Targeted PsA/PsO Therapies

Tumor necrosis factor (TNF) antagonists have improved outcomes for patients with psoriasis, but some patients are unresponsive to treatment (primary failure) or lose an initially effective response (secondary failure).
For Psoriasis patients who fail an anti-TNF, a third to two-thirds can respond to a different anti-TNF. Response is higher among secondary failures (initial response subsequently lost), possibly due to neutralising antibodies to the first anti-TNF developing over time; whereas primary non-responders (no response from the start) probably have disease driven more by a different mode of action (eg Th17 rather than TNF pathway). In the latter’s case, it is better to switch to a different therapeutic class (eg anti-IL17A, anti-IL12/23).

Dr. Philip Mease, MD presented the long-term efficacy and safety data for secukinumab in psoriatic arthritis (PsA) at the ACR Annual meeting in Washington,…

In the 3 years of Secukinumab’s trial data in Psoriatic Arthritis, it is reassuring to note that there is no increased signal of infections (including Tuberculosis), major cardiovascular events or malignancies when compared to placebo. Even Candida infections and colitis were very rare.

Ixekizumab, an interleukin-17A specific monoclonal antibody, for the treatment of biologic-naive patients with active psoriatic arthritis: results from the 24-week randomised, double-blind, placebo-controlled and active (adalimumab)-controlled period of the phase III trial SPIRIT-P1

Image result for Ixekizumab Side EffectsImage result for Ixekizumab Side Effects

Objective To assess the safety and efficacy of ixekizumab, a monoclonal antibody that inhibits interleukin-17A, in a double-blind phase III trial enrolling patients with active psoriatic arthritis (PsA). Methods Patients naive to biologic therapy with active PsA were randomised to subcutaneous injec…

New treatment options for psoriatic arthritis continue to be explored at this year’s ACR/ARHP Annual Meeting in Washington, DC. Guselkumab (GUS) is a fully…
IL23 is the main activator of the Th17 pathway, believed to be the predominant pathology of diseases like Psoriasis, Psoriatic Arthritis and Ankylosing Spondylitis. Downstream effector cytokines include IL17A, IL17F and IL22.
Targeting IL23 may have theoretical advantages over targeting IL17A:
1) downstream inhibition of IL22, which is believed to play a role in new bone formation and ankylosis in AS;
2) dampening of excessive and pathological IL17A production, sparing low level housekeeping IL17A maintenence of mucosal defence, thus avoiding the triggering of Inflammatory Bowel Disease which the Spondyloarthritis group of diseases are prone to. In fact, in a proof-of-concept study involving another anti-IL23, Risankizumab, it looked promising as a treatment for Crohn’s Disease.

WASHINGTON – Abatacept achieved promising results in patients with psoriatic arthritis through 24 weeks of treatment in a placebo-controlled, phase III…

Psoriatic Arthritis is a T-cell driven disease. It is therefore not surprising that Abatacept, a T-cell co-stimulation blocker, should work.

By Brian Hoyle…

Finally, a highly effective oral agent for Psoriatic Arthritis, and I’m not talking about Apremilast. Efficacy evident by the second week sounds good too!

WASHINGTON — Patients with psoriatic arthritis demonstrated a rapid and sustained response…

Tofacitinib blocks JAK2/TYK2 signaling, through which IL12 & IL23 activate pro-inflammatory cells. Perhaps this is how it exerts its effect against Psoriasis, Psoriatic Arthritis and Ankylosing Spondylitis.

For the more “stubborn” enthesitis, and perhaps more widespread psoriasis, the higher 10mg twice daily dose may work better.

Herpes Zoster is the infection to look out for.