6%, 71.4%, and 81.9%, respectively, and maintained through week 104 (87.2%, 85.1%, 88.9%, respectively) and week 120 (86.1%, 87.0%, 89.5%, respectively). Similar trends were observed for ACR50, ACR 70, and DAS28-ESR. Median change in total vdH-S at weeks 52, 104, and 120 ranged from 0.0 to 1.5 across treatment groups. Through week 120, 93.8%/97.1% had an AE with golimumab 50 mg/100 mg, respectively, and 19.7%/11.8% had an SAE. Infections were the most common AE. CONCLUSION Clinical response to golimumab 50 mg and 100 mg was maintained over 2 years in Japanese patients with active RA despite prior DMARDs.
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Affiliation(s)
- Tsutomu Takeuchi
- a Division of Rheumatology, Department of Internal Medicine , Keio University School of Medicine , Shinjuku-ku , Tokyo , Japan
| | - Masayoshi Harigai
- b Department of Epidemiology and Pharmacoepidemiology, Institute of Rheumatology , Tokyo Women's Medical University , Shinjuku-ku , Tokyo , Japan
| | - Yoshiya Tanaka
- c First Department of Internal Medicine, School of Medicine , University of Occupational and Environmental Health , Kitakyushu , Fukuoka , Japan
| | - Hisashi Yamanaka
- d Institute of Rheumatology , Tokyo Women?s Medical University , Shinjuku-ku , Tokyo , Japan
| | - Naoki Ishiguro
- e Department of Orthopedic Surgery , Nagoya University , Nagoya , Aichi , Japan
| | - Kazuhiko Yamamoto
- f Department of Allergy and Rheumatology , The University of Tokyo , Bunkyo-ku , Tokyo , Japan
| | - Nobuyuki Miyasaka
- g Department of Medicine & Rheumatology, Graduate School of Medical and Dental Sciences , Tokyo Medical and Dental University , Bunkyo-ku , Tokyo , Japan
| | - Takao Koike
- h Sapporo Medical Center NTT EC , Sapporo , Japan
| | - Yoshifumi Ukyo
- i Janssen Pharmaceutical K.K. , Chiyoda-ku , Tokyo , Japan
| | - Yutaka Ishii
- i Janssen Pharmaceutical K.K. , Chiyoda-ku , Tokyo , Japan
| | - Toru Yoshinari
- j Mitsubishi Tanabe Pharma Corporation , Chuo-ku , Tokyo , Japan
| | - Daniel Baker
- k Janssen Research & Development, LLC , Spring House , PA , USA
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Torre Alonso JC, Díaz Del Campo Fontecha P, Almodóvar R, Cañete JD, Montilla Morales C, Moreno M, Plasencia-Rodríguez C, Ramírez García J, Queiro R. Recommendations of the Spanish Society of Rheumatology on treatment and use of systemic biological and non-biological therapies in psoriatic arthritis. ACTA ACUST UNITED AC 2017; 14:254-268. [PMID: 29111261 DOI: 10.1016/j.reuma.2017.08.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 08/21/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The main purpose of this recommendation statement is to provide clinicians with the best available evidence and the best opinion agreed upon by the panelists for a rational use of synthetic disease modifying antirheumatic drugs (DMARDs) and biologicals in psoriatic arthritis (PsA) patients. The present document also focuses on important aspects in the management of PsA, such as early diagnosis, therapeutic objectives, comorbidities and optimization of treatment. METHODS The recommendations were agreed by consensus by a panel of 8 expert rheumatologists, previously selected by the Spanish Society of Rheumatology (SER) through an open call. The phases of the work were: identification of key areas for updating the previous consensus, analysis and synthesis of scientific evidence (modified Oxford system, Centre for Evidence-based Medicine, 2009) and formulation of recommendations based on this evidence and by consensus techniques. RESULTS Seventeen recommendations were issued for the treatment of PsA patients. Six of them were of general nature, ranging from the early diagnosis and treatment to the importance of assessing comorbidities. The other 11 were focused on the indications for DMARDs and biological therapy in the distinct clinical forms of the disease. Likewise, the situation of failure of the first biological is addressed and treatment algorithms and a table with the different biological therapies are also included. CONCLUSIONS We present the update of SER recommendations for the treatment of PsA with DMARDs and biologics.
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Affiliation(s)
| | | | - Raquel Almodóvar
- Unidad de Reumatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - Juan D Cañete
- Unidad de Artritis, Servicio de Reumatología, Hospital Clínic, Barcelona, España
| | | | - Mireia Moreno
- Servicio de Reumatología, Parc Taulí Hospital Universitari, Sabadell, Barcelona, España
| | | | - Julio Ramírez García
- Unidad de Artritis, Servicio de Reumatología, IDIBAPS y Hospital Clínic, Barcelona, España
| | - Rubén Queiro
- Sección de Reumatología, Hospital Universitario Central de Asturias, Oviedo, España.
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Urdaneta M, Jethwa H, Sultan R, Abraham S. A review on golimumab in the treatment of psoriatic arthritis. Immunotherapy 2017; 9:871-889. [PMID: 28838285 DOI: 10.2217/imt-2017-0063] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Psoriatic arthritis (PsA) causes inflammation in and around the joints and usually affects people who already have psoriasis. However, some patients develop the joint problems before the psoriasis. Currently, there are five anti-TNF-α agents licensed for use in patients with PsA: adalimumab, certolizumab pegol, etanercept, golimumab and infliximab. Golimumab, a human monoclonal antibody, has been approved by the US FDA for the treatment of PsA and is targeted against the pro-inflammatory molecule TNF-α. The Phase III GO-REVEAL study confirmed this drug was well tolerated and showed significant improvement in disease activity compared with placebo.
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Affiliation(s)
- Maria Urdaneta
- NIHR/Wellcome Trust Imperial Clinical Research Facility, Imperial College London, Hammersmith Hospital, London, UK
| | - Hannah Jethwa
- Rheumatology Department, Wexham Park Hospital, Slough, UK
| | - Reshma Sultan
- NIHR/Wellcome Trust Imperial Clinical Research Facility, Imperial College London, Hammersmith Hospital, London, UK
| | - Sonya Abraham
- NIHR/Wellcome Trust Imperial Clinical Research Facility, Imperial College London, Hammersmith Hospital, London, UK
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23
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Strand V, Balsa A, Al-Saleh J, Barile-Fabris L, Horiuchi T, Takeuchi T, Lula S, Hawes C, Kola B, Marshall L. Immunogenicity of Biologics in Chronic Inflammatory Diseases: A Systematic Review. BioDrugs 2017; 31:299-316. [PMID: 28612180 PMCID: PMC5548814 DOI: 10.1007/s40259-017-0231-8] [Citation(s) in RCA: 208] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES A systematic review was conducted to explore the immunogenicity of biologic agents across inflammatory diseases and its potential impact on efficacy/safety. METHODS Literature searches were conducted through November 2016 to identify controlled and observational studies of biologics/biosimilars administered for treatment of rheumatoid arthritis (RA), psoriatic arthritis (PsA), juvenile idiopathic arthritis (JIA), ankylosing spondylitis (AS), non-radiographic axial spondyloarthritis (nr-axSpA), psoriasis (Ps), Crohn's disease, and ulcerative colitis. RESULTS Of >21,000 screened publications, 443 were included. Anti-drug antibody (ADAb) rates varied widely among biologics across diseases (and are not directly comparable because of immunoassay heterogeneity); the highest overall rates were reported with infliximab (0-83%), adalimumab (0-54%), and infliximab biosimilar CT-P13 (21-52%), and the lowest with secukinumab (0-1%), ustekinumab (1-11%), etanercept (0-13%), and golimumab (0-19%). Most ADAbs were neutralizing, except those to abatacept and etanercept. ADAb+ versus ADAb- patients had lower rates of clinical response to adalimumab (RA, PsA, JIA, AS, Ps), golimumab (RA), infliximab (RA, PsA, AS, Ps), rituximab (RA), ustekinumab (Ps), and CT-P13 (RA, AS). Higher rates of infusion-related reactions were reported in infliximab- and CT-P13-treated ADAb+ patients. Background immunosuppressives/anti-proliferatives reduced biologic immunogenicity across diseases. CONCLUSIONS Based on reviewed reports, biologic/biosimilar immunogenicity differs among agents, with the highest rates observed with infliximab and adalimumab. As ADAb formation in biologic-/biosimilar-treated patients may increase the risk of lost response, the immunogenicity of these agents is an important (albeit not the only) consideration in the treatment decision-making process.
