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Psoriatic Arthritis: Newer and Older Therapies

  • Psoriatic Arthritis (JU Scher, Section Editor)
  • Published:
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Abstract

Purpose of Review

Psoriatic arthritis (PsA) is an immune-mediated systemic inflammatory disorder with heterogeneous clinical features. Treatment for PsA has progressed rapidly, especially over the past two decades. Herein we review relevant studies and key developments in treatment options for PsA from the past 5 years.

Recent Findings

Conventional disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate showed some efficacy for several domains of PsA, albeit less than that achieved with TNF inhibitors (TNFi). TNFi have been shown to be efficacious in treatment across all domains of PsA, particularly preventing radiographic damage, and are highly efficient early in the disease course. Inhibitors of IL-12/23, IL-17A, IL-23, phosphodiesterase 4, T cell costimulation, and janus kinases (JAK) have proven efficacious in the treatment of peripheral arthritis of PsA patients. The introduction of biosimilars to TNFi is expected to impact the treatment algorithm for PsA treatment by increasing access to biologic drugs. Newer treatment modalities including IL-23-specific inhibitors, IL-17A and IL-17F dual inhibitors, and jakinibs (janus kinase inhibitors) with different specificity are currently being developed for treatment of PsA.

Summary

The recent development of new therapeutic agents for PsA has led to better control of PsA across all of its disease domains. The future of PsA management will likely usher in treatment with different mechanisms of action, allow for more access to care, and hopefully see the possibility of precision medicine to help select the optimal treatment approach for individual PsA patients.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Mease P, Gladman D, Papp K. Prevalence of rheumatologist-diagnosed psoriatic arthritis in patients with psoriasis in European/North American dermatology clinics. J Am Acad Dermatol. 2013;69:729–35.

    PubMed  Google Scholar 

  2. Haroon M, Gallagher P, FitzGerald O. Diagnostic delay of more than 6 months contributes to poor radiographic and functional outcome in psoriatic arthritis. Ann Rheum Dis. 2015;74(6):1045–50.

    CAS  PubMed  Google Scholar 

  3. Gladman D, Thavaneswaran A, Chandran V, Cook R. Do patients with psoriatic arthritis who present early fare better than those presenting later in the disease? Ann Rheum Dis. 2011;70(12):2152–4.

    PubMed  Google Scholar 

  4. Kingsley GH, Kowalczyk A, Taylor H, Ibrahim F, Packham JC, McHugh NJ, et al. A randomized placebo-controlled trial of methotrexate in psoriatic arthritis. Rheumatology. 2012;51(8):1368–77.

    CAS  PubMed  Google Scholar 

  5. Mease PJ, Gladman D, Samad AS, Coates LC, Liu LX, Aras GA, et al. Design and rationale of the Study of Etanercept and Methotrexate in Combination or as Monotherapy in Subjects with Psoriatic Arthritis (SEAM-PsA). RMD open. 2018;4(1):e000606.

    PubMed  PubMed Central  Google Scholar 

  6. • Mease P, Gladman D, Collier D, Ritchlin C, Helliwell P, Liu L, et al. Etanercept and methotrexate as monotherapy or in combination in patients with psoriatic arthritis: a phase 3, double-blind, randomized controlled study. Arthritis Rheumatol. 2018;70 This study was the first study to assess the potential synergy between MTX and TNFi, in PsA. Different than what had been well demonstrated in RA, synergy was not observed for articular outcomes.

  7. Kavanaugh A, Husni ME, Harrison DD, Kim L, Lo KH, Leu JH, et al. Safety and efficacy of intravenous golimumab in patients with active psoriatic arthritis: results through week twenty-four of the GO-VIBRANT study. Arthritis Rheumatol. 2017;69(11):2151–61.

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Kavanaugh A, van der Heijde D, Beutler A, Gladman D, Mease P, Krueger GG, et al. 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(2):267–74.

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Kerschbaumer A, Baker D, Smolen J, Aletaha D. The effects of structural damage on functional disability in psoriatic arthritis. Ann Rheum Dis. 2017;76:2038–45.

