Latest Treatments for Psoriatic Arthritis
Ustekimumab, apremilast and abatacept join the list of medication options for PsA
Psoriatic arthritis (PsA) is a chronic, autoimmune, inflammatory form of arthritis that causes painful, swollen joints, as well as the skin symptoms associated with psoriasis. Approximately 30 percent of people with psoriasis develop PsA in addition to their skin condition. Treatment goals are to improve both joint and skin symptoms, as well as to prevent permanent joint damage.
Depending on its severity, psoriatic arthritis is treated with nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids and disease-modifying antirheumatic drugs (DMARDs) such as methotrexate. Biologics such as adalimumab (Humira), etanercept (Enbrel), golimumab (Simponi) and infliximab (Remicade) also are used when other treatments fail to bring relief. Despite effective treatment, many psoriatic arthritis patients are undertreated. Three drugs have recently been approved for use in psoriatic arthritis, increasing doctors’ and patients’ treatment options.
Ustekimumab Therapy for Psoriatic Arthritis
In September 2013, the U.S. Food and Drug Administration (FDA) approved the biologic ustekinumab (Stelara) for the treatment of moderate to severe psoriatic arthritis (PsA) in adult patients. Ustekimumab can be used alone or with methotrexate, giving PsA patients who haven’t responded to existing treatments another option. It was first approved in 2009 for the skin disease psoriasis. Unlike anti-TNFs, ustekinumab targets two other molecules involved in inflammation, interleukin-12 (IL-12) and interleukin-23 (IL-23).
The FDA based its approval on two phase III, randomized, double blind, placebo-controlled trials of more than 900 patients. The study participants had at least five tender and swollen joints and high levels of C-reactive protein (a measure of inflammation), and weren’t responding to current therapies.
Apremilast Therapy for Psoriatic Arthritis
In March 2014, the FDA approved the oral medication apremilast (Otezla) for clinically active psoriatic arthritis. Apremilast selectively blocks phosphodiesterase 4 (PDE4), an enzyme involved in inflammation.
In one phase 3 clinical trial, people treated with apremilast showed significant improvement in signs and symptoms of psoriatic arthritis - including tender and swollen joints, physical function and skin symptoms - after 16 weeks on the drug. Up to 40 percent of patients saw at least a 20 percent improvement as measured by the American College of Rheumatology response criteria compared with 19 percent of patients who took a placebo.
Abatacept for Psoriatic Arthritis
In July 2017, the U.S. Food and Drug Administration (FDA) approved the biologic abatacept (Orencia) to treat psoriatic arthritis in adults. It was already approved for rheumatoid arthritis (RA) and for one subtype of juvenile idiopathic arthritis (JIA).
Technically called a "selective costimulation modulator," abatacept works by targeting T-lymphocytes (T cells). These immune cells are overproduced in people with inflammatory arthritis. The drug attaches to the surface of T cells and blocks communication between these cells. It also blocks the production of chemicals that can lead to joint damage and symptoms like pain and swelling. It may be given as a monthly infusion or weekly injection.
The FDA approved abatacept based on the results of two randomized controlled trials involved nearly 600 adults with long-standing PsA.