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Affiliation(s)
- Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University School of Medicine, 306 Ramona Road, Portola Valley, CA, 94028, USA.
| | - Alejandro Balsa
- Rheumatology Unit, Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Jamal Al-Saleh
- Rheumatology Section, Dubai Hospital, Dubai, United Arab Emirates
| | - Leonor Barile-Fabris
- Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México City, Mexico
| | - Takahiko Horiuchi
- Department of Internal Medicine, Kyushu University Beppu Hospital, Beppu, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Sadiq Lula
- Market Access Solutions, Envision Pharma Group, London, UK
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Golimumab in real-life settings: 2 Years drug survival and predictors of clinical outcomes in rheumatoid arthritis, spondyloarthritis, and psoriatic arthritis. Semin Arthritis Rheum 2017; 47:108-114. [DOI: 10.1016/j.semarthrit.2017.01.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 12/19/2016] [Accepted: 01/16/2017] [Indexed: 12/11/2022]
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Braun J. New targets in psoriatic arthritis. Rheumatology (Oxford) 2017; 55:ii30-ii37. [PMID: 27856658 DOI: 10.1093/rheumatology/kew343] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 08/23/2016] [Indexed: 12/30/2022] Open
Abstract
PsA is an immune-mediated chronic inflammatory disease that affects both skin and joints; it is a heterogeneous disease characterized by synovitis, enthesitis, dactylitis and spondylitis. The impact on patients and the burden of disease are substantial. For assessment of the disease, patient-reported outcomes are increasingly important. Conventional therapy consists of NSAIDs, local and systemic CSs, and synthetic and biological DMARDs. While MTX, LEF, SSZ and CYC are the synthetic drugs mainly used, TNF-α blocking agents have represented the majority of biologics used in the last decade (infliximab, etanercept, adalimumab, certolizumab and golimumab). Treat-to-target strategies have been used successfully in PsA. This review concentrates on new developments, mainly covering biologic agents with an IL-17 inhibitor (secukinumab) and an anti-IL-23 agent (ustekinumab), but also synthetic drugs, including a novel phosphodiesterase-4 inhibitor (apremilast) and a Janus kinase inhibitor (tofacitinib) that blocks mainly Jak3 and Jak1 and, to a lesser extent, Jak2. The efficacy of some of these new agents may be even better for the skin than for the joints.
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Affiliation(s)
- Juergen Braun
- Rheumazentrum Ruhrgebiet, Herne, Ruhr University Bochum, Germany
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26
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TNF Inhibitors for Psoriasis and Psoriatic Arthritis. CURRENT DERMATOLOGY REPORTS 2017. [DOI: 10.1007/s13671-017-0174-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Turbeville JG, Patel NU, Cardwell LA, Oussedik E, Feldman SR. Recent Advances in Small Molecule and Biological Therapeutic Approaches in the Treatment of Psoriasis. Clin Pharmacol Ther 2017; 102:70-85. [DOI: 10.1002/cpt.688] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/10/2017] [Accepted: 03/11/2017] [Indexed: 01/31/2023]
Affiliation(s)
- JG Turbeville
- Center for Dermatology Research; Department of Dermatology, Wake Forest School of Medicine; Winston-Salem North Carolina USA
| | - NU Patel
- Center for Dermatology Research; Department of Dermatology, Wake Forest School of Medicine; Winston-Salem North Carolina USA
| | - LA Cardwell
- Center for Dermatology Research; Department of Dermatology, Wake Forest School of Medicine; Winston-Salem North Carolina USA
| | - E Oussedik
- Center for Dermatology Research; Department of Dermatology, Wake Forest School of Medicine; Winston-Salem North Carolina USA
| | - SR Feldman
- Center for Dermatology Research; Department of Dermatology, Wake Forest School of Medicine; Winston-Salem North Carolina USA
- Department of Pathology; Wake Forest School of Medicine; Winston-Salem North Carolina USA
- Department of Public Health Sciences; Wake Forest School of Medicine; Winston-Salem North Carolina USA
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28
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Kay J, Fleischmann R, Keystone E, Hsia EC, Hsu B, Zhou Y, Goldstein N, Braun J. Five-year Safety Data from 5 Clinical Trials of Subcutaneous Golimumab in Patients with Rheumatoid Arthritis, Psoriatic Arthritis, and Ankylosing Spondylitis. J Rheumatol 2016; 43:2120-2130. [PMID: 27803138 DOI: 10.3899/jrheum.160420] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2016] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Assess 5-year golimumab (GOL) safety in rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS). METHODS Subcutaneous (SC) GOL (50 mg or 100 mg every 4 weeks) was evaluated in phase 3 trials of patients with active RA, PsA, and AS. Safety data through Year 5 were pooled across 3 RA trials [1 each evaluating methotrexate (MTX)-naive, MTX-experienced, and antitumor necrosis factor (TNF)-experienced patients], 1 PsA trial, and 1 AS trial. Data summarized was derived from both placebo-controlled (through weeks 24-52) and uncontrolled study periods. For adverse events (AE) of special interest [serious infections (SI), opportunistic infections (OI), deaths, malignancies, demyelination, tuberculosis (TB)], incidence per 100 patient-years (pt-yrs) was determined. RESULTS Across all trials, 639 patients received placebo and 2228 received SC GOL 50 mg only (n = 671), 50 mg and 100 mg (n = 765), or 100 mg only (n = 792). Safety followup extended for averages of 28.5 and 203.2 weeks for placebo and GOL, respectively. Respective placebo and GOL AE incidence/100 pt-yrs (95% CI) through Year 5 were 4.86 (2.83-7.78) and 3.29 (2.92-3.69) for SI, 0.00 (0.00-0.86) and 0.23 (0.14-0.35) for TB, 0.00 (0.00-0.86) and 0.22 (0.13-0.34) for OI, 0.00 (0.00-0.86) and 0.10 (0.05-0.20) for lymphoma, 0.00 (0.00-0.86) and 0.08 (0.03-0.17) for demyelination, and 0.29 (0.01-1.59) and 0.41 (0.29-0.57) for death. TB, OI, lymphoma, and demyelination incidence appeared to be higher among patients receiving GOL 100 mg only. CONCLUSION SC GOL safety through Year 5 remained consistent with previously reported Year 3 findings and with other TNF antagonists. Numerically higher incidences of TB, OI, lymphoma, and demyelination were observed with 100 mg versus 50 mg. Clinicaltrials.gov identifiers: NCT00264537 (GO-BEFORE), NCT00264550 (GO-FORWARD), NCT00299546 (GO-AFTER), NCT00265096 (GO-REVEAL), and NCT00265083 (GO-RAISE).
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Affiliation(s)
- Jonathan Kay
- From the Division of Rheumatology, Department of Medicine, UMass Memorial Medical Center, and University of Massachusetts Medical School, Worcester, Massachusetts; Rheumatology, University of Texas Southwestern Medical Center and Metroplex Clinical Research Center, Dallas, Texas; Janssen Research and Development LLC, Spring House; University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Rheumatology, Rheumazentrum Ruhrgebeit, Herne, Germany. .,J. Kay, MD, Division of Rheumatology, and Department of Medicine, UMass Memorial Medical Center, University of Massachusetts Medical School; R. Fleischmann, MD, Rheumatology, University of Texas Southwestern Medical Center, and Metroplex Clinical Research Center; E. Keystone, MD, FRCP(C), Division of Rheumatology, University of Toronto; E.C. Hsia, MD, Janssen Research and Development LLC, and University of Pennsylvania; B. Hsu, MD, PhD, Janssen Research and Development LLC, and University of Pennsylvania; Y. Zhou, PhD, Janssen Research and Development LLC; N. Goldstein, MD, Janssen Research and Development LLC; J. Braun, MD, Rheumatology, Rheumazentrum Ruhrgebeit.
