Residual Disease Associated with Suboptimal Treatment Response in Patients with Psoriatic Arthritis: A Systematic Review of Real-World Evidence

Abstract

Objective This systematic literature review aimed to identify and summarise real-world observational studies reporting the type, prevalence and/or severity of residual symptoms and disease in adults with psoriatic arthritis (PsA) who have received treatment and been assessed against remission or low disease activity targets. Methods Patients had received treatment and been assessed with treat-to-target metrics, including minimal disease activity (MDA), Disease Activity Index in PsA (DAPSA) and others. MEDLINE, Embase® and the Cochrane Database of Systematic Reviews (CDSR) were searched using search terms for PsA, treatment targets and observational studies. Screening of search results was completed by two independent reviewers; studies were included if they reported relevant residual disease outcomes in adults with PsA who had received one or more pharmacological treatments for PsA in a real-world setting. Non-observational studies were excluded. Information from included studies was extracted into a prespecified grid by a single reviewer and checked by a second reviewer. Results Database searching yielded 2328 articles, of which 42 publications (27 unique studies) were included in this systematic literature review. Twenty-three studies reported outcomes for MDA-assessed patients, and 14 studies reported outcomes for DAPSA-assessed patients. Physician- and patient-reported residual disease was less frequent and/or severe in patients reaching targets, but often not absent, including when patients achieved very low disease activity (VLDA) or remission. For example, studies reported that 0–8% patients in remission according to DAPSA (or clinical DAPSA) had > 1 tender joint, 25–39% had Psoriasis Area and Severity Index (PASI) score > 1 and 0–10% had patient-reported pain > 15. Residual disease was usually less frequent and/or severe among patients achieving MDA-assessed targets versus DAPSA-­assessed targets, especially for skin outcomes. Conclusion The findings demonstrate a need for further optimisation of care for patients with PsA.

Bimekizumab in patients with active psoriatic arthritis and previous inadequate response or intolerance to tumour necrosis factor-α inhibitors: a randomised, double-blind, placebo-controlled, phase 3 trial (BE COMPLETE)

“…3 Despite the range of treatment options available for psoriatic arthritis, Lancet 2023; 401: 38-48 many patients continue to have residual symptoms that negatively impact their physical wellbeing and quality of life. 4,5 Furthermore, patients often lose response or develop intolerance to therapies; in clinical practice, the mechanisms under pinning such resistance are unclear and probably multifactorial. 1,6 There is an urgent need to analyse the varied causes of this loss of response and apply this understanding to treatment selection.…”

Clinical and Economic Benefit of Achieving Disease Control in Psoriatic Arthritis and Ankylosing Spondylitis: A Retrospective Analysis from the OM1 Registry

“…Likewise, remission is often accompanied by improved physical functioning, and therefore work abilities; thus, disease control also has a societal impact [25]. However, studies have shown that, despite achieving stringent disease control measures, many patients still report residual disease symptoms [26][27][28]. It is important that providers take a more patient-centered approach, not relying solely on measures of disease activity, but also incorporating patient-reported outcomes, such as pain, fatigue, and functional impairment, as these are outcomes that are important to patients.…”

Dual Biologic Therapy in Patients with Rheumatoid Arthritis and Psoriatic Arthritis

“…Multiple biologic therapies are currently available to treat PsA, yet refractory forms of the disease are not uncommon. 4 Dual biologic therapy represents a promising therapeutic option for these cases based on the synergistic effect of the simultaneous targeting of different inflammatory pathways. Differently from RA, no clinical trials investigated the efficacy and safety of this treatment approach in PsA.…”

“… 3 Similarly, a substantial proportion of PsA patients fail to reach remission and thus face living with residual disease. 4 Therefore, refining treatment strategies is required to optimize the care and reduce the burden of disease in resistant cases. Concomitant neutralization of multiple inflammatory pathways might offer a promising treatment approach in this setting.…”