An evidence-based review of certolizumab pegol in the treatment of active psoriatic arthritis: place in therapy

Abstract

Certolizumab pegol (CZP) is a pegylated humanized tumor necrosis factor-α inhibitor (TNFi) approved for the treatment of psoriatic arthritis (PsA) in Europe, the USA, and Latin American countries. CZP neutralizes TNF-α at its soluble and membrane portions. Due to the lack of Fc region, it does not induce complement or antibody-dependent cytotoxicity in vitro, unlike other TNFi. RAPID-PsA study, the only randomized clinical trial performed in PsA, is a Phase III clinical trial conducted in 409 PsA patients during 24 weeks. Patients were randomized to CZP (200 mg every 2 weeks or 400 mg every 4 weeks) or placebo. Patients in CZP arms reported improvements in skin disease, joint involvement, dactylitis, enthesitis, and quality of life. Safety profile was similar to that reported for other TNF-α inhibitors in PsA patients. This article summarizes the pharmacology and reviews the efficacy and tolerability of this drug in PsA. CZP is the newest TNFi with proved efficacy in all manifestations of psoriasis disease, except for axial involvement where the evidence has been derived from response to axial spondyloarthritis.

The Role of Tumor Necrosis Factor Alpha (TNF-α) in Autoimmune Disease and Current TNF-α Inhibitors in Therapeutics

“…It is a novel TNF-α inhibitor with a remarkable mechanism of action in comparison to other TNF-α inhibitors. Because of the PEGylation, certolizumab pegol can be more significantly distributed into inflamed tissues compared to infliximab and adalimumab [ 76 ]. The distinct structure of the inhibitor might be the reason behind the higher efficacy of certolizumab pegol in comparison with other TNF-α inhibitors [ 77 ].…”

Spotlight on certolizumab pegol in the treatment of axial spondyloarthritis: efficacy, safety and place in therapy

“…CZP is formed by the combination of a humanized Fab fragment (50 kDa) and a 40-kDa polyethylene glycol moiety (a polymer that is not immunogenic or toxic). 24 , 25 Its molecular structure leads to an increase of plasma half-life of the molecule to about 2 weeks. This allows 2–4 weekly subcutaneous injections.…”

“…CZP does not lead to apoptosis of peripheral blood monocytes or lymphocytes or neutrophil necrosis. 24 , 25 …”

“…It has also been shown greater drug distribution into inflamed tissues than that of infliximab (IFX) and adalimumab (ADA). 24 , 26 …”

“…The purpose of indicating LD is to achieve high concentrations of the drug during early stages of treatment, which accelerates drug response and reduces the production of drug antibodies. 24 …”