| | - Roy Fleischmann
- From the Division of Rheumatology, Department of Medicine, UMass Memorial Medical Center, and University of Massachusetts Medical School, Worcester, Massachusetts; Rheumatology, University of Texas Southwestern Medical Center and Metroplex Clinical Research Center, Dallas, Texas; Janssen Research and Development LLC, Spring House; University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Rheumatology, Rheumazentrum Ruhrgebeit, Herne, Germany.,J. Kay, MD, Division of Rheumatology, and Department of Medicine, UMass Memorial Medical Center, University of Massachusetts Medical School; R. Fleischmann, MD, Rheumatology, University of Texas Southwestern Medical Center, and Metroplex Clinical Research Center; E. Keystone, MD, FRCP(C), Division of Rheumatology, University of Toronto; E.C. Hsia, MD, Janssen Research and Development LLC, and University of Pennsylvania; B. Hsu, MD, PhD, Janssen Research and Development LLC, and University of Pennsylvania; Y. Zhou, PhD, Janssen Research and Development LLC; N. Goldstein, MD, Janssen Research and Development LLC; J. Braun, MD, Rheumatology, Rheumazentrum Ruhrgebeit
| | - Edward Keystone
- From the Division of Rheumatology, Department of Medicine, UMass Memorial Medical Center, and University of Massachusetts Medical School, Worcester, Massachusetts; Rheumatology, University of Texas Southwestern Medical Center and Metroplex Clinical Research Center, Dallas, Texas; Janssen Research and Development LLC, Spring House; University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Rheumatology, Rheumazentrum Ruhrgebeit, Herne, Germany.,J. Kay, MD, Division of Rheumatology, and Department of Medicine, UMass Memorial Medical Center, University of Massachusetts Medical School; R. Fleischmann, MD, Rheumatology, University of Texas Southwestern Medical Center, and Metroplex Clinical Research Center; E. Keystone, MD, FRCP(C), Division of Rheumatology, University of Toronto; E.C. Hsia, MD, Janssen Research and Development LLC, and University of Pennsylvania; B. Hsu, MD, PhD, Janssen Research and Development LLC, and University of Pennsylvania; Y. Zhou, PhD, Janssen Research and Development LLC; N. Goldstein, MD, Janssen Research and Development LLC; J. Braun, MD, Rheumatology, Rheumazentrum Ruhrgebeit
| | - Elizabeth C Hsia
- From the Division of Rheumatology, Department of Medicine, UMass Memorial Medical Center, and University of Massachusetts Medical School, Worcester, Massachusetts; Rheumatology, University of Texas Southwestern Medical Center and Metroplex Clinical Research Center, Dallas, Texas; Janssen Research and Development LLC, Spring House; University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Rheumatology, Rheumazentrum Ruhrgebeit, Herne, Germany.,J. Kay, MD, Division of Rheumatology, and Department of Medicine, UMass Memorial Medical Center, University of Massachusetts Medical School; R. Fleischmann, MD, Rheumatology, University of Texas Southwestern Medical Center, and Metroplex Clinical Research Center; E. Keystone, MD, FRCP(C), Division of Rheumatology, University of Toronto; E.C. Hsia, MD, Janssen Research and Development LLC, and University of Pennsylvania; B. Hsu, MD, PhD, Janssen Research and Development LLC, and University of Pennsylvania; Y. Zhou, PhD, Janssen Research and Development LLC; N. Goldstein, MD, Janssen Research and Development LLC; J. Braun, MD, Rheumatology, Rheumazentrum Ruhrgebeit
| | - Benjamin Hsu
- From the Division of Rheumatology, Department of Medicine, UMass Memorial Medical Center, and University of Massachusetts Medical School, Worcester, Massachusetts; Rheumatology, University of Texas Southwestern Medical Center and Metroplex Clinical Research Center, Dallas, Texas; Janssen Research and Development LLC, Spring House; University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Rheumatology, Rheumazentrum Ruhrgebeit, Herne, Germany.,J. Kay, MD, Division of Rheumatology, and Department of Medicine, UMass Memorial Medical Center, University of Massachusetts Medical School; R. Fleischmann, MD, Rheumatology, University of Texas Southwestern Medical Center, and Metroplex Clinical Research Center; E. Keystone, MD, FRCP(C), Division of Rheumatology, University of Toronto; E.C. Hsia, MD, Janssen Research and Development LLC, and University of Pennsylvania; B. Hsu, MD, PhD, Janssen Research and Development LLC, and University of Pennsylvania; Y. Zhou, PhD, Janssen Research and Development LLC; N. Goldstein, MD, Janssen Research and Development LLC; J. Braun, MD, Rheumatology, Rheumazentrum Ruhrgebeit
| | - Yiying Zhou
- From the Division of Rheumatology, Department of Medicine, UMass Memorial Medical Center, and University of Massachusetts Medical School, Worcester, Massachusetts; Rheumatology, University of Texas Southwestern Medical Center and Metroplex Clinical Research Center, Dallas, Texas; Janssen Research and Development LLC, Spring House; University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Rheumatology, Rheumazentrum Ruhrgebeit, Herne, Germany.,J. Kay, MD, Division of Rheumatology, and Department of Medicine, UMass Memorial Medical Center, University of Massachusetts Medical School; R. Fleischmann, MD, Rheumatology, University of Texas Southwestern Medical Center, and Metroplex Clinical Research Center; E. Keystone, MD, FRCP(C), Division of Rheumatology, University of Toronto; E.C. Hsia, MD, Janssen Research and Development LLC, and University of Pennsylvania; B. Hsu, MD, PhD, Janssen Research and Development LLC, and University of Pennsylvania; Y. Zhou, PhD, Janssen Research and Development LLC; N. Goldstein, MD, Janssen Research and Development LLC; J. Braun, MD, Rheumatology, Rheumazentrum Ruhrgebeit
| | - Neil Goldstein
- From the Division of Rheumatology, Department of Medicine, UMass Memorial Medical Center, and University of Massachusetts Medical School, Worcester, Massachusetts; Rheumatology, University of Texas Southwestern Medical Center and Metroplex Clinical Research Center, Dallas, Texas; Janssen Research and Development LLC, Spring House; University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Rheumatology, Rheumazentrum Ruhrgebeit, Herne, Germany.,J. Kay, MD, Division of Rheumatology, and Department of Medicine, UMass Memorial Medical Center, University of Massachusetts Medical School; R. Fleischmann, MD, Rheumatology, University of Texas Southwestern Medical Center, and Metroplex Clinical Research Center; E. Keystone, MD, FRCP(C), Division of Rheumatology, University of Toronto; E.C. Hsia, MD, Janssen Research and Development LLC, and University of Pennsylvania; B. Hsu, MD, PhD, Janssen Research and Development LLC, and University of Pennsylvania; Y. Zhou, PhD, Janssen Research and Development LLC; N. Goldstein, MD, Janssen Research and Development LLC; J. Braun, MD, Rheumatology, Rheumazentrum Ruhrgebeit
| | - Jürgen Braun
- From the Division of Rheumatology, Department of Medicine, UMass Memorial Medical Center, and University of Massachusetts Medical School, Worcester, Massachusetts; Rheumatology, University of Texas Southwestern Medical Center and Metroplex Clinical Research Center, Dallas, Texas; Janssen Research and Development LLC, Spring House; University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; Rheumatology, Rheumazentrum Ruhrgebeit, Herne, Germany.,J. Kay, MD, Division of Rheumatology, and Department of Medicine, UMass Memorial Medical Center, University of Massachusetts Medical School; R. Fleischmann, MD, Rheumatology, University of Texas Southwestern Medical Center, and Metroplex Clinical Research Center; E. Keystone, MD, FRCP(C), Division of Rheumatology, University of Toronto; E.C. Hsia, MD, Janssen Research and Development LLC, and University of Pennsylvania; B. Hsu, MD, PhD, Janssen Research and Development LLC, and University of Pennsylvania; Y. Zhou, PhD, Janssen Research and Development LLC; N. Goldstein, MD, Janssen Research and Development LLC; J. Braun, MD, Rheumatology, Rheumazentrum Ruhrgebeit
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Tan WSG, Kelly S, Pitzalis C. Targeted therapies: what they teach us about the pathogenesis of psoriasis and psoriatic arthritis. Expert Rev Clin Immunol 2016; 13:207-222. [PMID: 27690678 DOI: 10.1080/1744666x.2017.1241710] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Biologic therapy has revolutionized treatment pathways in psoriatic joint and skin disease. It has also provided a useful tool with which pathological pathways of this condition may be explored. Areas covered: This review presents data on the clinical and biological effects of targeted therapy in psoriatic arthritis and psoriasis. Therapeutic agents covered include inhibitors of TNFα, inhibitors of the IL-23/IL-17 axis and inhibitors of intracellular small molecules involved in the transduction of the inflammatory signal. Trial data on clinical and imaging efficacy is reviewed in parallel with studies on biological effects at tissue level. Pathological insights gained from the use of these treatments are explored. Expert commentary: A close relationship exists between specific pathological types and clinical manifestations of psoriatic disease, including responses to treatment. Studying these relationships is likely to improve understanding of disease and enable rational selection of specific treatments for patients with specific pathotypes.