    CAS  PubMed  Google Scholar 

  10. Kavanaugh A, Husni M, Harrison D, Kim L, Lo K, Noonan L, et al. Radiographic progression inhibition with intravenous golimumab in psoriatic arthritis: week 24 results of a phase III, randomized, double-blind, placebo-controlled trial. J Rheumatol. 2019;46(6):595–602.

    PubMed  Google Scholar 

  11. van Mens LJ, de Jong HM, Fluri I, Nurmohamed MT, van de Sande MG, Kok M, et al. Achieving remission in psoriatic arthritis by early initiation of TNF inhibition: a double-blind, randomised, placebo-controlled trial of golimumab plus methotrexate versus placebo plus methotrexate. Ann Rheum Dis. 2019;78(5):610–6.

    PubMed  Google Scholar 

  12. Simon D, Bayat S, Tascilar K, Kampylafka E, Meinderink T, Schuster L, et al. Effect of disease-modifying anti-rheumatic drugs on bone structure and strength in psoriatic arthritis patients. Ann Rheum Dis. 2019;78:1287.

    Google Scholar 

  13. FDA approves amjevita, a biosimilar to humira [news release]. Silver Spring, MD: US Food and Drug Administration. 2016. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm522243.htm. Accessed 23 July 2019.

  14. FDA approves inflectra, a biosimilar to remicade [news release]. Silver Spring, MD: US Food and Drug Administration. 2016. “http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm494227.htm” http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm494227.htm . Accessed 23 July 2019.

  15. Deeks E. GP2015: an etanercept biosimilar [published correction appears in BioDrugs. 2018 Aug 1]. BioDrugs. 2017;31(6):555–8.

    PubMed  PubMed Central  Google Scholar 

  16. McInnes IB, Kavanaugh A, Gottlieb AB, Puig L, Rahman P, Ritchlin C, et al. Efficacy and safety of ustekinumab in patients with active psoriatic arthritis: 1-year results of the phase 3, multicentre, double-blind, placebo-controlled PSUMMIT I trial. Lancet. 2013;382:780–9.

    CAS  PubMed  Google Scholar 

  17. Ritchlin C, Rahman P, Kavanaugh A, McInnes IB, Puig L, Li S, et al. Efficacy and safety of the anti-IL-12/23 p40 monoclonal antibody, ustekinumab, in patients with active psoriatic arthritis despite conventional non-biological and biological anti-tumour necrosis factor therapy: 6-month and 1-year results of the phase 3, multicentre, double-blind, placebo-controlled, randomised PSUMMIT 2 trial. Ann Rheum Dis. 2014;73(6):990–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  18. Kavanaugh A, Ritchlin C, Rahman P, Puig L, Gottlieb AB, Li S, et al. 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. 2014;73(6):1000–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Araujo EG, Englbrecht M, Hoepken S, Finzel S, Kampylafka E, Kleyer A, et al. Effects of ustekinumab versus tumor necrosis factor inhibition on enthesitis: results from the enthesial clearance in psoriatic arthritis (ECLIPSA) study. Semin Arthritis Rheum. 2019;48(4):632–7.

    CAS  PubMed  Google Scholar 

  20. NCT02438787. A study to evaluate the efficacy and safety of ustekinumab in the treatment of anti-TNF(alpha) refractory participants with active radiographic axial spondyloarthritis. 2018. “https://clinicaltrials.gov/ct2/show/NCT02438787” https://clinicaltrials.gov/ct2/show/NCT02438787 . Accessed 23 July 2019.

  21. NCT02407223. An efficacy and safety study of ustekinumab in participants with active nonradiographic axial spondyloarthritis. 2018. HYPERLINK “https://clinicaltrials.gov/ct2/show/NCT02407223” https://clinicaltrials.gov/ct2/show/NCT02407223. Accessed 23 July 2019.

  22. Blauvelt A, Papp KA, Griffiths CE, Randazzo B, Wasfi Y, Shen YK, et al. Efficacy and safety of guselkumab, an anti-interleukin-23 monoclonal antibody, compared with adalimumab for the continuous treatment of patients with moderate to severe psoriasis: results from the phase III, double-blinded, placebo- and active compara. J Am Acad Dermatol. 2018;76(3):405–17.

