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. 2024 May 15;83(6):760-774.
doi: 10.1136/ard-2024-225534.

Efficacy and safety of pharmacological treatment of psoriatic arthritis: a systematic literature research informing the 2023 update of the EULAR recommendations for the management of psoriatic arthritis

Andreas Kerschbaumer  1 , Josef S Smolen  2 , Ricardo J O Ferreira  3   4 , Heidi Bertheussen  5 , Xenofon Baraliakos  6 , Daniel Aletaha  2 , Dennis G McGonagle  7   8 , Désirée van der Heijde  9 , Iain B McInnes  10 , Bente Appel Esbensen  11   12 , Kevin L Winthrop  13 , Wolf-Henning Boehncke  14 , Jan W Schoones  15 , Laure Gossec  16   17
Affiliations

Efficacy and safety of pharmacological treatment of psoriatic arthritis: a systematic literature research informing the 2023 update of the EULAR recommendations for the management of psoriatic arthritis

Andreas Kerschbaumer et al. Ann Rheum Dis. .

Abstract

Objectives: To obtain an overview of recent evidence on efficacy and safety of pharmacological treatments in psoriatic arthritis (PsA).

Methods: This systematic literature research (SLR) investigated the efficacy and safety of conventional synthetic (cs), biological (b) and targeted synthetic (ts) disease-modifying antirheumatic drugs (DMARDs) in patients with PsA. A systematic database search using Medline, EMBASE, Cochrane CENTRAL was conducted to identify relevant articles published since the previous update in 2019 until 28 December 2022. Efficacy was assessed in trials while for safety observational data were also considered. Adverse events of special interest were infections (including herpes zoster, influenza and tuberculosis), malignancies, major adverse cardiovascular events, venous thromboembolisms, liver disease, laboratory changes and psychiatric adverse events. No meta-analyses were performed.

Results: For efficacy, of 3946 articles screened, 38 articles (30 trials) were analysed. The compounds investigated included csDMARDs (leflunomide, methotrexate), bDMARDs inhibiting IL17 (bimekizumab, brodalumab, ixekizumab, izokibep, secukinumab,), IL-23 (guselkumab, risankizumab, tildrakizumab), IL-12/23 (ustekinumab) as well as TNF (adalimumab, certolizumab-pegol, etanercept, infliximab, golimumab) and Janus Kinase inhibitors (JAKi) (brepocitinib, deucravacitinib, tofacitinib, upadacitinib). The compounds investigated were efficacious in improving signs and symptoms of PsA, improving physical functioning and quality of life. For safety, 2055 abstracts were screened, and 24 articles analysed: 15 observational studies and 9 long-term follow-ups of trials, assessing glucocorticoids, TNFi, IL-17i, JAKi, IL-12/23i and PDE4i (apremilast). Safety indicators were generally coherent with the previous SLR in 2019.

Conclusion: The results of this SLR informed the task force responsible for the 2023 update of the European Alliance of Associations for Rheumatology recommendations for pharmacological management of PsA.

Keywords: Biological Therapy; DMARDs (synthetic); Psoriatic Arthritis; Therapeutics.

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Conflict of interest statement