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Affiliation(s)
- Wang Sin Gina Tan
- a Centre for Experimental Medicine and Rheumatology, John Vane Science Centre , William Harvey Research Institute, St. Bartholomew's and Royal London School of Medicine , London , United Kingdom
| | - Stephen Kelly
- a Centre for Experimental Medicine and Rheumatology, John Vane Science Centre , William Harvey Research Institute, St. Bartholomew's and Royal London School of Medicine , London , United Kingdom
| | - Costantino Pitzalis
- a Centre for Experimental Medicine and Rheumatology, John Vane Science Centre , William Harvey Research Institute, St. Bartholomew's and Royal London School of Medicine , London , United Kingdom
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Aletaha D, Alasti F, Smolen JS. Disease activity states of the DAPSA, a psoriatic arthritis specific instrument, are valid against functional status and structural progression. Ann Rheum Dis 2016; 76:418-421. [DOI: 10.1136/annrheumdis-2016-209511] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 06/20/2016] [Accepted: 06/29/2016] [Indexed: 11/04/2022]
Abstract
BackgroundRecently, disease activity states were developed for the Disease Activity index for PSoriatic Arthritis (DAPSA). Here, we assess if different DAPSA disease activity states are associated with different degrees of functional impairment and different extents of joint damage progression in patients with psoriatic arthritis (PsA).MethodsWe used data from two pivotal trials of tumour necrosis factor (TNF) inhibitors in PsA (IMPACT II and GO-REVEAL) and identified patients in DAPSA remission (REM, ≤4), and low, moderate or high disease activity (LDA, ≤14; MDA, ≤28; HDA, >28) at 6 months. Across these groups we compared the functional scores (Health Assessment Questionnaire Disability Index, HAQ and physical component scale of the Short Form-36, PCS), and 1-year structural progression (PsA-modified Sharp/van der Heijde Score).ResultsWe identified 310 from GO-REVEAL and 130 from IMPACT II, with a mean (SD) baseline DAPSA of 48.8 (26.4) and 44.6 (17.9), respectively. HAQ scores increased across patients groups in the four DAPSA disease activity states, while PCS decreased (p<0.001 for both). The mean progression in the combined cohort was −0.47 for REM, −0.28 for LDA, −0.14 for MDA and 0.51 for HDA (p<0.001). This association was also significant in the individual trial cohorts, and in the subgroups of patients treated with TNF inhibitors or placebo. Higher DAPSA scores were significantly and independently associated with probability of structural progression in multiple analyses.ConclusionsDisease activity states of the PsA specific DAPSA score are highly valid for future use as endpoints in clinical trials or as targets in clinical practice.Trial registration numbersIMPACT 2: NCT02152254; GO-REVEAL: NCT00265096.
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Kavanaugh A, van der Heijde D, Beutler A, Gladman D, Mease P, Krueger GG, McInnes IB, Helliwell P, Coates LC, Xu S. Radiographic Progression of Patients With Psoriatic Arthritis Who Achieve Minimal Disease Activity in Response to Golimumab Therapy: Results Through 5 Years of a Randomized, Placebo-Controlled Study. Arthritis Care Res (Hoboken) 2016; 68:267-74. [PMID: 25779603 PMCID: PMC5066795 DOI: 10.1002/acr.22576] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 01/22/2015] [Accepted: 03/03/2015] [Indexed: 11/25/2022]
Abstract
Objective To evaluate long‐term outcomes in psoriatic arthritis (PsA) patients who achieved or did not achieve minimal disease activity (MDA) through 5 years of golimumab treatment in the GO‐REVEAL trial. Methods The GO‐REVEAL trial was a phase III, randomized, double‐blind trial with placebo‐control through week 24 followed by an open‐label extension of golimumab 50/100 mg treatment up to 5 years. In these post‐hoc analyses, MDA was defined by the presence of ≥5 of 7 PsA outcome measures (≤1 swollen joint, ≤1 tender joint, Psoriasis Area and Severity Index [PASI] ≤1, patient pain score ≤15, patient global disease activity score ≤20 [range 0–100], Health Assessment Questionnaire disability index [HAQ DI] ≤0.5, and ≤1 tender enthesis point). Results Treatment with golimumab yielded significantly higher MDA response rates versus patients randomized to placebo at week 14 (23.5% versus 1.0%; P < 0.0001), week 24 (28.1% versus 7.7%; P < 0.0001), and week 52 (42.4% versus 30.2%; P = 0.037). MDA was achieved at least once by ∼50% of golimumab‐treated patients overall. Irrespective of treatment randomization, achievement of MDA at ≥3 and ≥4 consecutive visits was associated with significantly less radiographic progression and more improvement in MDA components allowing specific assessment of physical function (HAQ DI) and overall disease activity (patient global assessment of disease activity) at week 256 versus patients not achieving MDA. Logistic regression analyses indicated that a 1‐unit higher baseline HAQ DI score yielded a significantly lower likelihood of achieving MDA at ≥3 (odds ratio 0.514 [95% confidence interval 0.321–0.824]; P = 0.006) and ≥4 (odds ratio 0.480 [95% confidence interval 0.290–0.795]; P = 0.004) consecutive visits. Conclusion Among golimumab‐treated PsA patients, better long‐term functional improvement, patient global assessment, and radiographic outcomes were observed when patients achieved persistent MDA.
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Affiliation(s)
| | | | - Anna Beutler
- Janssen Research & Development, Spring House, Pennsylvania
| | | | - Philip Mease
- Swedish Medical Center, Seattle, Washington, and University of Washington, Seattle
| | | | | | - Philip Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
| | - Laura C Coates
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
| | - Stephen Xu
- Janssen Research & Development, Spring House, Pennsylvania
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Kavanaugh A, Puig L, Gottlieb AB, Ritchlin C, Li S, Wang Y, Mendelsohn AM, Song M, Zhu Y, Rahman P, McInnes IB. Maintenance of Clinical Efficacy and Radiographic Benefit Through Two Years of Ustekinumab Therapy in Patients With Active Psoriatic Arthritis: Results From a Randomized, Placebo-Controlled Phase III Trial. Arthritis Care Res (Hoboken) 2016; 67:1739-49. [PMID: 26097039 PMCID: PMC5063124 DOI: 10.1002/acr.22645] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 06/05/2015] [Accepted: 06/16/2015] [Indexed: 01/01/2023]
Abstract
Objective To evaluate the efficacy and safety of ustekinumab through 2 years in adult patients with active psoriatic arthritis (PsA). Methods A total of 615 adult patients with active PsA were randomized to placebo, ustekinumab 45 mg, or ustekinumab 90 mg, at weeks 0, 4, and every 12 weeks through week 88 (last dose). At week 16, patients with <5% improvement in both tender and swollen joint counts entered blinded early escape (placebo to 45 mg, 45 mg to 90 mg, and 90 mg to 90 mg). All remaining placebo patients crossed over to ustekinumab 45 mg at week 24. Clinical efficacy measures included American College of Rheumatology criteria for 20% improvement (ACR20), Disease Activity Score in 28 joints using the C‐reactive protein level (DAS28‐CRP), and ≥75% improvement in the Psoriasis Area and Severity Index (PASI75). Radiographic progression was evaluated using the modified Sharp/van der Heijde score (SHS). Results At week 100, ACR20, DAS28‐CRP moderate/good response, and PASI75 rates ranged from 56.7–63.6%, 71.9–76.7%, and 63.9–72.5%, respectively, across the 3 treatment groups. In both ustekinumab groups, the median percent improvement in dactylitis and enthesitis was 100% at week 100. The mean changes in SHS score from week 52 to week 100 were similar to those observed from week 0 to week 52 in the ustekinumab groups. Through week 108, 70.7% and 9.7% of patients had an adverse event (AE) or serious AE, respectively. The rates and type of AEs were similar between the dose groups. Conclusion Clinical and radiographic benefits from ustekinumab treatment were maintained through week 100 in the PSUMMIT 1 study. No unexpected safety events were observed; the safety profile of ustekinumab in this population was similar to that previously observed in psoriasis patients treated with ustekinumab.
