Psoriatic arthritis

FitzGerald, Oliver; Ogdie, Alexis; Chandran, Vinod; Coates, Laura C.; Kavanaugh, Arthur; Tillett, William; Leung, Ying Ying; Wit, Maarten de; Scher, Jose U.; Mease, Philip J

doi:10.1038/s41572-021-00293-y

Cited by 135 publications

(95 citation statements)

References 180 publications

(178 reference statements)

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“…The demographic and clinical characteristics of the population analyzed were comparable to those observed in previous real-world studies conducted on PsA patients in Italy [ 14 – 17 ]. During the characterization period, around 35% of PsA patients had a diagnosis for PSO; this results is in line with that reported in the literature, i.e., that PSO represent a clinical features in 30% of PsA patients [ 2 ]. In addition, almost 7% and 2% of patients presented RA and AS, respectively, as previous manifestations [ 18 , 19 ].…”

Section: Discussionsupporting

confidence: 90%

Analysis of the Pharmacoutilization of Biological Drugs in Psoriatic Arthritis Patients: A Real-World Retrospective Study Among an Italian Population

Perrone¹,

Losi

Filippi

et al. 2022

Rheumatol Ther

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Introduction Real-world pharmacoutilization analysis of biological drugs in psoriatic arthritis (PsA) patients with the aim to evaluate biologic treatment patterns and pharmacoutilization among patients with PsA in Italy. Methods A retrospective study was conducted using administrative databases of Italian Entities. PsA patients were included and diagnosed by hospitalization and/or an active exemption code. Two analyses were performed: a cross-sectional for treatment patterns in patients enrolled among 2017–2020, and a longitudinal study during 2015 to investigate the pharmacoutilization, in terms of persistence and monthly maintenance dosage of biological/targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs). Patients with or without b/tsDMARDs prescriptions before inclusion were defined as bioexperienced or naïve, respectively. An analysis on ixekizumab-treated patients (IXE patients) from the 2017-to study ending was performed. Results PsA was diagnosed in 24,786 (2017), 27,221 (2018), 28,889 (2019), and 29,292 (2020) patients. Across 2017–2020, 31.1–40.5% of PsA patients were untreated with systemic medications, and 16.4–18.8% were under biological therapies. Among b/tsDMARD-treated patients, decreasing use of TNF-inhibitors (77.6–57.1%) and increasing IL-inhibitors (19.6–33.2%) was found across 2017–2020, respectively. Persistence to TNF-inhibitors and IL inhibitors as first-line ranged, respectively, 74.9–83.0% and 73.0–84.6%; specifically, 73.1–76.9% and 73.0–83.8% among bio-naïve, 83.3–90.0%, and 87.0% among bio-experienced. Among IXE-patients ( N = 178), 55.6% were bio-naïve, while 21.9% previously used secukinumab, 12.9% adalimumab, 10.1% etanercept. During a 1-year follow-up, 6.8% of IXE patients switched therapy. Conclusions This real-world study of PsA pharmacoutilization in Italy showed that more than one-third of patients were systemically untreated, and almost 20% were receiving biological medications. Among biological users, increasing use of IL-inhibitors and a decrease in TNF-inhibitors prescriptions over the years were found. A rather-high extent of persistency in treatment was observed. A focused analysis on IXE patients revealed over half of them to be bio-naïve, while around one-fourth were bio-experienced to IL inhibitors. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-022-00440-1.

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Section: Discussionsupporting

confidence: 90%

Analysis of the Pharmacoutilization of Biological Drugs in Psoriatic Arthritis Patients: A Real-World Retrospective Study Among an Italian Population

Perrone¹,

Losi

Filippi

et al. 2022

Rheumatol Ther

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“…The comorbidities sub-committee considered diseases with a specific link to PsA. Comorbidities of particular importance in PsA include cardiovascular disease (CVD), obesity, metabolic syndrome, liver disease (fatty liver disease in particular), mood disorders including depression and anxiety, chronic infections (hepatitis B, hepatitis C, HIV, tuberculosis and fungal infections), malignancy (for example, skin cancer and lymphoma), osteoporosis and fibromyalgia and/or central sensitization 37 . Recommendations around these key comorbidities are listed below and are also shown in Table 4 .…”

