Psoriatic Arthritis: New Recommendations and Emerging Therapies
An update to the EULAR recommendations for the management of PsA was presented this year, based on a systematic review of new treatment strategies and approved drugs with new mechanisms of action. In addition, there were several updates from clinical trials in PsA.
In a subgroup analysis of a phase 3, multicenter, double-blind, placebo-controlled trial evaluating the efficacy and safety of ustekinumab in patients with PsA with spondylitis and peripheral joint involvement, ustekinumab significantly improved signs and symptoms of the disease. Participants had improvements in the Bath Ankylosing Spondylitis Disease Activity Index and less peripheral radiographic progression through week 24 compared with the placebo group. The efficacy was maintained through week 100, and the drug was well tolerated and had an acceptable safety profile.
Mease and colleagues presented results from an open-label extension of a phase 2 study of brodalumab, a fully human anti–IL-17 receptor monoclonal antibody, evaluating the long-term safety and efficacy of the drug in patients with PsA. Brodalumab showed an acceptable safety profile and resulted in favorable treatment outcomes, which were maintained through week 108.
The results of the FUTURE 1 and FUTURE 2 trials of secukinumab in PsA were presented, demonstrating efficacy even in difficult-to-treat patients. The effects of intravenous secukinumab on radiographic progression in patients with PsA (FUTURE 1) were presented by van der Heijde and colleagues. Sustained inhibition of radiographic disease progression was observed through week 52, and switching to secukinumab in patients who were initially randomly assigned to receive placebo also inhibited radiographic progression.
The efficacy of subcutaneously administered secukinumab in patients with PsA who were naive to, nonresponsive to, or intolerant of TNF inhibitors was evaluated in a phase 3, multicenter, double-blind, placebo-controlled trial (FUTURE 2). Kavanaugh and colleagues presented results from this study, demonstrating efficacy of secukinumab 150 mg and 300 mg given at weeks 1, 2, 3, and 4 and every fourth week thereafter. Patients receiving secukinumab 300 mg who did not respond to or were intolerant of TNF inhibitors showed better responses.
Coates and Helliwell presented an analysis of methotrexate use in patients with early PsA from the Tight Control of PsA (TICOPA) study, showing improvements in clinical outcomes associated with the use of methotrexate. Although not statistically significant, a greater proportion of patients receiving methotrexate 15 mg per week or higher doses achieved ACR20 and ACR50 responses, as well as a 75% reduction in the Psoriasis Area and Severity Index, compared with patients receiving lower doses.
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Cite this: Ioannis Parodis. From Rome, the Latest in Rheumatology - Medscape - Aug 10, 2015.