Newer Drug Treatments for Psoriatic Arthritis
By Marianne Wait and Linda Rath
Get more information about the medications, ustekimumab, apremilast and abatacept that were approved by the FDA as options for treating 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. The goal of treatment is to improve both joint and skin symptoms and prevent or minimize permanent joint damage.. While there are a variety of treatments available, many PsA patients are undertreated, making newer drug approvals important to give doctors and patients more options.
Depending on its severity, psoriatic arthritis is typically treated with nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids and conventional disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate. Biologics such as adalimumab (Humira), etanercept (Enbrel), golimumab (Simponi) and infliximab (Remicade) are used when other treatments fail to bring relief or as part of an aggressive treatment strategy.
The U.S. Food and Drug Administration (FDA) approved three new drugs between 2013 and 2017 for use in psoriatic arthritis:
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.
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.
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.
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