    Google Scholar 

  23. Reich K, Papp KA, Blauvelt A, Tyring SK, Sinclair R, Thaçi D, et al. Tildrakizumab versus placebo or etanercept for chronic plaque psoriasis (reSURFACE 1 and reSURFACE 2): results from two randomised controlled, phase 3 trials. Lancet. 2017;390:276–88.

    CAS  PubMed  Google Scholar 

  24. Papp KA, Blauvelt A, Bukhalo M, Gooderham M, Krueger JG, Lacour JP, et al. Risankizumab versus ustekinumab for moderate-to-severe plaque psoriasis. N Engl J Med. 2017;376(16):1551–60.

    CAS  PubMed  Google Scholar 

  25. Reich K, Gooderham M, Thaçi D, Crowley JJ, Ryan C, Krueger JG, et al. Risankizumab compared with adalimumab in patients with moderate-to-severe plaque psoriasis (IMMvent): a randomised, double-blind, active-comparator-controlled phase 3 trial. Lancet. 2019;394:576–86.

    CAS  PubMed  Google Scholar 

  26. Baeten D, Østergaard M, Wei JC, Sieper J, Järvinen P, Tam LS, et al. Risankizumab, an IL-23 inhibitor, for ankylosing spondylitis: results of a randomised, double-blind, placebo-controlled, proof-of-concept, dose-finding phase 2 study. Ann Rheum Dis. 2018;77(9):1295–302.

    CAS  PubMed  PubMed Central  Google Scholar 

  27. Mease P, McInnes IB, Kirkham B, Kavanaugh A, Rahman P, Van der Heijde D, et al. Secukinumab improves active psoriatic arthritis symptoms and inhibits radiographic progression: primary results from the randomised, double-blind, phase III FUTURE 5 study. Ann Rheum Dis. 2018;77:890–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  28. Langley RG, Elewski BE, Lebwohl M, Reich K, Griffiths CE, Papp K, et al. Secukinumab in plaque psoriasis—results of two phase 3 trials. N Eng J Med. 2014;371(4):326–38.

    Google Scholar 

  29. Hueber W, Sands BE, Lewitzky S, Vandemeulebroecke M, Reinisch W, Higgins PD, et al. Secukinumab, a human anti-IL-17A monoclonal antibody, for moderate to severe Crohn’s disease: unexpected results of a randomised, double-blind placebo-controlled trial. Gut. 2012;61:1693–700.

    CAS  PubMed  PubMed Central  Google Scholar 

  30. Mease PJ, van der Heijde D, Ritchlin CT, Okada M, Cuchacovich RS, Shuler CL, et al. Ixekizumab, an interleukin-17A specific monoclonal antibody, for the treatment of biologic-naive patients with active psoriatic arthritis: results from the 24-week randomised, double-blind, placebo-controlled and active (adalimumab)-controlled period of t. Ann Rheum Dis. 2017;76(1):79–87.

    CAS  PubMed  Google Scholar 

  31. Nash P, Kirkham B, Okada M, Rahman P, Combe B, Burmester GR, et al. Ixekizumab for the treatment of patients with active psoriatic arthritis and an inadequate response to tumour necrosis factor inhibitors: results from the 24-week randomised, double-blind, placebo-controlled period of the SPIRIT-P2 phase 3 trial. Lancet. 2017;389:2317–27.

    CAS  PubMed  Google Scholar 

  32. Gordon KB, Blauvelt A, Papp KA, Langley RG, Luger T, Ohtsuki M, et al. Phase 3 trials of ixekizumab in moderate-to-severe plaque psoriasis. N Eng J Med. 2016;375(4):345–56.

    CAS  Google Scholar 

  33. Kavanaugh A, Marzo-Ortega H, Vender R, Wei CC, Birt J, Adams DH, et al. Ixekizumab improves patient-reported outcomes in patients with active psoriatic arthritis and inadequate response to tumour necrosis factor inhibitors: SPIRIT-P2 results to 52 weeks. Clin Exp Rheumatol. 2019;37(4):566–74.