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Affiliation(s)
| | - Lluís Puig
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - Shu Li
- Janssen Research & Development, Spring House, Pennsylvania
| | - Yuhua Wang
- Janssen Research & Development, Spring House, Pennsylvania
| | | | - Michael Song
- Janssen Research & Development, Spring House, Pennsylvania
| | - Yaowei Zhu
- Janssen Research & Development, Spring House, Pennsylvania
| | - Proton Rahman
- Memorial University, St. John's, Newfoundland and Labrador, Canada
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Touma Z, Thavaneswaran A, Chandran V, Pellett F, Cook RJ, Gladman DD. Clinical and Demographic Characteristics of Erosion-free and Erosion-present Status in Psoriatic Arthritis in a Cohort Study. J Rheumatol 2016; 43:1057-62. [PMID: 27036389 DOI: 10.3899/jrheum.150466] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Psoriatic arthritis (PsA) has been recognized as a severe erosive disease. However, some patients do not develop erosions. We aimed to determine the prevalence, characteristics, and predictors of erosion-free patients (EFP) as compared with erosion-present patients (EPP) among patients with PsA followed prospectively. METHODS This is a retrospective analysis conducted on patients from the Toronto PsA cohort. Patients with at least 10 years of followup and radiographs were analyzed. Radiographs were scored with the modified Steinbrocker method. Baseline (first visit to clinic) characteristics were used to predict the development of erosions with logistic regression models. To examine the effect of time-varying covariates, Cox regression models were fit for the time to development of erosions from baseline. RESULTS Among 290 patients, 12.4% were EFP and 87.6% were EPP over the study period. The mean time to development of erosion in the EPP over the course of followup was 6.8 ± 6.1 years. EFP were diagnosed with psoriasis at a younger age compared with EPP. In both models, actively inflamed joints and clinically damaged joints were predictive of the development of erosion, whereas a longer duration of psoriasis at baseline decreased the odds of developing erosion. EPP had a higher percentage of unemployment as compared with EFP at baseline and followup visits. CONCLUSION Among patients with PsA followed for at least 10 years, 12.4% never develop erosions. The clinical and radiographic findings can ultimately assist in the stratification of a patient's prognosis regarding the development of erosions.
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Affiliation(s)
- Zahi Touma
- From the Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto; Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada.Z. Touma, MD, FACP, FACR, PhD, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; A. Thavaneswaran, MMath, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; V. Chandran, MBBS, MD, DM, PhD, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; F. Pellett, BsC, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; R.J. Cook, PhD, Department of Statistics and Actuarial Science, University of Waterloo; D.D. Gladman, MD, FRCPC, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital
| | - Arane Thavaneswaran
- From the Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto; Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada.Z. Touma, MD, FACP, FACR, PhD, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; A. Thavaneswaran, MMath, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; V. Chandran, MBBS, MD, DM, PhD, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; F. Pellett, BsC, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; R.J. Cook, PhD, Department of Statistics and Actuarial Science, University of Waterloo; D.D. Gladman, MD, FRCPC, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital
| | - Vinod Chandran
- From the Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto; Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada.Z. Touma, MD, FACP, FACR, PhD, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; A. Thavaneswaran, MMath, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; V. Chandran, MBBS, MD, DM, PhD, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; F. Pellett, BsC, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; R.J. Cook, PhD, Department of Statistics and Actuarial Science, University of Waterloo; D.D. Gladman, MD, FRCPC, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital
| | - Fawnda Pellett
- From the Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto; Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada.Z. Touma, MD, FACP, FACR, PhD, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; A. Thavaneswaran, MMath, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; V. Chandran, MBBS, MD, DM, PhD, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; F. Pellett, BsC, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; R.J. Cook, PhD, Department of Statistics and Actuarial Science, University of Waterloo; D.D. Gladman, MD, FRCPC, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital
| | - Richard J Cook
- From the Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto; Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada.Z. Touma, MD, FACP, FACR, PhD, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; A. Thavaneswaran, MMath, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; V. Chandran, MBBS, MD, DM, PhD, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; F. Pellett, BsC, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; R.J. Cook, PhD, Department of Statistics and Actuarial Science, University of Waterloo; D.D. Gladman, MD, FRCPC, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital
| | - Dafna D Gladman
- From the Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto; Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada.Z. Touma, MD, FACP, FACR, PhD, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; A. Thavaneswaran, MMath, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; V. Chandran, MBBS, MD, DM, PhD, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; F. Pellett, BsC, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; R.J. Cook, PhD, Department of Statistics and Actuarial Science, University of Waterloo; D.D. Gladman, MD, FRCPC, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital.
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Edwards CJ, Blanco FJ, Crowley J, Birbara CA, Jaworski J, Aelion J, Stevens RM, Vessey A, Zhan X, Bird P. Apremilast, an oral phosphodiesterase 4 inhibitor, in patients with psoriatic arthritis and current skin involvement: a phase III, randomised, controlled trial (PALACE 3). Ann Rheum Dis 2016; 75:1065-73. [PMID: 26792812 PMCID: PMC4893110 DOI: 10.1136/annrheumdis-2015-207963] [Citation(s) in RCA: 184] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 12/12/2015] [Indexed: 12/27/2022]
Abstract
Objective To evaluate apremilast treatment in patients with active psoriatic arthritis, including current skin involvement, despite prior therapy with conventional disease-modifying antirheumatic drugs and/or biologic agents. Methods Patients (N=505) were randomised (1:1:1) to placebo, apremilast 20 mg twice daily, or apremilast 30 mg twice daily. Rescue therapy with apremilast was designated at week 16 for placebo patients not achieving 20% improvement in swollen and tender joint counts. At week 24, the remaining placebo patients were then randomised to apremilast 20 mg twice daily or 30 mg twice daily. The efficacy and safety of apremilast were assessed over 52 weeks. Results At week 16, significantly more patients receiving apremilast 20 mg twice daily (28%) and 30 mg twice daily (41%) achieved 20% improvement in American College of Rheumatology response criteria versus placebo (18%; p=0.0295 and p<0.0001, respectively), and mean decrease in the Health Assessment Questionnaire-Disability Index score was significantly greater with apremilast 30 mg twice daily (−0.20) versus placebo (−0.07; p=0.0073). In patients with baseline psoriasis body surface area involvement ≥3%, significantly more apremilast 30 mg twice daily patients achieved 50% reduction from baseline Psoriasis Area and Severity Index score (41%) versus placebo (24%; p=0.0098) at week 16. At week 52, observed improvements in these measures demonstrated sustained response with continued apremilast treatment. Most adverse events were mild to moderate in severity; the most common were diarrhoea, nausea, headache and upper respiratory tract infection. Conclusions Apremilast demonstrated clinically meaningful improvements in psoriatic arthritis and psoriasis at week 16; sustained improvements were seen with continued treatment through 52 weeks. Apremilast was generally well tolerated and demonstrated an acceptable safety profile. Trial registration number NCT01212770.
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Affiliation(s)
- Christopher J Edwards
- NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton, Southampton, UK
| | | | | | - Charles A Birbara
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | | | - Jacob Aelion
- West Tennessee Research Institute, Jackson, Tennessee, USA
| | | | | | | | - Paul Bird
- Combined Rheumatology Practice, University of New South Wales, Kogarah, New South Wales, Australia
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Boyd T, Kavanaugh A. Novel approaches to biological therapy for psoriatic arthritis. Expert Opin Biol Ther 2015; 16:173-86. [DOI: 10.1517/14712598.2016.1118045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Ramiro S, Smolen JS, Landewé R, van der Heijde D, Dougados M, Emery P, de Wit M, Cutolo M, Oliver S, Gossec L. Pharmacological treatment of psoriatic arthritis: a systematic literature review for the 2015 update of the EULAR recommendations for the management of psoriatic arthritis. Ann Rheum Dis 2015; 75:490-8. [PMID: 26660203 DOI: 10.1136/annrheumdis-2015-208466] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 10/30/2015] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To update the evidence on the efficacy and safety of pharmacological agents in psoriatic arthritis (PsA). METHODS Systematic literature review of randomised controlled trials comparing pharmacological interventions in PsA: non-steroidal anti-inflammatory drugs, glucocorticoid, synthetic disease modifying antirheumatic drugs (sDMARDs) either conventional or targeted, biologicals (bDMARDs), placebo or any combination. Main outcomes were American College of Rheumatology (ACR)20-50, Psoriasis Area Severity Index 75, radiographic progression, and withdrawals due to adverse events (AEs). Multiple studies of the same intervention were meta-analysed using random effects. RESULTS In total, 25 papers and 12 abstracts were included. The efficacy of tumour necrosis factor inhibitors (including the recently added golimumab and certolizumab pegol) was confirmed and 16 articles/abstracts focused on 3 drugs with new modes of action: ustekinumab (UST), secukinumab (SEC) and apremilast (APR). All were placebo-compared trials and met their primary end point, ACR20. In 2 studies with UST ACR20 was met by 50% and 44% of patients with UST 90 mg, 42% and 44% with UST 45 mg vs 23% and 20% with placebo, respectively. In two studies with SEC ACR20 ranged 54% (SEC 300 mg), 50-51% (SEC 150 mg), 29-51% (SEC 75 mg) and 15-17% (placebo). In four studies with APR, ACR20 ranged 32-43% (APR 30 mg), 29-38% (APR 20 mg) and 17-20% (placebo). For all three drugs, no more withdrawals due to AEs than placebo were seen and, in general, safety appeared satisfactory. A strategy trial, TIght COntrol of Psoriatic Arthritis (TICOPA), showed better ACR responses with treatment adaptations upon tight control compared with standard care. CONCLUSIONS UST, SEC and APR are new drugs with efficacy demonstrated for the treatment of PsA. No major safety signals arise, but long-term studies are needed. This review informed about the European League Against Rheumatism recommendations for management of PsA.