Competing interests: AK, Speakers bureau, Consultancy: AbbVie, Amgen, Galapagos, Janssen, Eli Lilly, MSD, Novartis, Pfizer and UCB. JSS: research grants from Abbvie, Astra-Zeneca, Lilly, Galapagos; Royalties from Elsevier (textbook); consulting fees from Abbvie, Galapagos/Gilead, Novartis-Sandoz, BMS, Samsung, Sanofi, Chugai, R-Pharma, Lilly; Honoraria from Samsung, Lilly, R-Pharma, Chugai, MSD Janssen, Novartis-Sandoz; participation in advisory board from Astra-Zeneca. RJOF, research grants: Medac, Lilly; Consulting fees: Sanofi. HB, none. XB: Scientific grants: Abbvie, MSD, Novartis. Consultancies, honoraria and advisory board member for Abbvie, Amgen, Celltrion, Chugai, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Pfizer, Roche, Sandoz, UCB. Membership on an entity’s Board of Directors or advisory committees: ASAS President, EULAR President Elect. DA, research grants: Galapagos, Lilly; Consulting fees: Abbvie, Gilead, Janssen, Lilly, Merck, Novartis, Sanofi. DGM, research grants: Janssen, Abbvie, Lilly, Novartis. UCB, BMS, Moonlake; consulting fees: Janssen, Abbvie, Lilly, Novartis. UCB, BMS, Moonlake, Celgene; honoraria: Janssen, Abbvie, Lilly, Novartis. UCB, BMS, Moonlake; support to attending meetings: Novartis Janssen. DvdH: consulting fees AbbVie, Argenx, Bayer, BMS, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Lilly, Novartis, Pfizer, Takeda, UCB Pharma. Director of Imaging Rheumatology bv. Associate editor Annals Rheumatic Diseases, editorial board member Journal of Rheumatology and RMD Open, Advisor Assessment Axial Spondyloarthritis international Society. IBM, Honoraria/consultation fees and grants/research supports: Abbvie, Amgen, BMS, Causeway Therapeutics, Cabaletta, Eli Lilly, Gilead, Janssen, Novartis, Pfizer, Sanofi, UCB, Evelo, Compugen, AstraZeneca, Moonlake; Non Exec Roles: NHS GGC Board Member, Evelo Board of Directors, Versus Arthritis Trustee Status; Stock or Stock Options: Evelo, Cabaletta, Compugen, Causeway Therapeutics, Dextera. BAE, none. KLW, Research: BMS, Pfizer; Consulting: Pfizer, AbbVie, Union Chimique Belge (UCB), Eli Lilly & Company, Galapagos, GlaxoSmithKline (GSK), Roche, Gilead, BMS, Regeneron, Sanofi, AstraZeneca, Novartis, W-HB, Honoraria: Abbvie, Almirall, BMS, Janssen, Leo, Eli Lilly, Novartis, UCB; Expert testimony: Novartis; Participation on a Data Safety Monitoring Board or Advisory Board: Abbvie, Almirall, BMS, Janssen, Leo, Eli Lilly, Novartis, UCB. JWS, none. LG reports grants from AbbVie, Biogen, Lilly, Novartis, UCB, personal fees from AbbVie, Amgen, BMS, Celltrion, Janssen, Lilly, MSD, Novartis, Pfizer, UCB, non-financial support from AbbVie, Amgen, Galapagos, Janssen, MSD, Novartis, Pfizer, UCB, outside the submitted work.

Figures

Figure 1
Figure 1
PRISMA flow chart of the efficacy and safety search of studies in PsA published 2018–2022. ACR, American College of Rheumatology; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; PsA, psoriatic arthritis; SLR, systematic literature research.
Figure 2
Figure 2
Efficacy results of randomised controlled trials stratified by mode of action and disease domain. Data from previous systematic literature research are also accounted for in this figure. *Different instruments used in studies. ABA, abatacept; ACR, American College of Rheumatology Response; ADA, adalimumab; APR, apremilast; BKZ, bimekizumab; CD, cluster of differentiation; CZP, certolizumab-pegol; ETN, etanercept; GOL, golimumab; GUS, guselkumab; HAQ, Health Assessment Questionnaire Disability Index; IL, interleukin; IFX, infliximab; IXE, ixekizumab; JAK, Janus kinases; PDE4, phosphodiesterase-4; PsA-mSvdHS, Psoriatic Arthritis modified Sharp van der Heijde Score; RIS, risankizumab; SEC, secukinumab; TNF, tumour necrosis factor; TOFA, tofacitinib; UPA, upadacitinib; UST, ustekinumab.
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References

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