New Psoriatic Arthritis Guidelines Recommend TNFi as First-Line Therapy Option

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The guidelines include a strong recommendation against smoking.
The guidelines include a strong recommendation against smoking.

A new treatment guideline for psoriatic arthritis (PsA) recommends a treat-to-target approach and the use of tumor necrosis factor inhibitors (TNFi) as a first-line therapy option in patients with active PsA. 

The guideline is jointly authored by the American College of Rheumatology (ACR) and the National Psoriasis Foundation (NPF). It is the first guideline that specifically recommends trying TNFi biologics in treatment-naïve patients first, before using oral small molecule drugs (OSM). 

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"The available evidence suggested that in the absence of certain conditions, many treatment-naïve patients would benefit from trying a TNFi biologic first," said Dafna Gladman, MD, University of Toronto and member of the NPF Medical Board who served as a content expert for the guidelines. She went on to say that OSMs can continue to be used as a first-line option for patients who have contraindications to TNFi treatment or in patients with severe PsA or psoriasis that prefer an oral treatment. 

The guidelines also include a strong recommendation against smoking, as the literature suggests it reduces the efficacy of biologics. 

The authors developed the guidelines using GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology; most of the recommendations were "conditional" because of low or very low quality evidence available in some areas. Principle investigator Jasvinder Singh, MD, called for more head-to-head trials of "various treatments and comparative effectiveness studies in both trial populations and PsA populations with comorbidities."

Check back with Rheumatology Advisor for further in-depth coverage of the 2018 American College of Rheumatology/National Psoriasis Foundation guideline.

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