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Affiliation(s)
- Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Josef S Smolen
- Division of Rheumatology, Department of Medicine, Medical University of Vienna, Hietzing Hospital, Vienna, Austria
| | - Robert Landewé
- Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, Amsterdam and Atrium Medical Center, Heerlen, The Netherlands
| | | | - Maxime Dougados
- Medicine Faculty, Paris Descartes University, Paris, France Rheumatology B Department, APHP, Cochin Hospital, Paris, France
| | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Maarten de Wit
- EULAR past Vice President representing People with Arthritis/Rheumatism in Europe (PARE)
| | - Maurizio Cutolo
- Research Laboratory and Clinical Division of Rheumatology, Department of Internal Medicine, University of Genova, Italy
| | | | - Laure Gossec
- Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS), Paris, France Department of rheumatology, AP-HP, Pitié Salpêtrière Hospital, Paris, France
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Caso F, Lubrano E, Del Puente A, Caso P, Peluso R, Foglia F, Benigno C, Girolimetto N, Bottiglieri P, Scarpa R, Costa L. Progress in understanding and utilizing TNF-α inhibition for the treatment of psoriatic arthritis. Expert Rev Clin Immunol 2015; 12:315-31. [PMID: 26558483 DOI: 10.1586/1744666x.2016.1117941] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The improved recognition of pathogenetic molecular mechanisms has led to the use of drugs targeting cytokines in different inflammatory arthropathies as well psoriatic arthritis (PsA). In particular, the progress in knowledge on tumor necrosis factor (TNF)-α in the pathogenesis of PsA has changed the therapeutic approach by use of direct and receptor cytokine antagonists. Currently, infliximab (IFX), adalimumab, etanercept, golimumab and certolizumab pegol represent the five anti-TNF-α available for the treatment of PsA. This review describes evidence on treatment aimed at neutralizing TNF-α in PsA patients, from the first study in 2000 until today, mainly derived from randomized clinical trials. In comparison with traditional therapies, anti-TNF-α agents have shown to have more efficacy both in treating clinical aspects, including enthesitis, dactylitis, joint pain and swelling, axial involvement, nail and skin lesions, and in reducing radiographic progression. Moreover, anti-TNF-α agents have been demonstrated to be reasonably safe in PsA, as confirmed by data derived by different registries.
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Affiliation(s)
- Francesco Caso
- a Rheumatology Unit, Department of Clinical Medicine and Surgery , University Federico II , Naples , Italy.,b Rheumatology Unit, Department of Medicine DIMED , University of Padova , Padova , Italy
| | - Ennio Lubrano
- c Department of Medicine and Health Sciences "Vincenzo Tiberio" , University of Molise , Campobasso , Italy
| | - Antonio Del Puente
- a Rheumatology Unit, Department of Clinical Medicine and Surgery , University Federico II , Naples , Italy
| | - Paolo Caso
- d Geriatric Unit, Faculty of Medicine and Psychology , "Sapienza" University of Rome, S. Andrea Hospital , Rome , Italy
| | - Rosario Peluso
- a Rheumatology Unit, Department of Clinical Medicine and Surgery , University Federico II , Naples , Italy
| | - Francesca Foglia
- a Rheumatology Unit, Department of Clinical Medicine and Surgery , University Federico II , Naples , Italy
| | - Carolina Benigno
- a Rheumatology Unit, Department of Clinical Medicine and Surgery , University Federico II , Naples , Italy
| | - Nicolò Girolimetto
- a Rheumatology Unit, Department of Clinical Medicine and Surgery , University Federico II , Naples , Italy
| | - Paolo Bottiglieri
- a Rheumatology Unit, Department of Clinical Medicine and Surgery , University Federico II , Naples , Italy
| | - Raffaele Scarpa
- a Rheumatology Unit, Department of Clinical Medicine and Surgery , University Federico II , Naples , Italy
| | - Luisa Costa
- a Rheumatology Unit, Department of Clinical Medicine and Surgery , University Federico II , Naples , Italy.,b Rheumatology Unit, Department of Medicine DIMED , University of Padova , Padova , Italy
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Sritheran D, Leung YY. Making the next steps in psoriatic arthritis management: current status and future directions. Ther Adv Musculoskelet Dis 2015; 7:173-86. [PMID: 26425146 DOI: 10.1177/1759720x15595966] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory condition with articular and extra-articular manifestations: peripheral arthritis, axial disease, enthesitis, dactylitis, and skin and nail disease. It is associated with cardiovascular comorbidities. It is now recognized as a new entity, different from rheumatoid arthritis and other spondyloarthritis in terms of clinical manifestations, pathogenesis, and response to therapies. Anti-tumor necrosis factors (anti-TNFs) have demonstrated clinical efficacies exceeding that of conventional disease modifying antirheumatic drugs (DMARDs). The current treatment paradigms recommend early diagnosis and treatment, and a strategic and target orientated approach, aiming at a low disease activity status. New understanding in the immunopathogenesis of PsA has led to new treatment targets. This review addresses the evidence of current treatment for each of the domains as an aid to the clinician managing these patients in the clinic. Some new therapeutic targets are presented. We highlight the importance of development and validation in outcome measures, including that of composite scores that capture various disease domains that will facilitate future clinical trials to inform the best treatment.
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Affiliation(s)
- Diviya Sritheran
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
| | - Ying Ying Leung
- Department of Rheumatology and Immunology, Singapore General Hospital, he Academia, Level 4, 20 College Road, 169856, Singapore and Duke-NUS Graduate Medical School, Singapore
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Kang EJ, Kavanaugh A. Psoriatic arthritis: latest treatments and their place in therapy. Ther Adv Chronic Dis 2015; 6:194-203. [PMID: 26137209 DOI: 10.1177/2040622315582354] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Psoriatic arthritis (PsA) is a heterogeneous chronic inflammatory disease that may affect peripheral and axial joints, entheses, skin and nails, and other organs. Treatment with nonsteroidal anti-inflammatory drugs, steroid and disease-modifying antirheumatic drugs had been the backbone of traditional management of PsA for many years. However, improvement in our understanding of immunopathogenesis of PsA has led to new immunomodulatory therapies. Introduction of novel agents has raised the bar for treatment and helped drive research into additional therapeutic options.
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Affiliation(s)
- Eun Jin Kang
- Division of Rheumatology, Department of Medicine, Busan Medical Center, Busan, Republic of Korea
| | - Arthur Kavanaugh
- Division of Rheumatology, Allergy, and Immunology, Center for Innovative Therapy, University of California, San Diego, 9500 Gilman Drive, Mail Code 0943, La Jolla, CA 92037, USA
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Michelsen B, Fiane R, Diamantopoulos AP, Soldal DM, Hansen IJW, Sokka T, Kavanaugh A, Haugeberg G. A comparison of disease burden in rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis. PLoS One 2015; 10:e0123582. [PMID: 25853482 PMCID: PMC4390320 DOI: 10.1371/journal.pone.0123582] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 03/04/2015] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The main objective of this study was to compare disease burden in rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (ax-SpA). METHODS In this cross-sectional study, all the RA (1093), PsA (365) and ax-SpA (333) patients who visited the out-patient clinic of the Hospital of Southern Norway Trust during the year 2013 were included; the RA patients all had a RA diagnosis verified by the treating rheumatologist, the PsA patients all fulfilled the ClASsification for Psoriatic ARthritis (CASPAR) criteria and the ax-SpA patients all fulfilled the Assessment of SpondyloArthritis international Society (ASAS) classification criteria for ax-SpA. Patient-reported health status, demographic variables, medications, and composite scores of disease activity were assessed. The main analyses were performed using General Linear Models adjusted for age, sex and multiple comparisons. Correlation analyses were performed using Spearman's rho. RESULTS The reported pain, joint pain, patient's global assessment and fatigue were similar in PsA and ax-SpA, but significantly lower in RA. The 28-joint Disease Activity Score (DAS28) (0.3±0.1, p = 0.003), Clinical Disease Activity Index (CDAI) (1.0±0.4, p = 0.028) and Routine Assessment of Patient Index Data 3 (RAPID3) (0.4±0.1, p = 0.004) were all significantly higher in PsA vs. RA. RAPID3 showed moderate to high correlation with DAS28 (rho = 0.521, p<0.001) and CDAI (rho = 0.768, p<0.001) in RA and PsA, and with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) (rho = 0.902, p<0.001) and Bath Ankylosing Spondylitis Functional Index (BASFI) (0.865, p<0.001) in ax-SpA and PsA. CONCLUSION In conclusion, patient- reported outcome measures were similar in our population of PsA and ax-SpA patients, but significantly lower for the RA patients. Composite disease activity measures were lower in RA than in PsA and ax-SpA, but the magnitude of these differences was small and probably not of clinical significance. Our study indicates that disease burden in RA, PsA and ax-SpA may be more similar than previously demonstrated.
