Patients’ priorities, individual burden should guide psoriatic arthritis treatment
Click Here to Manage Email Alerts
SCOTTSDALE, Ariz. — Understanding patients’ disease burden and priorities can help rheumatologists choose the best therapy for psoriatic arthritis, noted a speaker at the Basic and Clinical Immunology for the Busy Clinician symposium.
According to M. Elaine Husni, MD, MPH, of the Cleveland Clinic, in a medical landscape with many potential therapies, including TNF inhibitors, interleukin-17, IL-23 and Janus kinase (JAK) inhibitors, considering case specifics is more important than ever.
“In many of the diseases we treat, we really look at joints and disease burden, but here I feel that there are patients that come in with mild disease — mild psoriasis, mild joints — and we can treat them without a biologic,” Husni told attendees in a hybrid presentation. “And then, I see people that are really severe — severe joints, severe psoriasis — and we really then push the envelope, and we are trying many different biologics because they are recalcitrant or refractory.”
In the middle of these two extremes, Husni said, patients may present with mild joint involvement and severe skin involvement, or vice-versa.
“How I think about these overarching principles, how I think about what we should do with these patients, is I look at their disease burden, I look at the concept of treat-to-target, and then the guidelines,” Husni said.
No matter the burden, each factor needs to be taken into account in order to select the optimal treatment for the patient and situation. Decisions get “trickier,” Husni said, when patients demonstrate greater skin involvement in addition to joint involvement.
If patients fail to respond well to one TNF inhibitor, it is not recommended for them to attempt therapy with another drug in the same class, according to Husni.
“There is also some concern about some real-world data showing diminished drug persistence with each successive TNF,” she said. “The point of this is just to remind us that it is not just the question of whether or not TNF should be the standard of care for psoriatic arthritis, but to really understand some of the subgroups and what is really bothering the patient.”
Additionally, various comorbidities can impact the class of therapy rheumatologists choose for their patients.
Potential therapies Husni recommended rheumatologists consider when treating patients with PsA include IL-17 inhibitors, such as secukinumab (Cosentyx, Novartis), and IL-23 inhibitors, such as guselkumab (Tremfya, Janssen).
“Hopefully I have been able to get you excited about all of the different medicines that are now available and still coming pretty fast,” Husni said. “Hopefully highlighting the different manifestations, comorbidities and severity of skin versus joints will help you think about individualized treatment plans for our patients.”
Collapse
Husni E. PsA – is TNF still the standard of care? Presented at Basic and Clinical Immunology for the Busy Clinician, Feb. 25-26, 2023; Scottsdale, Arizona (hybrid meeting).
Click Here to Manage Email Alerts