DOI: https://doi.org/10.30841/2307-5112.4.2020.217350

Management of Patients with Psoriatic Arthritis – Analysis and Discussion of the Main Points of the EULAR Recommendations 2019

Є. Д. Єгудіна, С. А. Трипілка

Abstract


Updated recommendations of the European League Against Rheumatism (EULAR) on the pharmacological management of psoriatic arthritis (PsA) 2019 were presented in May 2020. The recommendations are compiled in accordance with the standardized EULAR operating procedures, a systematic review of the literature, followed by a consensus meeting of 28 international members of the task force for guideline development.

Updated recommendations include 6 general principles and 12 recommendations. General principles relate to the nature of PsA and the diversity of both musculoskeletal and non-musculoskeletal manifestations; emphasizes the need for joint decision-making by the patient and the doctor. The recommendations represent treatment strategies for pharmacological therapy. Nonsteroidal anti-inflammatory drugs and local injections of glucocorticoids are offered as initial therapy; for patients with arthritis and poor prognostic factors, such as polyarthritis or monoarthritis/oligoarthritis, accompanied by dactylitis or joint damage, it is recommended that the usual synthetic disease-modifying antirheumatic drugs (DMARD) be started quickly. If the treatment objective is not achieved using this strategy, biological DMARD (bDMARD) should be initiated, targeting tumor necrosis factor (TNF), interleukin (IL)-17A, or IL-12/23 taking into account skin lesions. If axial disease predominates, an TNF inhibitor or an IL-17A inhibitor should be started as a first-line DMARD.

The use of Janus kinase inhibitors is considered primarily after the ineffectiveness of bDMARD. Inhibition of phosphodiesterase-4 is proposed for patients who are not suitable for other drugs, usually in the context of a mild disease. The switching of drugs and dose tapering in the phase of sustained remission are considered. This guideline provides an updated consensus on the pharmacological treatment of PsA based on a combination of evidence and expert opinion.

Keywords


recommendations; EULAR; psoriatic arthritis; dactylitis; enthesitis; disease modifying antirheumatic drugs

References


Aaltonen K, Heinonen A, Joensuu J, et al. Effectiveness and drug survival of TNF-inhibitors in the treatment of psoriatic arthritis: a prospective cohort study. Semin Arthritis Rheum 2017;46(6):732–739. doi: 10.1016/j.semarthrit.2016.09.005

Baraliakos X, Coates LC, Gossec L. Secukinumab improves axial manifestations in patients with psoriatic arthritis and inadequate response to NSAIDs: primary analysis of phase 3 trial. Atlanta, Georgia, USA: ACR/ARP Annual Meeting, 2019.

Behrens F, Cañete JD, Olivieri I, et al. Tumour necrosis factor inhibitor monotherapy vs combination with MTX in the treatment of PSA: a systematic review of the literature. Rheumatology 2015;54(5):915–26.doi: 10.1093/rheumatology/keu415

Blauvelt A, Papp KA, Griffiths CEM, 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 comparator-controlled voyage 1 trial. J Am Acad Dermatol 2017;76(3):405–417. doi: 10.1016/j.jaad.2016.11.041.

Blauvelt A, Reich K, Tsai T-F, et al. Secukinumab is superior to ustekinumab in clearing skin of subjects with moderate-to-severe plaque psoriasis up to 1 year: Results from the CLEAR study. J Am Acad Dermatol 2017;76(1):60–69.e9. doi: 10.1016/j.jaad.2016.08.008

Carrascosa JM, de la Cueva P, Ara M, et al. Methotrexate in moderate to severe psoriasis: review of the literature and expert recommendations. Actas Dermosifiliogr 2016; 107(3):194–206. doi: 10.1016/j.ad.2015.10.005.