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Affiliation(s)
- Brigitte Michelsen
- Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway
| | - Ragnhild Fiane
- Norwegian University of Science and Technology, Trondheim, Norway
| | - Andreas P. Diamantopoulos
- Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway
- Norwegian University of Science and Technology, Trondheim, Norway
| | - Dag Magnar Soldal
- Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway
| | | | | | - Arthur Kavanaugh
- Division of Rheumatology, Allergy, Immunology, University of California San Diego, San Diego, California, United States of America
| | - Glenn Haugeberg
- Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway
- Hospital of Southern Norway Trust, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
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Smith EMD, Foster HE, Beresford MW. The development and assessment of biological treatments for children. Br J Clin Pharmacol 2015; 79:379-94. [PMID: 24750505 PMCID: PMC4345949 DOI: 10.1111/bcp.12406] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 04/11/2014] [Indexed: 12/14/2022] Open
Abstract
The development of biological agents with specific immunological targets has revolutionized the treatment of a wide variety of paediatric diseases where traditional immunosuppressive agents have been partly ineffective or intolerable. The increasing requirement for pharmaceutical companies to undertake paediatric studies has provided impetus for studies of biologics in children. The assessment of biological agents in children to date has largely relied upon randomized controlled trials using a withdrawal design, rather than a parallel study design. This approach has been largely used due to ethical concerns, including use of placebo treatments in children with active chronic disease, and justified on the basis that treatments have usually already undergone robust assessment in related adult conditions. However, this study design limits the reliability of the data and can confuse the interpretation of safety results. Careful ongoing monitoring of safety and efficacy in real-world practice through national and international biologics registries and robust reporting systems is crucial. The most commonly used biological agents in children target tumour necrosis factor-α, interleukin-1, interleukin-6 and cytotoxic lymphocyte-associated antigen-4. These agents are most frequently used in paediatric rheumatic diseases. This review discusses the development and assessment of biologics within paediatric rheumatology with reference to the lessons learned from use in other subspecialties.
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Affiliation(s)
- Eve M D Smith
- Institute of Translational Medicine, University of LiverpoolLiverpool, UK
| | - Helen E Foster
- Paediatric Rheumatology, Institute of Cellular Medicine, Newcastle UniversityNewcastle upon Tyne, UK
- Great North Children's Hospital, Newcastle Hospitals NHS Foundation TrustNewcastle upon Tyne, UK
| | - Michael W Beresford
- Institute of Translational Medicine, University of LiverpoolLiverpool, UK
- Alder Hey Children's NHS Foundation TrustLiverpool, UK
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Spadaro A, Montepaone M, Lubrano E. A novel biological target for the treatment of psoriatic arthritis. Immunotherapy 2015; 6:515-8. [PMID: 24896622 DOI: 10.2217/imt.14.39] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Evaluation of: Kavanaugh A, Ritchlin C, Rahman P et al.; on behalf of the PSUMMIT-1 and -2 Study Groups. Ustekinumab, an anti-IL-12/23 p40 monoclonal antibody, inhibits radiographic progression in patients with active psoriatic arthritis: results of an integrated analysis of radiographic data from the Phase 3, multicentre, randomised, double-blind, placebo-controlled PSUMMIT-1 and PSUMMIT-2 trials. Ann. Rheum. Dis. 73(6), 1000-1006 (2014). The IL-23/IL-17 axis plays a major role in the immunopathogenesis of psoriatic arthritis (PsA), inducing the production of proinflammatory cytokines (e.g., IL-1, TNF-α, IL-6 and IL8), osteoclastogenesis and cartilage degradation. This pathway represents a novel target in the treatment of PsA. Ustekinumab is a human monoclonal antibody that prevents the human IL-12/IL-23 p40 subunit from binding to the IL12Rβ1 receptor chain. The current paper sustains that clinical efficacy of ustekinumab is associated with inhibition of radiological progression in active PsA.
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Affiliation(s)
- Antonio Spadaro
- Dipartimento di Medicina Interna e Specialità Mediche, UOC di Reumatologia, "Sapienza", Università di Roma, Italy
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Braun J, Kiltz U, Heldmann F, Baraliakos X. Emerging drugs for the treatment of axial and peripheral spondyloarthritis. Expert Opin Emerg Drugs 2015; 20:1-14. [PMID: 25575936 DOI: 10.1517/14728214.2015.993378] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The topic under discussion is of strong relevance to the field of spondyloarthritis (SpA) because, in addition to established biological, there are new promising compounds. The reason for the review is to put all available data together to allow for an overview on recent developments and to especially inform readers about emerging drugs, biologics and small molecules in the field of SpA. AREAS COVERED This review on new therapies in axial and peripheral SpA comprising psoriatic arthritis (PsA) shows, that, in addition to the established anti-TNF agents infliximab, etanercept, adalimumab, golimumab, certolizumab and the first biosimilar approved in the EU, there are at least two emerging biologics in the field of SpA: ustekinumab, a compound targeting IL12/IL-23 via the p40 subunit of both cytokines works for psoriasis and PsA and probably also for Crohn's disease, and the anti-IL-17 antibody secukinumab which has also been shown to work in psoriasis, both compounds seem to also work in ankylosing spondylitis. In addition, the potential of two small molecules, apremilast a phoshodiesterase4 inhibitor and tofacitinib, a januskinase inhibitor is discussed. EXPERT OPINION Since, in contrast to rheumatoid arthritis, the therapeutic array in SpA is currently limited to TNF-blockers, and since there is still an unmet need because some patients do not respond to anti-TNF therapy at all or they loose response, new agents with a different mechanism of action are eagerly awaited.
