Novel combination biologic therapy for recalcitrant psoriasis and psoriatic arthritis in a medically complex patient

2021 ◽  
Author(s):  
Sarah Hanna ◽  
Peter Youssef ◽  
Patricia Lowe
Keyword(s):  
Psoriatic Arthritis ◽  
Biologic Therapy ◽  
Complex Patient

scholarly journals AB0809 HOW WELL ARE BIOLOGICS RETAINED IN PSORIATIC ARTHRITIS - A REAL WORLD STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1706.1-1706
Author(s):  
I. Jawad ◽  
M. K. Nisar
Keyword(s):  
Clinical Trials ◽  
Psoriatic Arthritis ◽  
Real World ◽  
Biologic Therapy ◽  
Health Economy ◽  
Nice Guidelines ◽  
Drug Survival ◽  
Gi Symptoms ◽  
Conventional Dmards ◽  
Significant Difference

Background:Biologics have led to a sea change in the management of psoriatic arthritis (PsA) with unprecedented improvement in the signs, symptoms and radiographic damage, resulting in improvement in functionality and quality of life. However longitudinal data for their retention and tolerability is sparse.Objectives:Our objective was to evaluate real-world biologic therapy duration and reasons for discontinuing treatment.Methods:We conducted a retrospective analysis of our PsA electronic register from 1994 up to and including April 2019 at our university teaching hospital. We had access to full patient records including details on co-morbidities, drugs and disease management.Results:335 patients were identified with PsA. 58% of them were female with mean age of 46 yr (13-81). 113 (33.7%) patients had been treated with a biologic with 105 (93%) continuing at the time of analysis. 60 individuals were prescribed combination therapy with DMARDs. Mean age was 43.3 years (13-81) with 56% women. The biologics sample was ethnically diverse including 80% White Caucasian patients, 17% Asian and others (3%). Significant co-morbidities included cardiovascular disease (18.6%) and diabetes (4.4%). Eight different biologics were in use with adalimumab being the most prescribed (67%).35 (30.9%) patients had stopped biologics at some point with 76 episodes of cessation. 6% of our sample had discontinued two or more biologic treatments. The mean duration before biologic therapy was discontinued was 18.2 months (8 days to 9.5 years), which was almost twice as long as the average period before discontinuing a DMARD (9.9 months). Main reasons for stopping treatment included 23% each due to GI symptoms, neurological causes, cutaneous symptoms and other side effects. The remaining 8% reported fatigue as the reason for stopping therapy.Conclusion:To our knowledge this is the first dedicated retrospective review of a large real world PsA cohort comparing drug survival and tolerability of biologics against DMARDs. Biologic therapies are well tolerated in psoriatic arthritis. There is no significant difference amongst various modes of action. Over a quarter of the patients discontinue the drug owing to intolerance with mean drug survival of 18 months. In contrast nearly two-thirds were intolerant of DMARDs and stopped within ten months. Thus both the rate and duration of biologic retention is significantly better than conventional DMARDs. This has significant economic impact as NICE guidelines require an adequate trial of two DMARDs for six months prior to advanced therapy. However, this approach is unlikely to be cost effective as the disease progresses whilst patients struggle with DMARDs prescription and thus delay biologics which are more likely to be tolerated and retained longer. Hence there is an urgent need to review NICE guidelines to allow earlier employment of biologics in the treatment paradigm with significant benefits to both patients and the health economy.Disclosure of Interests:Issrah Jawad: None declared, Muhammad Khurram Nisar Grant/research support from: Muhammad Nisar undertakes clinical trials and received support (including attendance at conferences, speaker fees and honoraria) from Roche, Chugai, MSD, Abbvie, Pfizer, BMS, Celgene, Novartis and UCB, Consultant of: Muhammad Nisar undertakes clinical trials and received support (including attendance at conferences, speaker fees and honoraria) from Roche, Chugai, MSD, Abbvie, Pfizer, BMS, Celgene, Novartis and UCB, Speakers bureau: Muhammad Nisar undertakes clinical trials and received support (including attendance at conferences, speaker fees and honoraria) from Roche, Chugai, MSD, Abbvie, Pfizer, BMS, Celgene, Novartis and UCB

