Tailored treatment options for patients with psoriatic arthritis and psoriasis: review of established and new biologic and small molecule therapies.

Sarah Elyoussfi,Coziana Ciurtin,Benjamin J Thomas

doi:10.1007/s00296-016-3436-0

Sarah Elyoussfi, Coziana Ciurtin + Show 1 more

Open Access

https://doi.org/10.1007/s00296-016-3436-0

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Abstract

The diverse clinical picture of PsA suggests the need to identify suitable therapies to address the different combinations of clinical manifestations. This review aimed to classify the available biologic agents and new small molecule inhibitors (licensed and nonlicensed) based on their proven efficacy in treating different clinical manifestations associated with psoriasis and PsA. This review presents the level of evidence of efficacy of different biologic treatments and small molecule inhibitors for certain clinical features of treatment of PsA and psoriasis, which was graded in categories I–IV. The literature searches were performed on the following classes of biologic agents and small molecules: TNF inhibitors (adalimumab, etanercept, infliximab, golimumab, certolizumab), anti-IL12/IL23 (ustekinumab), anti-IL17 (secukinumab, brodalumab, ixekizumab), anti-IL6 (tocilizumab), T cell modulators (alefacept, efalizumab, abatacept, itolizumab), B cell depletion therapy (rituximab), phosphodiesterase 4 inhibitor (apremilast) and Janus kinase inhibitor (tofacitinib). A comprehensive table including 17 different biologic agents and small molecule inhibitors previously tested in psoriasis and PsA was generated, including the level of evidence of their efficacy for each of the clinical features included in our review (axial and peripheral arthritis, enthesitis, dactylitis, and nail and skin disease). We also proposed a limited set of recommendations for a sequential biologic treatment algorithm for patients with PsA who failed the first anti-TNF therapy, based on the available literature data. There is good evidence that many of the biologic treatments initially tested in psoriasis are also effective in PsA. Further research into both prognostic biomarkers and patient stratification is required to allow clinicians the possibility to make better use of the various biologic treatment options available. This review showed that there are many potentially new treatments that are not included in the current guidelines that can be used for selected categories of patients based on their disease phenotype, clinician experience and access to new biologic therapies.

Highlights

Psoriatic arthritis (PsA) is a heterogeneous disease, which shares characteristic clinical features, genetic markers and positive family history with the larger group of seronegative spondyloarthropathies
We proposed a limited set of recommendations for a sequential biologic treatment algorithm for patients with PsA who failed the first anti-TNF therapy, based on the available literature data
This review showed that there are many potentially new treatments that are not included in the current guidelines that can be used for selected categories of patients based on their disease phenotype, clinician experience and access to new biologic therapies

Summary

Introduction

Psoriatic arthritis (PsA) is a heterogeneous disease, which shares characteristic clinical features (sacroiliitis, spondylitis, enthesitis, psoriasis, uveitis), genetic markers and positive family history with the larger group of seronegative spondyloarthropathies. The purpose of this was to generate a comprehensive summary of efficacy of biologic treatments for different clinical features of patients with PsA and psoriasis, such as axial disease, peripheral joint involvement, dactylitis, enthesitis, and nail and skin disease.

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