Section: Treatment Schemamentioning

confidence: 99%

Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA): updated treatment recommendations for psoriatic arthritis 2021

et al. 2022

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Since the second version of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations were published in 2015, therapeutic options for psoriatic arthritis (PsA) have advanced considerably. This work reviews the literature since the previous recommendations (data published 2013–2020, including conference presentations between 2017 and 2020) and reports high-quality, evidence-based, domain-focused recommendations for medication selection in PsA developed by GRAPPA clinicians and patient research partners. The overarching principles for the management of adults with PsA were updated by consensus. Principles considering biosimilars and tapering of therapy were added, and the research agenda was revised. Literature searches covered treatments for the key domains of PsA: peripheral arthritis, axial disease, enthesitis, dactylitis, and skin and nail psoriasis; additional searches were performed for PsA-related conditions (uveitis and inflammatory bowel disease) and comorbidities. Individual subcommittees used a GRADE-informed approach, taking into account the quality of evidence for therapies, to generate recommendations for each of these domains, which were incorporated into an overall schema. Choice of therapy for an individual should ideally address all disease domains active in that patient, supporting shared decision-making. As safety issues often affect potential therapeutic choices, additional consideration was given to relevant comorbidities. These GRAPPA treatment recommendations provide up-to-date, evidence-based guidance on PsA management for clinicians and people with PsA.

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“…IMRDs are a heterogeneous group of diseases and display differences in genetic susceptibility loci, immune system activation, environmental risk factors and treatment response patterns (6)(7)(8). Recent approaches to further understand the pathogenic mechanisms of IMRDs, combined with molecular analysis of disease response following targeted cytokine therapy, are providing critical molecular characterization and mechanistic knowledge of the shared pathophysiology and differences that exist across IMRDs (1).…”

Section: Cell and Cytokine Signatures In Rheumatic Diseasesmentioning

confidence: 99%

NR4A1-3 nuclear receptor activity and immune cell dysregulation in rheumatic diseases

Murphy

Crean

2022

Front. Med.

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The development and progression of immune-mediated rheumatic disease (IMRD) involves dysfunction of innate and adaptive immune cell populations leading to altered responses including inflammasome activation, dysregulated cytokine networks, increased immune cell numbers and multifaceted cell-cell communication. Several rheumatic diseases are further characterized by the presence of autoantibodies, immune complex mediated complement activation and the deficit of peripheral immune tolerance due to reduced regulatory T-lymphocyte cell function. Ultimately, in rheumatic disease the loss in cellular and tissue homeostasis culminates in the advancement of chronic inflammation. The three members of the NR4A subfamily of nuclear receptors are immediate early genes, and act as potent transcriptional responders to changes in the cellular and tissue microenvironment. Subfamily members are rapidly expressed in diseases characterized by inflammation and function to control the differentiation and activity of innate and adaptive immune cells in a cell-type and cell-context specific manner. Rheumatic disease including rheumatoid-, psoriatic-, osteo-arthritis and systemic sclerosis display altered NR4A1-3 activity in controlling immune cell migration and function, production of paracrine signaling molecules, synovial tissue hyperplasia, and regulating cartilage turn-over in vivo. Additionally, NR4A1-3 activities mediate cytokine, prostanoid and growth factor signaling to control angiogenesis, modulate the regulatory functions of mesenchymal stromal cells, alter the activation status of dendritic cells, influence the generation of peripheral myeloid and T-lymphocyte lineages and promote the maintenance of functional regulatory T-cells. Further reports uncover the potential of moderating NR4A 1-3 receptors as therapeutic targets in altering immune tolerance, pathological angiogenesis and controlling inflammation in several models of disease.

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Psoriatic arthritis

Cited by 135 publications

References 180 publications

Analysis of the Pharmacoutilization of Biological Drugs in Psoriatic Arthritis Patients: A Real-World Retrospective Study Among an Italian Population

Analysis of the Pharmacoutilization of Biological Drugs in Psoriatic Arthritis Patients: A Real-World Retrospective Study Among an Italian Population

Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA): updated treatment recommendations for psoriatic arthritis 2021

NR4A1-3 nuclear receptor activity and immune cell dysregulation in rheumatic diseases

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