    PubMed  Google Scholar 

  34. • Kavanaugh A, Gottlieb A, Morita A, Merola J, Lin C, Birt J, et al. The contribution of joint and skin improvements to the health-related quality of life of patients with psoriatic arthritis: a post hoc analysis of two randomised controlled studies. Ann Rheum Dis. 2019. https://doi.org/10.1136/annrheumdis-2018-215003 This study documents that the largest improvements in quality of life in PsA are achieved when there is improvement in both articular and dermatologic domains.

    PubMed  PubMed Central  Google Scholar 

  35. Ritchlin C, Kavanaugh A, Merola J, Schett G, Scher J, Warren R, et al. Dual neutralization of IL-17A and IL-17F with bimekizumab in patients with active PsA: results from a 48-week phase 2b, randomized, double blind, placebo-controlled, dose-ranging study. Arthritis Rheumatol. 2018;(70):Supplement 10.

  36. Mease PJ, Genovese MC, Greenwald MW, Ritchlin CT, Beaulieu AD, Deodhar A, et al. Brodalumab, an anti-IL17RA monoclonal antibody, in psoriatic arthritis. N Eng J Med. 2014;370(24):2295–306.

    Google Scholar 

  37. Farahnik B, Beroukhim K, Abrouk M, Nakamura M, Zhu TH, Singh R, et al. Brodalumab for the treatment of psoriasis: a review of phase III trials. Dermatol Ther. 2016;6(2):111–24.

    Google Scholar 

  38. Kavanaugh A, Mease PJ, Gomez-Reino JJ, Adebajo AO, Wollenhaupt J, Gladman DD, et al. Treatment of psoriatic arthritis in a phase 3 randomised, placebo-controlled trial with apremilast, an oral phosphodiesterase 4 inhibitor. Ann Rheum Dis. 2014;73(6):1020–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  39. Kavanaugh A, Mease PJ, Gomez-Reino JJ, Adebajo AO, Wollenhaupt J, Gladman DD, et al. Longterm (52-week) results of a phase III randomized, controlled trial of apremilast in patients with psoriatic arthritis. J Rheumatol. 2015;42:479.

    CAS  PubMed  Google Scholar 

  40. Gladman D, Rigby W, Azevedo VF, Behrens F, Blanco R, Kaszuba A, et al. Tofacitinib for psoriatic arthritis in patients with an inadequate response to TNF inhibitors. N Engl J Med. 2017;377:1525.

    CAS  PubMed  Google Scholar 

  41. Mease P, Hall S, FitzGerald O, van der Heijde D, Merola JF, Avila-Zapata F, et al. Tofacitinib or adalimumab versus placebo for psoriatic arthritis. N Engl J Med. 2017;377:1537.

    CAS  PubMed  Google Scholar 

  42. Mease P, Coates LC, Helliwell PS, Stanislavchuk M, Rychlewska-Hanczewska A, Dudek A, et al. Efficacy and safety of filgotinib, a selective Janus kinase 1 inhibitor, in patients with active psoriatic arthritis (EQUATOR): results from a randomised, placebo-controlled, phase 2 trial. Lancet. 2018;392:2367–74.

    CAS  PubMed  Google Scholar 

  43. Papp K, Gordon K, Thaçi D, Morita A, Gooderham M, Foley P, et al. Phase 2 trial of selective tyrosine kinase 2 inhibition in psoriasis. N Engl J Med. 2018;379:1313–21.

    CAS  PubMed  Google Scholar 

  44. Mease P, Genovese MC, Gladstein G, Kivitz AJ, Ritchlin C, Tak PP, et al. Abatacept in the treatment of patients with psoriatic arthritis: results of a six-month, multicenter, randomized, double-blind, placebo-controlled, phase II trial. Arthritis Rheum. 2011;63(4):939–48.

    CAS  PubMed  Google Scholar 

  45. Mease PJ, Gottlieb AB, van der Heijde D, FitzGerald O, Johnsen A, Nys M. Efficacy and safety of abatacept, a T-cell modulator, in a randomised, double-blind, placebo-controlled, phase III study in psoriatic arthritis. Ann Rheum Dis. 2017;76(9):1550–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  46. Genovese MC, Mease PJ, Thomson GT, Kivitz AJ, Perdok RJ, Weinberg MA, et al. Safety and efficacy of adalimumab in treatment of patients with psoriatic arthritis who had failed disease modifying antirheumatic drug therapy. J Rheumatol. 2007;34:1040–50.

