Psoriatic arthritis (PsA) is a chronic inflammatory disease that affects joints and skin, leading to pain, swelling, and stiffness. The treatment of PsA has evolved significantly in recent years, with the introduction of new therapies that target specific pathways involved in the pathogenesis of the disease. A recent journal publication has provided valuable insights into the treatment of PsA, highlighting the efficacy and safety of these novel therapies.
Efficacy and Safety of Apremilast in Psoriatic Arthritis: A study published in Annals of the Rheumatic Diseases evaluated the efficacy and safety of apremilast, an oral phosphodiesterase 4 inhibitor, in patients with psoriatic arthritis. The study found that apremilast was effective in reducing the signs and symptoms of psoriatic arthritis and improving physical function, with a favorable safety profile.
Apremilast is a relatively new medication that was approved by the U.S. Food and Drug Administration (FDA) in 2014 for the treatment of psoriatic arthritis and later for moderate to severe plaque psoriasis. It was developed as a novel small molecule inhibitor of phosphodiesterase 4 (PDE4) and has shown efficacy in reducing inflammation and improving symptoms in patients with these conditions.
Apremilast is orally administered and is rapidly absorbed, with peak plasma concentrations reached within 2 hours after administration. It is extensively metabolized in the liver and primarily eliminated through the urine. Apremilast has a half-life of approximately 6 to 9 hours, allowing for twice-daily dosing.
Apremilast works by inhibiting the enzyme phosphodiesterase 4 (PDE4), which is involved in the breakdown of cyclic adenosine monophosphate (cAMP). By inhibiting PDE4, apremilast increases intracellular levels of cAMP, which in turn leads to downregulation of pro-inflammatory cytokines such as tumor necrosis factor-alpha (TNF-alpha), interleukin-17 (IL-17), and interleukin-23 (IL-23). This anti-inflammatory effect helps reduce the symptoms of psoriatic arthritis and plaque psoriasis.
Apremilast is indicated for the treatment of adult patients with active psoriatic arthritis and for the treatment of moderate to severe plaque psoriasis in patients who are candidates for phototherapy or systemic therapy. It is often used as a first-line treatment for these conditions or as an alternative for patients who have not responded to or cannot tolerate other therapies. Apremilast has been shown to reduce joint pain and swelling in patients with psoriatic arthritis and to improve skin clearance in patients with plaque psoriasis.
Long-term Outcomes of Biologic Therapy in Psoriatic Arthritis: A retrospective study published in Arthritis Research & Therapy assessed the long-term outcomes of biologic therapy in patients with psoriatic arthritis. The study found that biologic therapy was associated with sustained improvements in disease activity, physical function, and quality of life over a 5-year period. A systematic review and network meta-analysis published in Rheumatology compared the efficacy and safety of different biologic agents in the treatment of psoriatic arthritis. The study found that certain biologic agents, such as TNF inhibitors and IL-17 inhibitors, were more effective than others in reducing disease activity and improving physical function.
Tumor necrosis factor-alpha (TNF-alpha) inhibitors are a class of medications that were first introduced for the treatment of rheumatoid arthritis in the late 1990s. They revolutionized the treatment of inflammatory diseases by targeting a key cytokine involved in the inflammatory process.
TNF inhibitors are typically administered by subcutaneous injection or intravenous infusion. They have varying half-lives, ranging from a few days to a couple of weeks, depending on the specific medication. TNF inhibitors are metabolized in the liver and excreted mainly through the kidneys.
TNF inhibitors work by binding to and inhibiting the activity of TNF-alpha, a pro-inflammatory cytokine that plays a key role in the pathogenesis of inflammatory diseases such as rheumatoid arthritis, psoriatic arthritis, and inflammatory bowel disease. By blocking the action of TNF-alpha, these medications help reduce inflammation and alleviate symptoms.
TNF inhibitors are used for the treatment of several inflammatory diseases, including rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, plaque psoriasis, and inflammatory bowel disease (Crohn’s disease and ulcerative colitis). They are often prescribed for patients who have not responded to or cannot tolerate other treatments. TNF inhibitors have been shown to reduce joint inflammation, improve physical function, and slow the progression of joint damage in patients with these conditions.
IL-17 inhibitors are a relatively new class of medications that have been developed for the treatment of inflammatory diseases. The first IL-17 inhibitor, secukinumab, was approved by the U.S. Food and Drug Administration (FDA) in 2015 for the treatment of plaque psoriasis, psoriatic arthritis, and ankylosing spondylitis. Since then, other IL-17 inhibitors, such as ixekizumab and brodalumab, have also been approved for similar indications.
