Novel approaches to biological therapy for psoriatic arthritis

ABSTRACT

Introduction: Improved understanding of the immunopathogenic mechanisms in psoriatic arthritis (PsA) has led to the development of targeted biological therapies, which demonstrate superior clinical efficacy to traditional disease-modifying antirheumatic drugs (DMARDs). There are currently 3 classes of biological agents that are approved for the treatment of psoriatic disease: tumor necrosis factor alpha inhibitors (TNFi), including etanercept, infliximab, adalimumab, golimumab, and certolizumab pegol; ustekinumab, a monoclonal antibody (mAb) directed against interleukin (IL)-12 and IL-23; and secukinumab, a human anti-IL-17A mAb. Other agents are in development. Our growing experience with these medications has revolutionized the approach to disease management in PsA.

Areas covered: This article discusses the rationale for using biological therapies in PsA, highlighting clinical trial evidence that supports the use of these agents. We summarize novel treatment approaches using biological therapies in the management of PsA, including early intervention, targeted therapy, TNFi switching, combination therapy, and tapering or discontinuation of biological therapy. We conclude with a discussion of the importance comorbidities have on selection of therapy.

Expert opinion: The advent of highly effective biological therapies has revolutionized the management of patients with PsA. Growing experience with these agents has led to novel treatment approaches that may improve clinical outcomes for PsA patients.

KEYWORDS:

• Biological therapy
• clinical trials
• immunosuppressive agents
• interleukin-17 inhibitors
• psoriatic arthritis
• secukinumab
• tumor necrosis factor alpha inhibitors
• ustekinumab

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Article highlights

• Biologic DMARDs, particularly TNFi, effectively treat all domains of disease activity in PsA.

• There is accumulating evidence for the efficacy of newer agents (e.g., ustekinumab and secukinumab) in patients who cannot tolerate or are refractory to TNFi.

• Early intervention and targeted therapy have had observed benefits in PsA and may lead to improved disease outcomes.

• In patients achieving low-disease activity or remission, tapering or discontinuing therapy may be realistic options, although further research is required to determine the long-term impact of this treatment strategy.

• The importance of comprehensive management, including treating comorbidities, has become increasingly recognized.

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