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Affiliation(s)
- Juergen Braun
- Rheumazentrum Ruhrgebiet , Claudiusstr. 45, 44649 Herne , Germany +49 2325 592131 ; +49 2325592136 ;
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Soubrier AS, Bele-Philippe P, Cortet B, Ramdane-Sebbane N, Bacle-Boutry MA, Lemeunier L, Flipo RM, Paccou J. Treatment response, drug survival and safety of anti-tumour necrosis factor α therapy in 193 patients with psoriatic arthritis: A twelve-year “real life” experience. Joint Bone Spine 2015; 82:31-7. [DOI: 10.1016/j.jbspin.2014.08.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 08/05/2014] [Indexed: 01/12/2023]
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Torregrosa Calatayud JL, Garcías Ladaria J, Sánchez Carazo JL, Pérez-Ferriols A, Oliver Martínez V, Calvo Catalá J, Alegre de Miquel V. Intensification therapy with golimumab: a new treatment strategy for moderate-severe refractory psoriasis. Int J Dermatol 2014; 53:e585-7. [DOI: 10.1111/ijd.12574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Juan Garcías Ladaria
- Department of Dermatology; Consorcio General Hospital; University of Valencia; 46014 Valencia Spain
| | - José Luis Sánchez Carazo
- Department of Dermatology; Consorcio General Hospital; University of Valencia; 46014 Valencia Spain
| | - Amparo Pérez-Ferriols
- Department of Dermatology; Consorcio General Hospital; University of Valencia; 46014 Valencia Spain
| | - Vicente Oliver Martínez
- Department of Dermatology; Consorcio General Hospital; University of Valencia; 46014 Valencia Spain
| | - Javier Calvo Catalá
- Department of Rheumatology; Consorcio General Hospital; University of Valencia; 46014 Valencia Spain
| | - Víctor Alegre de Miquel
- Department of Dermatology; Consorcio General Hospital; University of Valencia; 46014 Valencia Spain
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Lories RJ, de Vlam K. Tumour necrosis factor inhibitors in the treatment of psoriatic arthritis: a view on effectiveness, clinical practice and toxicity. Expert Opin Biol Ther 2014; 14:1825-36. [DOI: 10.1517/14712598.2014.967211] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Behrens F, Cañete JD, Olivieri I, van Kuijk AW, McHugh N, Combe B. Tumour necrosis factor inhibitor monotherapy vs combination with MTX in the treatment of PsA: a systematic review of the literature. Rheumatology (Oxford) 2014; 54:915-26. [PMID: 25349441 DOI: 10.1093/rheumatology/keu415] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The aim of this study was to review the available evidence on TNF inhibitor monotherapy vs combination therapy with MTX in PsA. METHODS A literature search was conducted up to and including October 2013 for randomized controlled trials (RCTs) and observational studies comparing TNF inhibitor monotherapy vs combination therapy with MTX in patients with PsA. Key information was extracted from the abstracts and/or full text of the articles retrieved. RESULTS Eleven published articles and three conference abstracts were retrieved, reporting on six RCTs of four TNF inhibitors. Most RCTs found no differences in efficacy for peripheral arthritis between patients treated with or without MTX. However, the studies were not powered to answer this question. Some data suggest that concomitant MTX may reduce the progression of structural damage. No significant differences in other outcomes have been reported. Data on TNF inhibitor monotherapy vs MTX combination therapy were reported from six registries. Three registries reported that the use of concomitant MTX did not affect the efficacy of TNF inhibitor therapy. Data from three European Union registries suggest that TNF inhibitor (especially mAbs) drug survival is superior in patients taking concomitant MTX, while one Canadian registry reported no difference. CONCLUSION Available evidence on the efficacy and safety of TNF inhibitor monotherapy vs add-on MTX therapy shows little or no improvement with combination therapy, although the use of concomitant MTX appears to prolong TNF inhibitor drug survival of mAb TNF inhibitors. Registries and observational studies have the potential to fill some of the knowledge gaps in this area.
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Affiliation(s)
- Frank Behrens
- CIRI/Division of Rheumatology and Fraunhofer Institute IME, Translational Medicine and Pharmacology, Goethe University, Frankfurt/Main, Germany, Arthritis Unit, Rheumatology Department, Hospital Clinic and IDIBAPS, Barcelona, Spain, Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Italy, Rheumatology Department, Reade/Jan van Breemen Research Institute, Amsterdam, The Netherlands, Rheumatology Department, Royal National Hospital for Rheumatic Diseases, Bath, UK and Departement de Rhumatologie Hôpital Lapeyronie-Université Montpellier I, UMR 5535, Montpellier, France
| | - Juan D Cañete
- CIRI/Division of Rheumatology and Fraunhofer Institute IME, Translational Medicine and Pharmacology, Goethe University, Frankfurt/Main, Germany, Arthritis Unit, Rheumatology Department, Hospital Clinic and IDIBAPS, Barcelona, Spain, Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Italy, Rheumatology Department, Reade/Jan van Breemen Research Institute, Amsterdam, The Netherlands, Rheumatology Department, Royal National Hospital for Rheumatic Diseases, Bath, UK and Departement de Rhumatologie Hôpital Lapeyronie-Université Montpellier I, UMR 5535, Montpellier, France
| | - Ignazio Olivieri
- CIRI/Division of Rheumatology and Fraunhofer Institute IME, Translational Medicine and Pharmacology, Goethe University, Frankfurt/Main, Germany, Arthritis Unit, Rheumatology Department, Hospital Clinic and IDIBAPS, Barcelona, Spain, Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Italy, Rheumatology Department, Reade/Jan van Breemen Research Institute, Amsterdam, The Netherlands, Rheumatology Department, Royal National Hospital for Rheumatic Diseases, Bath, UK and Departement de Rhumatologie Hôpital Lapeyronie-Université Montpellier I, UMR 5535, Montpellier, France
| | - Arno W van Kuijk
- CIRI/Division of Rheumatology and Fraunhofer Institute IME, Translational Medicine and Pharmacology, Goethe University, Frankfurt/Main, Germany, Arthritis Unit, Rheumatology Department, Hospital Clinic and IDIBAPS, Barcelona, Spain, Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Italy, Rheumatology Department, Reade/Jan van Breemen Research Institute, Amsterdam, The Netherlands, Rheumatology Department, Royal National Hospital for Rheumatic Diseases, Bath, UK and Departement de Rhumatologie Hôpital Lapeyronie-Université Montpellier I, UMR 5535, Montpellier, France
| | - Neil McHugh
- CIRI/Division of Rheumatology and Fraunhofer Institute IME, Translational Medicine and Pharmacology, Goethe University, Frankfurt/Main, Germany, Arthritis Unit, Rheumatology Department, Hospital Clinic and IDIBAPS, Barcelona, Spain, Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Italy, Rheumatology Department, Reade/Jan van Breemen Research Institute, Amsterdam, The Netherlands, Rheumatology Department, Royal National Hospital for Rheumatic Diseases, Bath, UK and Departement de Rhumatologie Hôpital Lapeyronie-Université Montpellier I, UMR 5535, Montpellier, France
| | - Bernard Combe
- CIRI/Division of Rheumatology and Fraunhofer Institute IME, Translational Medicine and Pharmacology, Goethe University, Frankfurt/Main, Germany, Arthritis Unit, Rheumatology Department, Hospital Clinic and IDIBAPS, Barcelona, Spain, Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Italy, Rheumatology Department, Reade/Jan van Breemen Research Institute, Amsterdam, The Netherlands, Rheumatology Department, Royal National Hospital for Rheumatic Diseases, Bath, UK and Departement de Rhumatologie Hôpital Lapeyronie-Université Montpellier I, UMR 5535, Montpellier, France
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Huynh D, Kavanaugh A. Psoriatic arthritis: current therapy and future approaches. Rheumatology (Oxford) 2014; 54:20-8. [DOI: 10.1093/rheumatology/keu237] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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Therapeutic options after treatment failure in rheumatoid arthritis or spondyloarthritides. Adv Ther 2014; 31:780-802. [PMID: 25112460 DOI: 10.1007/s12325-014-0142-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Indexed: 02/08/2023]
Abstract
The prognosis for patients with rheumatoid arthritis or spondyloarthritides has improved dramatically due to earlier diagnosis, recognition of the need to treat early with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), alone or in combinations, the establishment of treatment targets, and the development of biological DMARDs (bDMARDs). Many patients are now able to achieve clinical remission or low disease activity with therapy, and reduce or eliminate systemic corticosteroid use. Guidelines recommend methotrexate as a first-line agent for the initial treatment of rheumatoid arthritis; however, a majority of patients will require a change of csDMARD or step up to combination therapy with the addition of another csDMARD or a bDMARD. However, treatment failure is common and switching to a different therapy may be required. The large number of available treatment options, combined with a lack of comparative data, makes the choice of a new therapy complex and often not evidence based. We summarize and discuss evidence to inform treatment decisions in patients who require a change in therapy, including baseline factors that may predict response to therapy.
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Carrascosa JM, van Doorn M, Lahfa M, Nestle F, Jullien D, Prinz J. Clinical relevance of immunogenicity of biologics in psoriasis: Implications for treatment strategies. J Eur Acad Dermatol Venereol 2014; 28:1424-30. [DOI: 10.1111/jdv.12549] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 04/10/2014] [Indexed: 11/27/2022]
Affiliation(s)
- J.-M. Carrascosa
- Department of Dermatology; Hospital Universitari Germans Trias i Pujol; Barcelona Spain
| | - M.B.A. van Doorn
- Department of Dermatology; Erasmus MC University Medical Centre; Rotterdam The Netherlands
| | - M. Lahfa
- Department of Dermatology; Hôpital Larrey; Toulouse France
| | - F.O. Nestle
- St. John's Institute of Dermatology; King's College London School of Medicine; London UK
| | - D. Jullien
- Faculty of medicine; University of Lyon; Lyon France
- Department of Dermatology; Hôpital Edouard Herriot; Lyon France
| | - J.C. Prinz
- Clinic for Dermatology and Allergology; Ludwig-Maximilians-University; Munich Germany
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