New Treatment Paradigms in Psoriatic Arthritis

An Update on New Therapeutics Approved by the U.S. Food and Drug Administration

Maria L. Acosta Felquer; Enrique R. Soriano

Disclosures

Curr Opin Rheumatol. 2015;27(2):99-106. 

In This Article

Abstract and Introduction

Abstract

Purpose of review The purpose of this study is to give an overview of the new treatments approved by the U.S. Food and Drug Administration (FDA) for use in psoriatic arthritis (PsA).

Recent findings FDA has approved three new drugs for PsA: Certolizumab-pegol: a PEGylated Fc-free tumour necrosis factor inhibitor (TNFi); ustekinumab: an anti interleukin (IL)-12 and IL-23 mAb; and apremilast and oral phosphodiesterase 4 inhibitor. On well designed and extensive developing programmes, all three drugs proved to be effective for the treatment of most PsA manifestations, including peripheral arthritis, skin involvement, enthesitis, dactylitis, quality of life and radiographic progression in patients failing traditional disease modifying drugs (DMARDs) and TNFi. Safety profile of all three drugs seems to be reassuring until now, although long-term data are still not available. Although Certolizumab-pegol is likely to be placed among the other TNFi, ustekinumab and apremilast, due to lower efficacy on arthritis, are being more frequently used as second-line therapy after TNFi failure, especially among rheumatologists.

Summary There are new therapeutic options approved for the treatment of PsA. For the first time, well proved effective therapies with a different mechanism of action than the inhibition of TNF alpha are available for the treatment of this progressive disease.

Introduction

New treatment paradigms have been suggested in psoriatic arthritis (PsA) and are receiving great acceptance by the rheumatology community. These include early treatment,[1] remission as a treatment objective,[2] assessment of all domains involved within this heterogeneous disease[3] and frequent measuring of disease activity and adjusting therapy accordingly (treat to target).[4]

It is clear that in order to achieve these goals, we need effective therapies. The introduction of biologic therapies with tumour necrosis factor inhibitors (TNFis) has greatly improved our ability to treat the various manifestations of PsA. There are five TNFis approved by the U.S. Food and Drug Administration (FDA) for use in PsA: infliximab, etanercept, adalimumab, golimumab and, most recently, certolizumab pegol.[5–9] Efficacy among different TNFi is comparable at least on musculoskeletal manifestations with ACR20 responses of around 60%.[10] This leaves a large number of patients who fail to respond or who lose efficacy over time. Driven at least in part by this unmet clinical need, new targets and therapies have been developed. In this review, we are going to focus on the new treatments approved by the FDA in the last year.

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