scholarly journals BIOLOGIC THERAPY OF PSORIATIC ARTHRITIS

Reumatismo ◽  
2011 ◽  
Vol 59 (1s) ◽  
Author(s):  
D.D. Gladman
Keyword(s):  
Psoriatic Arthritis ◽  
Biologic Therapy

scholarly journals Treatment patterns and costs for anti-TNFα biologic therapy in patients with psoriatic arthritis

2016 ◽  
Vol 17 (1) ◽  
Author(s):  
Jacqueline B. Palmer ◽  
Yunfeng Li ◽  
Vivian Herrera ◽  
Minlei Liao ◽  
Melody Tran ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Biologic Therapy ◽  
Treatment Patterns

scholarly journals Brazilian Society of Rheumatology 2020 guidelines for psoriatic arthritis

2021 ◽  
Vol 61 (1) ◽  
Author(s):  
Sueli Carneiro ◽  
Penelope Esther Palominos ◽  
Sônia Maria Alvarenga Anti ◽  
Rodrigo Luppino Assad ◽  
Rafaela Silva Guimarães Gonçalves ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Interrater Reliability ◽  
Biologic Therapy ◽  
Evidence Based ◽  
Review Of The Literature ◽  
Immune Disease ◽  
Level Of Evidence ◽  
Brazilian Society ◽  
Conventional Drug ◽  
Clinical Questions

AbstractPsoriatic arthritis (PsA) is a chronic and systemic immune disease characterized by inflammation of peripheral and/or axial joints and entheses in patients with psoriasis (PsO). Extra-articular and extracutaneous manifestations and numerous comorbidities can also be present. These recommendations replace the previous version published in May 2013. A systematic review of the literature retrieved 191 articles that were used to formulate 12 recommendations in response to 12 clinical questions, divided into 4 sections: diagnosis, non-pharmacological treatment, conventional drug therapy and biologic therapy. These guidelines provide evidence-based information on the clinical management for PsA patients. For each recommendation, the level of evidence (highest available), degree of strength (Oxford) and degree of expert agreement (interrater reliability) are reported.

Biologic Therapy Utilization in Patients With Moderate to Severe Psoriasis and Psoriatic Arthritis: An Observational Summary of Biologic Therapy Use in a Clinical Setting

2018 ◽  
Vol 22 (6) ◽  
pp. 567-576 ◽  
Author(s):  
Wayne P. Gulliver ◽  
Shane Randell ◽  
Susanne Gulliver ◽  
Valerie Gregory ◽  
Sean Nagle ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Clinical Research ◽  
Plaque Psoriasis ◽  
Biologic Therapy ◽  
Severe Psoriasis ◽  
Second Line ◽  
Biologic Therapies ◽  
Biologic Treatment ◽  
Treatment Pathways ◽  
Severe Plaque Psoriasis