    CAS  PubMed  Google Scholar 

  47. Mease PJ, Gladman DD, Ritchlin CT, Ruderman EM, Steinfeld SD, Choy EH, et al. Adalimumab for the treatment of patients with moderately to severely active psoriatic arthritis: results of a double-blind, randomized, placebo-controlled trial. Arthritis Rheum. 2005;52:3279–89.

    CAS  PubMed  Google Scholar 

  48. Mease PJ, Goffe BS, Metz J, VanderStoep A, Finck B, Burge DJ. Etanercept in the treatment of psoriatic arthritis and psoriasis: a randomised trial. Lancet. 2000;356:385–90.

    CAS  PubMed  Google Scholar 

  49. Mease PJ, Kivitz AJ, Burch FX, Siegel EL, Cohen SB, Ory P, et al. Etanercept treatment of psoriatic arthritis: safety, efficacy, and effect on disease progression. Arthritis Rheum. 2004;50:2264–72.

    CAS  PubMed  Google Scholar 

  50. Antoni C, Krueger GG, de Vlam K, Birbara C, Beutler A, Guzzo C, et al. Infliximab improves signs and symptoms of psoriatic arthritis: results of the IMPACT 2 trial. Ann Rheum Dis. 2005;64:1150–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  51. Sakkas L, Alexiou I, Simopoulou T, Vlychou M. Enthesitis in psoriatic arthritis. Semin Arthritis Rheum. 2013;43:325–34.

    PubMed  Google Scholar 

  52. Patrick MT, Stuart PE, Raja K, Gudjonsson JE, Tejasvi T, Yang J, et al. Genetic signature to provide robust risk assessment of psoriatic arthritis development in psoriasis patients. Nature Commun. 2018;9(1):4178.

    Google Scholar 

  53. Eder L, Chandran V, Pellet F, Shanmugarajah S, Rosen CF, Bull SB, et al. Human leucocyte antigen risk alleles for psoriatic arthritis among patients with psoriasis. Ann Rheum Dis. 2012;71(1):50–5.

    PubMed  Google Scholar 

  54. Eder L, Polachek A, Rosen CF, Chandran V, Cook R, Gladman DD. The development of psoriatic arthritis in patients with psoriasis is preceded by a period of nonspecific musculoskeletal symptoms: a prospective cohort study. Arthritis Rheumatol. 2017;69(3):622–9.

    PubMed  Google Scholar 

  55. Cuchacovich R, Garcia-Valladares I, Espinoza L. Combination biologic treatment of refractory psoriasis and psoriatic arthritis. J Rheumatol. 2012;39(1):187–93.

    PubMed  Google Scholar 

  56. Miyagawa I, Nakayamada S, Nakano K, Kubo S, Iwata S, Miyazaki Y, et al. Precision medicine using differentbiological DMARDs based on characteristic phenotypes of peripheral T helper cells in psoriatic arthritis. Rheumatol. 2018;58(2):336–44.

    Google Scholar 

  57. Bravo A, Kavanaugh A. Bedside to bench: defining the immunopathogenesis of psoriatic arthritis. Nat Rev Rheumatol Epub Sep. 2019. https://doi.org/10.1036/s41584-019-0285-8.

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  1. Division of Rheumatology, Allergy & Immunology, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA

    Robert Chao & Arthur Kavanaugh

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Correspondence to Arthur Kavanaugh.

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Robert Chao declares that he has no conflict of interest. Arthur Kavanaugh declares he has professional relationships with several companies that have products mentioned in this paper, including Amgen, AbbVie, Eli Lilly, Pfizer, Gilead, Novartis, Celgene, Janssen, and BMS.

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Chao, R., Kavanaugh, A. Psoriatic Arthritis: Newer and Older Therapies. Curr Rheumatol Rep 21, 75 (2019). https://doi.org/10.1007/s11926-019-0866-1

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