<p>An Update for the Clinician on Biologics for the Treatment of Psoriatic Arthritis</p>

Abstract

Psoriatic arthritis (PsA) is a chronic inflammatory arthropathy typically associated with psoriasis (PsO). The pathogenesis is strictly related to the association among the presence of genetic risk alleles and innate and acquired immune response with dramatic consequences on bone remodeling. Clinically, PsA patients may present heterogenicity of articular and periarticular manifestations that may be associated with the presence of comorbidities making treatment decision challenging in patients management. The identification of patient-targeted therapies is still a critical issue. Actually, several biological and synthetic drugs are promising in terms of efficacy and safety profile. National and international treatment recommendations support clinicians in the decision of the best treatment, although they may have limits basically related to updates and different outcomes included in the clinical studies evaluated. The aim of this narrative review is therefore to give guidance for clinicians for PsA patients treatment. For this purpose, we evaluated evidence on biological therapies efficacy used for PsA treatment. Specifically, we reviewed data on biological therapies, Janus kinases (JAK) inhibitors, and drugs with a new mechanism of action that are part of the treatment pipeline. The concept of "switching" and "swapping" is also described, as well as data concerning special populations such as pregnant women and elderly patients.

Secukinumab: A Review in Psoriatic Arthritis

“…PsA is a chronic and multifaceted disease which has a significant impact on HR-QOL in terms of physical dysfunction, pain, fatigue, work disability and emotional/social impairment [ 4 ]. In clinical trials, secukinumab was associated with clinically meaningful improvements in patient-reported measures of physical function and HR-QOL (including pain, fatigue and work productivity) compared with placebo, with these improvements sustained over the longer term (Sect.…”

“…Over recent decades, the development of biological DMARDs (bDMARDs) has considerably changed the PsA treatment landscape [ 1 ]. The first bDMARDs to be approved were the tumour necrosis factor inhibitors (TNFi), based on the finding that TNF-α is a key mediator of acute inflammation in PsA [ 4 ]. In addition to TNF-α, other proinflammatory cytokines, such as interleukin (IL)-12, IL-17 and IL-23, have been shown to play a key role in the pathogenesis of PsA [ 1 , 4 , 5 ].…”

“…The first bDMARDs to be approved were the tumour necrosis factor inhibitors (TNFi), based on the finding that TNF-α is a key mediator of acute inflammation in PsA [ 4 ]. In addition to TNF-α, other proinflammatory cytokines, such as interleukin (IL)-12, IL-17 and IL-23, have been shown to play a key role in the pathogenesis of PsA [ 1 , 4 , 5 ]. IL-17A (a member of the IL-17 family) is up-regulated in psoriatic lesional skin and in the synovial fluid of PsA patients [ 1 , 4 , 5 ], providing a rationale for the development of targeted anti-IL-17 therapies [ 5 ].…”

From Bed to Bench and Back: TNF-α, IL-23/IL-17A, and JAK-Dependent Inflammation in the Pathogenesis of Psoriatic Synovitis

“…In regard to bedside application, the choice of the preferred bDMARD as a first-line biological treatment in patients with peripheral arthritis and selection of the correct strategy after failure of the first bDMARD (historically a TNFi) are aspects of interest, despite available evidence supporting clinical decisions being scant ( Silvagni et al, 2019 ; Chimenti et al, 2020 ). Indeed, after almost 20 years of TNFi availability in the field of PsA, the capability to treat PsA with this class of drugs in the clinic has been reinforced by long-term efficacy and safety data ( Fagerli et al, 2018 ; Haugeberg et al, 2018 ).…”

Pain Medication and Corticosteroid Use in Ankylosing Spondylitis, Psoriatic Arthritis, and Rheumatoid Arthritis in the United States: A Retrospective Observational Study

“…Non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, opioids, and neuromodulators are conventionally used to manage pain and/or inhibit inflammation in AS, PsA, and RA while disease-modifying antirheumatic drugs (DMARDs) slow the progression of the disease by relieving underlying inflammatory responses [4,6,8,10]. Highly specific biologics and targeted synthetic DMARDs are generally prescribed after the failure of conventional synthetic DMARD (csDMARD) therapy in clinical care and have shown to improve HRQoL by reducing inflammatory pain symptoms [11][12][13][14]. Biologic DMARDs (bDMARDs) such as adalimumab, etanercept, ixekizumab, secukinumab, golimumab, and the Janus kinase inhibitor tofacitinib are reported to significantly reduce pain in patients with AS, PsA, and/or RA in clinical trials [15][16][17][18][19][20][21][22].…”