Musculoskeletal ultrasound in monitoring response to apremilast in psoriatic arthritis patients: results from a longitudinal study

Ceccarelli, Fulvia; Lucchetti, Ramona; Perricone, Carlo; Cipriano, Enrica; Truglia, S.; Miranda, F.; Riccieri, Valeria; Franco, Manuela Di; Alessandri, Cristiano; Valesini, Guido; Conti, Fabrizio

doi:10.1007/s10067-019-04674-3

Cited by 13 publications

(7 citation statements)

References 19 publications

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“…To date there are no studies utilizing US to compare responses to different forms of biologic therapy, and a recent systematic review of US [ 19 ] highlighted the lack of research that focused solely on PsA. The limited data available has demonstrated response in terms of US synovitis and tenosynovitis to therapy [ 57 , 80 ], but no prognostic US signs have been demonstrated in PsA [ 81 ]. There have been a number of scoring systems for inflammatory polyarthritis that are relevant in PsA ( Table 2 ) [ 61–73 ].…”

Section: Usmentioning

confidence: 99%

Integrating imaging and biomarker assessment to better define psoriatic arthritis and predict response to biologic therapy

2021

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The treatment options for PsA have substantially expanded over the last decade. Approximately 40% of patients will not respond to first-line anti-TNF-α therapies. There is limited data to help clinicians select the most appropriate biologic therapy for PsA patients, including guidance for decisions on biologic therapy switching. In this review we will examine the current understanding of predictors of response to treatment. Imaging technology has evolved to allow us to better study psoriatic disease and define disease activity, including synovitis and enthesitis. Enthesitis is implicated in the pathogenesis, diagnosis and prognosis of PsA. It appears to be a common thread among all of the various PsA clinical presentations. Enthesitis mainly manifests as tenderness, which is difficult to distinguish from FM, chronic pain and mechanically associated enthesopathy, and it might be relevant for understanding the apparent 40% failure of existing therapy. Excess adipose tissue makes if more difficult to detect joint swelling clinically, as many PsA patients have very high BMIs. Integrating imaging and clinical assessment with biomarker analysis could help to deliver stratified medicine in PsA and allow better treatment decision making. This could include which patients require ongoing biologic therapy, which class of biologic therapy that should be, and who alternatively requires management of non-inflammatory disease.

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Section: Usmentioning

confidence: 99%

Integrating imaging and biomarker assessment to better define psoriatic arthritis and predict response to biologic therapy

2021

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“…It should also be highlighted that this study included only biologic-naïve patients, in whom the effect of apremilast may be more pronounced than in biologic-experienced patients [ 10 ], who were also included in the pivotal RCTs PALACE 1–3 and real-world observational studies of apremilast described below. The eligibility requirement for patients to be biologic-naïve in APROACH resulted in a short median PsA disease duration of 0.9 years at baseline contrary to other studies including both bio-naïve and bio-experienced patients where the median/mean disease duration at enrollment range was 6.8–35.9 years [ 10 , 15 – 18 , 25 – 29 ]. This presumably reflects the current real-world PsA management paradigm in Greece, where patients who are inadequate responders or intolerant to csDMARDs are started earlier treatment with apremilast, without necessitating a steroid bridging therapy.…”

Section: Discussionmentioning

confidence: 95%

“…These values fall near the upper end of the 32.1–41% 16-week and the 52.6–67.1% 52-week ACR20 range reported in the clinical trial settting, including PALACE 1–3 [ 15 – 17 ], a pooled analysis of PALACE 1–3 [ 18 ], the PALACE 4 RCT [ 19 ], and the ACTIVE Phase IIIB trial [ 20 ]. Improvements in disease activity with apremilast have also been observed in the real-world setting [ 26 , 27 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

Apremilast for biologic-naïve, peripheral psoriatic arthritis, including patients with early disease: results from the APROACH observational prospective study

et al. 2023

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To evaluate the effect of the phosphodiesterase 4 inhibitor apremilast in biologic-naïve patients with early peripheral PsA in terms of disease activity, clinical manifestations, patient-perceived outcomes, as well as apremilast’s safety profile in routine care settings of Greece. Non-interventional, multicenter, 52-week prospective cohort study, enrolling biologic-naïve patients with early active peripheral PsA who started apremilast after intolerance or inadequate response (within the first 12 months of treatment) to an initial conventional synthetic (cs)DMARD treatment. Non-responder imputation was applied for missing data.In total, 167 consecutive patients (mean age: 52.5 years; median PsA duration: 0.9 years) were analyzed. At baseline, the median (interquartile range) clinical Disease Activity in Psoriatic Arthritis (cDAPSA) score was 22.0 (16.0–29.0), with 86.8% of patients having at least moderate (29.3% high) disease activity; 87.4% had skin psoriasis, 37.7% nail psoriasis, 30.7% enthesitis, and 12.4% dactylitis. At 16, 24, and 52 weeks, 28.7, 42.5, and 48.5% of patients, achieved ≥ 50% improvement in their baseline cDAPSA score, respectively. At week 52, 55.6, 50, and 26.8% of evaluable patients achieved complete resolution of enthesitis, dactylitis and nail psoriasis, respectively. Improvements were also observed in patient’s health state assessed by the Psoriatic Arthritis Impact of Disease 12-item questionnaire, and health-related quality of life. The 52-week drug survival rate was 75%, while 13.8% of patients experienced at least one adverse drug reaction.Biologic-naïve patients with early PsA, treated with apremilast experienced significant improvements in disease activity, extra-articular manifestations and patient-centered outcomes, accompanied by a favorable tolerability profile.

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“…104 Nevertheless data from real life studies have recently evidenced that APR is able to induce an early and sustained improvement on ultrasonographic inflammatory status at articular and peri-articular level. 109 As other PDE4 inhibitors, APR showed generally an acceptable safety profile. 110 The most common reported AEs were diarrhea, nausea, headache, and URTI.…”

Section: Targeted Synthetic Dmardsmentioning

confidence: 95%

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

Chimenti¹,

D’Antonio²,

Conigliaro³

et al. 2020

BTT

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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.

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Musculoskeletal ultrasound in monitoring response to apremilast in psoriatic arthritis patients: results from a longitudinal study

Cited by 13 publications

References 19 publications

Integrating imaging and biomarker assessment to better define psoriatic arthritis and predict response to biologic therapy

Integrating imaging and biomarker assessment to better define psoriatic arthritis and predict response to biologic therapy

Apremilast for biologic-naïve, peripheral psoriatic arthritis, including patients with early disease: results from the APROACH observational prospective study

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

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