CEBM. Oxford centre for evidencebased Medicine—Levels of evidence (March 2009), 2009. Available: https://www.cebm.net/2009/06/oxford-centre-evidence-basedmedicine- levelsevidence-march-2009/

ClinicalTrials. gov. Efficacy, safety, and tolerability study of apremilast to treat early Oligoarticular psoriatic arthritis. Available: https://clinicaltrials.gov/ct2/show/NCT03747939

Coates LC, Moverley AR, McParland L, et al. Effect of tight control of inflammation in early psoriatic arthritis (TICOPA): a UK multicentre, open-label, randomised controlled trial. Lancet 2015;386 (10012):2489–98. doi: 10.1016/S0140-6736(15)00347-5

Costa L, Caso F, Del Puente A, et al. Incidence of malignancies in a cohort of psoriatic arthritis patients taking traditional disease modifying antirheumatic drug and tumor necrosis factor inhibitor therapy: an observational study. J Rheumatol 2016;43(12):2149–2154. doi: 10.3899/jrheum.160542

Cutolo M, Myerson GE, Fleischmann RM, et al. A phase III, randomized, controlled trial of apremilast in patients with psoriatic arthritis: results of the PALACE 2 trial. J Rheumatol 2016;43(9):1724–34. doi: 10.3899/jrheum.151376.

Deodhar A, Gottlieb AB, Boehncke W-H, et al. Efficacy and safety of guselkumab in patients with active psoriatic arthritis: a randomised, double-blind, placebo-controlled, phase 2 study. Lancet 2018;391(10136):2213–2224. doi: 10.1016/S0140-6736(18)30952-8.

El Miedany Y, El Gaafary M, Youssef S, et al. Tailored approach to early psoriatic arthritis patients: clinical and ultrasonographic predictors for structural joint damage. Clin Rheumatol 2015;34(2):307–13. doi: 10.1007/s10067-014-2630-2.

Ema confirms Xeljanz to be used with caution in patients at high risk of blood clots. Available: https://www.ema.europa.eu/en/news/ema-confirms-xeljanz-be-usedcaution-patients- highrisk-blood- clots [Accessed 2 Apr 2020].

Fan A, Pereira B, Tournadre A, et al. Frequency of concomitant fibromyalgia in rheumatic diseases: monocentric study of 691 patients. Semin Arthritis Rheum 2017;47(1):129–132. doi: 10.1016/j.semarthrit.2017.01.005.

Ferguson LD, Siebert S, McInnes IB, et al. Cardiometabolic comorbidities in RA and PsA: lessons learned and future directions. Nat Rev Rheumatol 2019;15(8):461–474. doi: 10.1038/s41584-019-0256-0.

Gladman D, Rigby W, Azevedo VF, et al. Tofacitinib for psoriatic arthritis in patients with an inadequate response to TNF inhibitors. N Engl J Med 2017;377(16):1525–1536. doi: 10.1056/NEJMoa1615977.

Gorlier C, Orbai A-M, Puyraimond-Zemmour D, et al. Comparing patient-perceived and physician-perceived remission and low disease activity in psoriatic arthritis: an analysis of 410 patients from 14 countries. Ann Rheum Dis 2019;78(2):201–208. doi: 10.1136/annrheumdis-2018-214140

Gossec L, Smolen JS, Gaujoux-Viala C, et al. European League against rheumatism recommendations for the management of psoriatic arthritis with pharmacological therapies. Ann Rheum Dis 2012;71(1):4–12. doi: 10.1136/annrheumdis-2011-200350.

Gossec L, Smolen JS, Ramiro S, et al. European League against rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update. Ann Rheum Dis 2016;75 (3):499–510. doi: 10.1136/annrheumdis-2015-208337.

Gudu T, Etcheto A, de Wit M, et al. Fatigue in psoriatic arthritis – a cross-sectional study of 246 patients from 13 countries. Joint Bone Spine 2016;83(4):439–43. doi: 10.1016/j.jbspin.2015.07.017.

Gudu T, Gossec L. Quality of life in psoriatic arthritis. Expert Rev Clin Immunol 2018;14(5):405–417. doi: 10.1080/1744666X.

