Treat-to-target and Improving Outcomes in Psoriasis: A Report from the GRAPPA 2014 Annual Meeting

Treating to Target(s) With Interleukin-17 Inhibitors

Background:

The treat-to-target (T2T) strategy has become established in several medical specialties as a key guidance to optimal therapeutic decision making. T2T may be effective in the assessment of the biologic class of agents called interleukin (IL)-17 inhibitors, which are emerging as a safe and effective treatment option for autoimmune inflammatory conditions such as plaque psoriasis, psoriatic arthritis (PsA), and ankylosing spondylitis (AS).

Objective:

The objective of this article is to use a T2T approach for the evaluation of the effectiveness and safety of IL-17 inhibitors in the management of patients with plaque psoriasis, PsA, and AS.

Methods:

Following a comprehensive literature search, a full-day meeting was convened to discuss and identify the T2T targets for psoriasis, PsA, and AS. Clinical trial evidence was presented for the approved IL-17 inhibitors—secukinumab, ixekizumab, and brodalumab—to assess whether these data meet T2T safety and efficacy targets.

Results:

All 3 approved agents were significantly superior to placebo and active controls in the achievement of T2T targets for psoriasis. Secukinumab and ixekizumab were likewise associated with significantly better outcomes than controls in the PsA targets, and secukinumab resulted in significant AS target improvements vs placebo. The IL-17 inhibitors were also associated with low rates of serious adverse events and exacerbations of common comorbid conditions.

Conclusion:

Phase III trial results support the T2T benefit and safety of IL-17 inhibitors according to their specific indications for the management of patients with plaque psoriasis, PsA, and AS.

Prologue: 2014 Annual Meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)

The 2014 Annual Meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) was held in New York, New York, USA, and attended by rheumatologists, dermatologists, and representatives of biopharmaceutical companies and patient groups. Summaries of presentations at that meeting are introduced, including the GRAPPA-organized Fellows Symposium adjacent to the 2014 Swiss Psoriasis Day in Geneva. At the GRAPPA meeting itself, a Trainees Symposium was organized for rheumatology fellows and dermatology residents to present their research work; several patient research partners (PRP) organized Building Bridges, a session of interactive dialogue regarding the roles and responsibilities of PRP and researchers participating in working groups at GRAPPA and elsewhere; and 5 dermatology sessions were held to report on the international dermatology outcome measures group. Among the meeting topics were dermatologists’ management of psoriatic arthritis (PsA); the unmet need for a comprehensive assessment tool for psoriasis; the Psoriasis Symptom Inventory; and the importance of treat-to-target strategies for managing psoriasis. Other presentations included an update of GRAPPA’s research initiative to develop evidence-based criteria to identify inflammatory arthritis, enthesitis, dactylitis, and spondylitis; the utility of magnetic resonance imaging in PsA; a review of the PsA working group at OMERACT (Outcome Measures in Rheumatology); and updates on several GRAPPA educational projects. Considerable time was allotted to discussions of GRAPPA’s efforts to update its treatment guidelines for PsA.