Systematic literature review of non-topical treatments for early, untreated (systemic therapy naïve) psoriatic disease: a GRAPPA initiative

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>Psoriatic disease (PsD) is a complex systemic disorder with cutaneous and musculoskeletal (MSK) manifestations. Current evidence on pharmacological interventions –effective Across-The-Spectrum-Of-Clinical-Manifestations (ATSOCM) of early, systemic treatment-naïve PsD- is limited. This review aims to appraise such evidence.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>This systematic review examined seven Patient-Intervention-Comparator-Outcome (PICO) research questions to address the interventions’ efficacy on: ATSOCM PsD activity; peripheral arthritis; dactylitis; spondylitis; enthesitis; skin; and nails. Early PsD was defined as a disease duration of ≤ 2 years, except for studies investigating outcomes restricted to the skin. Eligible references were clinical trials or well-designed prospective studies/series reporting on: adult humans, untreated, with cutaneous and/or MSK features of PsD.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Nine references (out of 160 319, publication range 1946–2019) fulfilled the eligibility criteria. No study adopted comprehensive (that is, simultaneous assessment of different PsD manifestations) composite indices as primary outcome measures. Individual studies reported that apremilast and biologics successfully improved outcomes (DAPSA, MDA, PASDAS, PASI, PsARC) when efficacy analyses were restricted to single manifestations of untreated PsD. Only qualitative synthesis of evidence was possible, due to: a) data heterogeneity (disease classification criteria, outcome measures); b) unavailable data subsets -focused on early, untreated PsD- at single study level; c) insufficient data on the participants’ exposure to previous treatment.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Effective interventions –albeit limited in scope- for early, treatment-naïve PsD were found. No study provided evidence about the management of co-occurring cutaneous and MSK manifestations in early, treatment-naïve PsD. This review highlighted an unmet need in research on early PsD.</jats:p> </jats:sec>

Early intervention and disease memory in psoriasis: A literature review

“…The data on early intervention in psoriatic arthritis (PsA) is sparse, although a few studies suggest that early intervention may be beneficial 34 . In a randomised placebo‐controlled trial ( n = 51), a total of 81% of patients with early PsA (0.5 years mean duration) achieved remission when treated with golimumab and MTX compared with 42% in those treated with MTX and placebo at week 22 ( p = 0.004) 35 …”

Advanced Glycation End Products and Psoriasis

“…However, bone erosions can occur early in the disease’s course and lead to disability and impaired function of affected joints and bones [ 18 ]. The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) has recognized different domains of PsA including synovitis, enthesitis/dactylitis, nail, skin, and axial involvement [ 19 ]. Synovitis could potentially affect any joint, but it is more commonly observed in the hands or feet.…”

Sarkoidose im Kopf-Hals-Bereich – eine diagnostische Herausforderung am Beispiel lokaler Hautmanifestationen

“…Lymphome, Metastasen) als Differenzialdiagnose naheliegender [7,8] In der Dermatologie geht der Trend seit Jahren von der Lokalzur Systembehandlung und es bestehen multiple etablierte Therapieregime mit beispielsweise monoklonalen Antikörpern (Anti-TNF-Alfa; Anti-IL-17 etc. ), Immunsuppressiva oder Immunmodulatoren [9][10][11][12]. Möglicherweise hat dies den Blick für extrakutane Krankheitsursachen (more than skin deep) geschärft [13,14].…”