AI Article Synopsis
- Randomised controlled trials have been conducted to compare the effectiveness of different disease-modifying antirheumatic drugs (DMARDs) for treating psoriatic arthritis (PsA), but few studies directly compare them against each other.
- A systematic review and Bayesian network meta-analysis of 46 studies assessed the efficacy and safety of various DMARDs, focusing on American College of Rheumatology (ACR) responses and skin severity measured by the Psoriasis Area and Severity Index (PASI).
- The analysis found that while some TNF inhibitors showed slightly better ACR responses than IL inhibitors, IL-17A/IL-17RA inhibitors and guselkumab were more effective for skin symptoms and overall safety, suggesting treatment choices
Article Abstract
Introduction: Randomised controlled trials (RCTs) have compared biological and targeted systemic disease-modifying antirheumatic drugs (DMARDS) against placebo in psoriatic arthritis (PsA); few have compared them head to head.
Objectives: To compare the efficacy and safety of all evaluated DMARDs for active PsA, with a special focus on biological DMARDs (bDMARDs) licensed for PsA or psoriasis.
Methods: A systematic review identified RCTs and Bayesian network meta-analysis (NMA) compared treatments on efficacy (American College of Rheumatology (ACR) response, Psoriasis Area and Severity Index (PASI) response, resolution of enthesitis and dactylitis) and safety (patients discontinuing due to adverse events (DAE)) outcomes. Subgroup analyses explored ACR response among patients with and without prior biological therapy exposure.
Results: The NMA included 46 studies. Results indicate that some tumour necrosis factor inhibitors (anti-TNFs) may perform numerically, but not significantly, better than interleukin (IL) inhibitors on ACR response but perform worse on PASI response. Few significant differences between bDMARDs on ACR response were observed after subgrouping for prior bDMARD exposure. Guselkumab and IL-17A or IL-17RA inhibitors-brodalumab, ixekizumab, secukinumab-were best on PASI response. These IL-inhibitors and adalimumab were similarly efficacious on resolution of enthesitis and dactylitis. Infliximab with and without methotrexate, certolizumab 400 mg every 4 weeks and tildrakizumab showed the highest rates of DAE; abatacept, golimumab and the IL-inhibitors, the lowest.
Conclusions: Despite similar efficacy for ACR response, IL-17A and IL-17RA inhibitors and guselkumab offered preferential efficacy to anti-TNFs in skin manifestations, and for enthesitis and dactylitis, thereby supporting drug selection based on predominant clinical phenotype.
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|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8943739 | PMC |
| http://dx.doi.org/10.1136/rmdopen-2021-002074 | DOI Listing |
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