Heiberg MS, Kaufmann C, Rodevand E, et al. The comparative effectiveness of anti-TNF therapy and methotrexate in patients with psoriatic arthritis: 6 month results from a longitudinal, observational, multicentre study. Ann Rheum Dis 2007;66(8):1038–42. doi: 10.1136/ard.2006.064808

Heiberg MS, Koldingsnes W, Mikkelsen K, et al. The comparative one-year performance of anti-tumor necrosis factor alpha drugs in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis: results from a longitudinal, observational, multicenter study. Arthritis Rheum 2008;59(2):234–40. doi: 10.1002/art.23333

Hellgren K, Dreyer L, Arkema EV, et al. Cancer risk in patients with spondyloarthritis treated with TNF inhibitors: a collaborative study from the ARTIS and DANBIO registers. Ann Rheum Dis 2017;76(1):105–111. doi: 10.1136/annrheumdis-2016-209270

Husni ME, Merola JF, Davin S. The psychosocial burden of psoriatic arthritis. Semin Arthritis Rheum 2017;47(3):351–360. doi: 10.1016/j.semarthrit.

Janta I, Martínez-Estupiñán L, Valor L, et al. Comparison between full and tapered dosages of biologic therapies in psoriatic arthritis patients: clinical and ultrasound assessment. Clin Rheumatol 2015;34(5):935–42.doi: 10.1007/s10067-015-2880-7.

Kaeley GS, Eder L, Aydin SZ, et al. Enthesitis: a hallmark of psoriatic arthritis. Semin Arthritis Rheum 2018;48 (1):35–43. doi: 10.1016/j.semarthrit.2017.12.008

Kalyoncu U, Bayindir Zun, Ferhat Oksüz M, et al. The psoriatic arthritis registry of turkey: results of a multicentre registry on 1081 patients. Rheumatology 2017;56(2):279–286. doi: 10.1093/rheumatology/kew375

Kerschbaumer A, Smolen JS, Dougados M, et al. Pharmacological treatment of psoriatic arthritis: a systematic literature research for the 2019 update of the EULAR recommendations for the management of psoriatic arthritis. Ann Rheum Dis: 2020;0:1–9. doi:10.1136/annrheumdis-2020-217163.

Mease P. Is reduction or discontinuation of therapy an acceptable possibility in psoriatic arthritis? Clin Exp Rheumatol 2013;31(78):S59–62.

Mease PJ, van der Heijde D, Ritchlin CT, 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, doubleblind, placebo-controlled and active (adalimumab)-controlled period of the phase III trial SPIRIT-P1. Ann Rheum Dis 2017;76 (1):79–87. doi: 10.1136/annrheumdis-2016-209709.

Mease PJ, Gottlieb AB, van der Heijde D, et al. 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):1550–1558. doi: 10.1136/annrheumdis-2016-210724.

Mease PJ, Kellner H, Morita A, et al. OP0307 efficacy and safety of risankizumab, a selective IL-23p19 inhibitor, in patients with active psoriatic arthritis over 24 weeks: results from a phase 2 trial. Ann Rheum Dis 2018;77:200–1.

Mease P, Coates LC, Helliwell PS, 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(10162):2367–2377. doi: 10.1016/S0140-6736(18)32483-8.

Mease PJ, Gladman DD, Collier DH, et al. Etanercept and methotrexate as monotherapy or in combination for psoriatic arthritis: primary results from a randomized, controlled phase III trial. Arthritis Rheumatol 2019;71(7):1112–1124. doi: 10.1002/art.40851.

Mease PJ, Smolen JS, Behrens F, et al. A head-to- head comparison of the efficacy and safety of ixekizumab and adalimumab in biological-naïve patients with active psoriatic arthritis: 24-week results of a randomised, open-label, blinded-assessor trial. Ann Rheum Dis 2020;79(1):123–131. doi: 10.1136/annrheumdis-2019-215386

Mease PJ, Kavanaugh A, Reimold A, et al. Secukinumab provides sustained improvements in the signs and symptoms of psoriatic arthritis: final 5-year results from the phase 3 future 1 study. ACR Open Rheumatol 2020;22(1): 18–25. doi: 10.1002/acr2.11097

Menter A, Gelfand JM, Connor C, et al. Joint AAD-NPF guidelines of care for the management of psoriasis with systemic non-biological therapies. J Am Acad Dermatol 2020;9622. doi: 10.1016/j.jaad.2020.02.044

Nash P, Kirkham B, Okada M, 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 SPIRITP2 phase 3 trial. The Lancet 2017;389(10086):2317–2327.doi: 10.1016/S0140-6736(17)31429-0

Nash P, Ohson K, Walsh J, et al. Early and sustained efficacy with apremilast monotherapy in biological-naïve patients with psoriatic arthritis: a phase IIIB, randomised controlled trial (active). Ann Rheum Dis 2018;77(5):690–698. doi: 10.1136/annrheumdis-2017-211568.