Plaque psoriasis affects approximately 2% to 3% of the global population, with psoriatic arthritis observed in approximately 20% to 30% of these individuals. Upon advances in research pathophysiology and treatment over the past decade, biologic therapies have been used more to treat moderate to severe psoriasis. In Canada, reimbursement bodies have defined prior authorization criteria to determine patient eligibility for funding of biologic treatments in moderate to severe plaque psoriasis. Generally, patients will have been treated with conventional therapies such as topical steroids, phototherapy, or systemic treatments such as methotrexate and cyclosporine before starting a biologic therapy. In difficult cases or severe flares in otherwise controlled disease, practitioners may augment the regimen with one or more conventional treatments. The objective of this observational report was to identify treatment pathways for psoriasis and psoriatic arthritis patients in Canada by examining initial biologic treatment and subsequent treatment optimization patterns for informed reimbursement discussions and decisions. A retrospective chart review was conducted at Newlab Clinical Research using medical records of patients who received at least 1 of 4 biologic agents approved at that time of the survey in Canada for the treatment of plaque psoriasis (adalimumab, etanercept, infliximab, ustekinumab). The study population consisted of patients who had moderate to severe plaque psoriasis, diagnosed by a dermatologist, for at least 6 months before the study index date and who attended Newlab Clinical Research between 2008 and 2013. All current and previous agents prescribed for the treatment of psoriasis were captured. A total of 248 patients with psoriasis treated with biologics were identified, of whom 27 (10.9%) were also diagnosed with psoriatic arthritis. Prior to initiating treatment with a biologic, most patients (72.1%) were treated with (or contraindicated to) methotrexate/cyclosporine. Treatment was supplemented with topical agents (70.6%) and/or followed by a course of ultraviolet light phototherapy (51.6%). Only 2.4% of patients were treated with a biologic first. Of 248 patients treated with biologics, almost half (47.6%) needed add-on therapy, whereas 16.5% of patients had an increase in dose or dosing interval. Furthermore, 14.1% of patients added a topical agent, 10.5% a topical steroid, or 6.5% a course of phototherapy while continuing biologic therapies. Finally, 30.4% of patients switched to another biologic treatment. Adalimumab was the most common agent used as a second-line agent (37.2%), and patients who started on adalimumab mainly switched to ustekinumab as a second-line agent (73.9%). Infliximab was the agent least often used as second-line therapy.

scholarly journals Cost-Effectiveness Analysis of Sequential Biologic Therapy with Ixekizumab Versus Secukinumab in the Treatment of Active Psoriatic Arthritis with Concomitant Moderate-to-Severe Psoriasis in the UK

2020 ◽  
Vol 4 (4) ◽  
pp. 635-648 ◽  
Author(s):  
Bernd Schweikert ◽  
Chiara Malmberg ◽  
Örjan Åkerborg ◽  
Gayathri Kumar ◽  
Debby Nott ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Cost Effectiveness ◽  
Biologic Therapy ◽  
Cost Effectiveness Analysis ◽  
Severe Psoriasis ◽  
Effectiveness Analysis ◽  
The Uk

scholarly journals Apremilast in the treatment of psoriatic arthritis: a perspective review

2017 ◽  
Vol 9 (2) ◽  
pp. 45-53 ◽  
Author(s):  
Michael Reed ◽  
David Crosbie
Keyword(s):  
Psoriatic Arthritis ◽  
Biologic Therapy ◽  
Clinical Trial Data ◽  
Trial Data ◽  
Efficacy And Safety ◽  
Biologic Therapies ◽  
Phosphodiesterase 4 ◽  
Psoriatic Disease ◽  
New Treatment ◽  
Orally Active

Apremilast is an orally-active small molecule which inhibits phosphodiesterase-4 (PDE4). Clinical trials have demonstrated its efficacy and safety in psoriatic arthritis (PsA) and psoriasis. Established therapeutic options have variable effectiveness across the different domains of psoriatic disease. Whilst biologic therapies have proven to be of significant benefit to many patients, not all patients respond, and others are not eligible or do not tolerate biologic therapy. We review the mechanism of action, pharmacokinetics and clinical trial data with regards to both efficacy and safety for apremilast and consider where this new treatment may be positioned in the treatment of PsA.

scholarly journals Differentiation between osteoarthritis and psoriatic arthritis: implications for pathogenesis and treatment in the biologic therapy era

Rheumatology ◽  
2014 ◽  
Vol 54 (1) ◽  
pp. 29-38 ◽  
Author(s):  
D. McGonagle ◽  
K.-G. A. Hermann ◽  
A. L. Tan
Keyword(s):  
Psoriatic Arthritis ◽  
Biologic Therapy
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