Moving the Goalpost Toward Remission: The Case for Combination Immunomodulatory Therapies in Psoriatic Arthritis

Scher, Jose U.; Ogdie, Alexis; Merola, Joseph F.; Ritchlin, Christopher T.

doi:10.1002/art.41765

Cited by 6 publications

(2 citation statements)

References 30 publications

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“…The presence of multiple parallel and contrasting disease pathways raises the possibility that combination biologics may be an effective strategy, but there are safety concerns with these combination therapies, based in part on the experience in patients with RA, which greatly dampens the enthusiasm for this approach. A major advantage to considering combination treatments with agents that inhibit IL‐17 or IL‐23 is their excellent safety record (87). Recent findings from the VEGA Trial in patients with ulcerative colitis support the efficacy and safety of combination biologics.…”

Section: Discussionmentioning

confidence: 99%

Expert Perspective: Management of the Psoriatic Arthritis Patient After Failure of One Tumor Necrosis Factor Inhibitor

Leung

Kavanaugh

Ritchlin

2023

Arthritis & Rheumatology

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The index case, a 36-year-old woman, had psoriasis (PsO) on her scalp, arms, legs, and trunk since age 25 years that was inadequately controlled with topical agents. She has a past medical history of treated hypertension and depression. She is an active smoker. Three years prior to our case evaluation, she developed polyarthritis, inflammatory back pain, and plantar fasciitis. Methotrexate (MTX) was added to her treatment regimen, first administered orally then subcutaneously, but the patient stated she could only tolerate 12.5 mg/week due to gastrointestinal and systemic adverse events. The dose of 12.5 mg/week resulted in minimal benefit. In addition, the patient was recently married and reported that pregnancy was being considered, and therefore treatment with MTX was stopped. She then experienced a flare of PsO and arthritis.Physical examination was notable for the presence of moderate-to-severe PsO (12% affected body surface area [BSA]), 6-7 swollen and tender joints, and evidence of mild erosive changes on hand radiographs. Monotherapy with adalimumab 40 mg every other week was initiated. The patient improved during treatment with adalimumab over 10 weeks, with 60-70% improvement in her clinical symptoms overall, but continued to experience mild residual joint pain and signs of PsO (2-4% BSA). Approximately 3 months ago, she noted profound fatigue, 90 minutes of morning stiffness, and diffuse joint pain. She found it difficult to continue her work in retail and reported feeling frustrated, anxious, and depressed. Her skin PsO also worsened and became more bothersome to her. On physical examination, her blood pressure was 140/90 mm Hg, pulse rate was 72 beats per minute, and body mass index was 35 kg/m 2 . She had psoriasiform plaques on her trunk and extremities (8% BSA). Musculoskeletal examination revealed 6 tender and 4 swollen joints, and she had a Disease Activity Index for PsA (DAPSA) score of 29 (a DAPSA score of >28 represents high disease activity). There were multiple tender entheses, most notably in the plantar fasciae, left Achilles tendon, and the left elbow lateral condyle. Pain was elicited in the right sacroiliac (SI) joint on provocative testing, and also at several locations unassociated with entheses.

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Section: Discussionmentioning

confidence: 99%

Expert Perspective: Management of the Psoriatic Arthritis Patient After Failure of One Tumor Necrosis Factor Inhibitor

Leung

Kavanaugh

Ritchlin

2023

Arthritis & Rheumatology

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“…Så vidt meg bekjent har ingen myndigheter eller faglige foreninger av betydning så langt anbefalt en slik kombinasjon. Vi kan forvente at det vil komme nytt evidensgrunnlag for kombinasjonsbehandling, med etterlengtet utprøving av doseringer, sekvens og hyppighet (7). Men det vil ta tid.…”

Section: Erfaring Fra Kombinasjonsbehandlingunclassified

Kombinasjonsbehandling med biologiske og andre avanserte legemidler

Uhlig

2023

Tidsskriftet

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Till Uhlig er spesialist i revmatologi og professor ved Universitetet i Oslo, seksjonsoverlege ved Nasjonal kompetansetjeneste for revmatologisk rehabilitering og seniorforsker ved Forskningssenter for behandling innen revmatologi og muskelskjelettsykdommer (REMEDY), Diakonhjemmet sykehus. Forfatteren har fylt ut ICMJE-skjemaet og oppgir følgende interessekonflikter: Han har mottatt honorar fra Galapagos, Lilly, Pfizer og UCB, som alle produserer biologiske eller andre avanserte legemidler. Kanskje enkelte pasienter med krevende kroniske inflammatoriske tilstander trenger kombinasjonsbehandling?Saerlig innen spesialitetene revmatologi, gastroenterologi og hudsykdommer behandles kroniske sykdommer med biologiske og andre avanserte legemidler, som såkalte biologiske sykdomsmodifiserende antirevmatiske legemidler (bDMARD) eller målrettede syntetiske legemidler (tsDMARD). De nedregulerer den immunologiske inflammasjonsprosessen og brukes blant annet i behandlingen av revmatoid artritt, spondyloartritter, inflammatorisk tarmsykdom og psoriasis.

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