Nikiphorou E, Negoescu A, Fitzpatrick JD, et al. Indispensable or intolerable? Methotrexate in patients with rheumatoid and psoriatic arthritis: a retrospective review of discontinuation rates from a large UK cohort. Clin Rheumatol 2014;56(5):609–14. doi: 10.1007/s10067-014-2546-x

Ogdie A, Yu Y, Haynes K, et al. Risk of major cardiovascular events in patients with psoriatic arthritis, psoriasis and rheumatoid arthritis: a population-based cohort study. Ann Rheum Dis 2015;74(2):326–32. doi: 10.1136/annrheumdis-2014-205675.

Orbai A-M, de Wit M, Mease P, et al. International patient and physician consensus on a psoriatic arthritis core outcome set for clinical trials. Ann Rheum Dis 2017;76(4):673–680. doi: 10.1136/annrheumdis-2016-210242.

Papp KA, Blauvelt A, Bukhalo M, et al. Risankizumab versus ustekinumab for moderate-to- severe plaque psoriasis. N Engl J Med 2017;376:1551–60 DOI: 10.1056/NEJMoa1607017

Peluso R, Iervolino S, Vitiello M, et al. Extra-Articular manifestations in psoriatic arthritis patients. Clin Rheumatol 2015;34(4):745–53. doi: 10.1007/s10067-014-2652-9.

Ramiro S, Smolen JS, Landewé R, et al. Pharmacological treatment of psoriatic arthritis: a systematic literature review for the 2015 update of the EULAR recommendations for the management of psoriatic arthritis. Ann Rheum Dis 2016;75(3):490–8. doi: 10.1136/annrheumdis-2015-208466

Ritchlin C, Rahman P, Kavanaugh A, 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;73:990–9.

Schreiber S, Colombel J-F, Feagan BG, et al. Incidence rates of inflammatory bowel disease in patients with psoriasis, psoriatic arthritis and ankylosing spondylitis treated with secukinumab: a retrospective analysis of pooled data from 21 clinical trials. Ann Rheum Dis 2019;78(4):473–479. doi: 10.1136/annrheumdis-2018-214273

Siebert S, Millar NL, McInnes IB. Why did IL-23p19 inhibition fail in as: a tale of tissues, trials or translation? Ann Rheum Dis 2019;78(8):1015–1018. doi: 10.1136/annrheumdis-2018-213654.

Smolen JS, Braun J, Dougados M, et al. Treating spondyloarthritis, including ankylosing spondylitis and psoriatic arthritis, to target: recommendations of an international Task force. Ann Rheum Dis 2014;73(1):6–16. doi: 10.1136/annrheumdis-2013-203419.

Smolen JS, Schöls M, Braun J, et al. Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international Task force. Ann Rheum Dis 2018;77(1):3–17.doi: 10.1136/annrheumdis-2017-211734.

van der Heijde D, Aletaha D, Carmona L, et al. 2014 update of the EULAR standardised operating procedures for EULAR-endorsed recommendations. Ann Rheum Dis 2015;74(1):8–13. doi: 10.1136/annrheumdis-2014-206350.

van der Heijde D, Ramiro S, Landewé R, et al. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis 2017;76(6):978–991. doi: 10.1136/annrheumdis-2016-210770.

Wells AF, Edwards CJ, Kivitz AJ, et al. Apremilast monotherapy in DMARD-naive psoriatic arthritis patients: results of the randomized, placebo-controlled PALACE 4 trial. Rheumatology 2018;57(7):1253–1263. doi: 10.1093/rheumatology/key032.

Zisapel M, Zisman D, Madar-Balakirski N, et al. Prevalence of TNF-α blocker immunogenicity in psoriatic arthritis. J Rheumatol 2015;42(1):73–8. doi: 10.3899/jrheum.140685.




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