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Despite advances, patients with PsA still have unmet needs
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DESTIN, Fla. — Despite a recent explosion of new and emerging medications, patients with psoriatic arthritis still have many unmet needs, including more personalized treatment and control over immunogenicity, according to Philip J. Mease, MD, of the University of Washington.
“There is an increasing smorgasbord of options that we have for treating PsA,” Mease told attendees at the 2019 Congress of Clinical Rheumatology. “First, the obvious thing to say is that this is a delightful time to be a PsA-ologist, because we have such a number of medicines that available to us to try in our patients.”
“We still don’t have the kind of immunophenotyping testing to pick out which is going to the most rational, first mechanism to use, but we have a number of treatment options that are highly effective for all the various clinical domains of PsA,” he added.
However, even as advancements and new studies continue to expand treatment options — including interluklen-17 and -23 inhibitors, JAK inhibitors, TNF inhibitors and others — much more needs to be done to improve patient care, Mease said.
According to Mease, patients need more personalized treatment and immunophenotyping, which would allow providers to determine the best treatments for specific individuals.
“I think we need biomarkers in PsA — we need it for diagnosis, we need it for disease severity monitoring,” Mease said. “Also, we need immunophenotyping to know who is going to respond best to what therapy. However, the challenge here would be the multiple different clinical domains, and the fact that there might be, even in the same individual, different responses in those domains.”
In addition, he added that physicians should work toward the goal of stopping or aborting PsA before it even starts in select patients with psoriasis.
“There is a strong question out there: Can we head off PsA at the pass?” Mease said. “Can this be done through more affective and aggressive treatment of psoriasis? Most patients will have psoriasis long before they develop PsA.”
According to Mease, rheumatologists should also work to “break through the limits of the 60/40/20 response,” which is encountered in virtually all clinical trials, as well as gain greater control of immunogenicity in patients.
“We’re seeing some of that now,” he said. “I also think that some of that is going to come with playing with combination therapies in the future.” – by Jason Laday
Reference:
Mease PJ. New treatments in psoriatic arthritis. Presented at: Congress of Clinical Rheumatology; May 2-5, 2019; Destin, Fla.
Disclosure: Mease reports grants, consulting fees and/or speaking fees from AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly, Galapagos, Genentech, Gilead, Janssen, Novartis, Pfizer, SUN and UCB.