IL-17 inhibitors are typically administered by subcutaneous injection and have a relatively long half-life, ranging from 10 to 17 days, depending on the specific medication. They are metabolized in the liver and excreted primarily through the kidneys. IL-17 inhibitors are usually given as maintenance therapy, with dosing intervals ranging from once weekly to once every three months, depending on the medication and indication.
IL-17 inhibitors work by targeting interleukin-17 (IL-17), a pro-inflammatory cytokine that plays a key role in the pathogenesis of inflammatory diseases. By inhibiting the activity of IL-17, these medications help reduce inflammation and alleviate symptoms in patients with conditions such as psoriasis, psoriatic arthritis, and ankylosing spondylitis.
IL-17 inhibitors are used for the treatment of several inflammatory diseases, including plaque psoriasis, psoriatic arthritis, and ankylosing spondylitis. They are often prescribed for patients who have not responded to or cannot tolerate other treatments. IL-17 inhibitors have been shown to be effective in reducing skin symptoms in patients with psoriasis and improving joint symptoms in patients with psoriatic arthritis and ankylosing spondylitis.
Role of Janus Kinase Inhibitors in Psoriatic Arthritis: A review article published in Current Rheumatology Reports discussed the role of Janus kinase (JAK) inhibitors in the treatment of psoriatic arthritis. The article highlighted the efficacy and safety of JAK inhibitors in psoriatic arthritis and their potential role as a treatment option for patients who do not respond to conventional therapies.
Janus kinase (JAK) inhibitors are a relatively new class of medications that have been developed for the treatment of inflammatory diseases. The first JAK inhibitor, tofacitinib, was approved by the U.S. Food and Drug Administration (FDA) in 2012 for the treatment of rheumatoid arthritis. Since then, other JAK inhibitors, such as baricitinib and upadacitinib, have been approved for similar indications.
JAK inhibitors are orally administered and are rapidly absorbed, with peak plasma concentrations reached within 1 to 2 hours after administration. They have relatively short half-lives, ranging from 3 to 12 hours, depending on the specific medication. JAK inhibitors are metabolized in the liver and excreted primarily through the urine.
JAK inhibitors work by inhibiting the activity of Janus kinases, which are enzymes that play a key role in the signaling pathways of cytokines involved in inflammation. By blocking the action of JAK enzymes, these medications help reduce inflammation and alleviate symptoms in patients with inflammatory diseases such as rheumatoid arthritis, psoriatic arthritis, and ulcerative colitis.
JAK inhibitors are used for the treatment of several inflammatory diseases, including rheumatoid arthritis, psoriatic arthritis, and ulcerative colitis. They are often prescribed for patients who have not responded to or cannot tolerate other treatments. JAK inhibitors have been shown to be effective in reducing joint inflammation and improving physical function in patients with these conditions.
These recent publications highlight the evolving landscape of treatment options for psoriatic arthritis, including the use of biologic agents, lifestyle interventions, and novel therapeutic approaches such as JAK inhibitors. Further research is needed to continue improving outcomes for patients with psoriatic arthritis.
Reference:
- Papp K, Reich K, Leonardi CL, et al. Apremilast, an oral phosphodiesterase 4 (PDE4) inhibitor, in patients with moderate to severe plaque psoriasis: Results of a phase III, randomized, controlled trial (Efficacy and Safety Trial Evaluating the Effects of Apremilast in Psoriasis [ESTEEM] 1). J Am Acad Dermatol. 2015;73(1):37-49. doi:10.1016/j.jaad.2015.05.005
- Kavanaugh A. TNF inhibitors: A new approach to the treatment of rheumatoid arthritis. Inflamm Res. 1998;47(Suppl 2):S66-S70. doi:10.1007/s000110050325
- Langley RG, Elewski BE, Lebwohl M, et al. Secukinumab in plaque psoriasis–results of two phase 3 trials. N Engl J Med. 2014;371(4):326-338. doi:10.1056/NEJMoa1314258
- Mease PJ, McInnes IB, Kirkham B, et al. Secukinumab Inhibition of Interleukin-17A in Patients with Psoriatic Arthritis. N Engl J Med. 2015;373(14):1329-1339. doi:10.1056/NEJMoa1412679
