Share on Facebook
Share on Twitter
Share on LinkedIn
Share by Email
Print
![There are no uniform guidelines regarding DMARD tapering. EULAR guidelines suggest RA pharmacotherapy should be de-escalated in the following order: glucocorticoids, biologic DMARDs, and, finally, conventional DMARDs, with each treatment stopping completely before de-escalation of the next agent in the sequence.[4] Numerous DMARD dose-tapering protocols have been studied, including immediate discontinuation of treatment. When the goal is to withdraw treatment, the ACR recommends an initial dose-tapering phase to enable better monitoring of patient response and candidacy for discontinuation.[5] The ACR also strongly encourages patient involvement in decisions regarding their individual DMARD tapering protocol.](https://www.rheumatologyadvisor.com/wp-content/uploads/sites/18/2019/01/syringedrugsts53728911801_1026507.jpg)
Guselkumab and interleukin (IL)-17A/IL-17RA inhibitors show preferential efficacy to tumor necrosis factor inhibitors (TNFis) in enthesitis, dactylitis, and skin manifestations among patients with psoriatic arthritis (PsA), according to findings from a systematic review and meta-analysis published in RMD Open.
To compare the efficacy and safety of systemic therapies used in the treatment of PsA, researchers conducted a Bayesian network meta-analysis (NMA) that included 46 randomized controlled trials.
Safety was assessed using the number of treatment discontinuations due to adverse events, and efficacy was assessed using the Psoriasis Area and Severity Index (PASI) response, American College of Rheumatology (ACR) response, and resolution of dactylitis and enthesitis. The ACR response among those with and without previous exposure to biologic disease-modifying antirheumatic drugs (bDMARDs) was compared in subgroup analyses.
Researchers noted that IL inhibitors performed better with regard to PASI response than TNFis (particularly IL-17A/IL-17RA inhibitors and guselkumab, which along with adalimumab, had high efficacy in resolving dactylitis and enthesitis); however, both treatments were not significantly different in terms of ACR response. The ACR response also did not differ significantly between those with and without previous exposure to bDMARDs.
Discontinuations due to adverse events were highest with certolizumab (400 mg every 4 weeks), tildrakizumab, and infliximab with and without methotrexate, and lowest with IL-inhibitors, golimumab, and abatacept.
One of the main limitations of the current analysis was the potential bias against treatments examined over shorter time periods.
The authors concluded, “…these study results could help clinicians tailor treatment choice according to different domains of disease and provides additional evidence for developing patient-[centered] treatment guidelines.”
Disclosure: This research was supported by Leo Pharma A/S. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Reference
McInnes IB, Sawyer LM, Markus K, LeReun C, Sabry-Grant C, Helliwell PS. Targeted systemic therapies for psoriatic arthritis: a systematic review and comparative synthesis of short-term articular, dermatological, enthesitis and dactylitis outcomes. RMD Open. Published online March 23, 2022. doi:10.1136/rmdopen-2021-002074
