Non-anti-TNF Biologics in Psoriatic Arthritis at EULAR 2011

P. Mease stated, that “there remains an unmet medical need for effective therapies for patients who do not benefit from TNFi initially, lose response over time, or have adverse effects, even with trials of multiple TNFi agents and traditional oral DMARDs.” He included co-stimulatory blockade agents which modulate T cell activity, B cell depletion, other targets than TNF, “such as IL-12/23, IL-17, IL-6, and the multiple cytokines inhibited by the JAK inhibitors or the phosphodiesterase 4 (PDE4) inhibitor, apremilast”.


I had already blogged on F. van den Bosch, who discussed „how to treat psoriatic arthritis?” Upon failure of methotrexate as a “therapeutic option, approved anti-TNF agents, such as etanercept, adalimumab, infliximab and golimumab, have been shown to improve dramatically the outcomes for patients, often tackling both the rheumatological and the dermatological aspects of the disease.” He didn'd mention leflunomide and cyclosporin A, though. But new agents have been studied or are in development for psoriatic arthritis: abatacept, ustekinumab, and secukinumab as well as small oral molecules (protein kinase inhibitors) such as apremilast or tofacitinib.
http://rheumatologe.blogspot.de/2012/07/ustekinumab-and-other-options-in.html.

My idea has been to look at the data presented at the Eular 2012.

Abatacept – no study on psoriatic arthritis.

Alefacept – no study on psoriatic arthritis.

Apremilast – no study on psoriatic arthritis.

Rituximab – 159 studies and no study on psoriatic arthritis. There has been a case report: http://www.ncbi.nlm.nih.gov/pubmed/18854517. And a report “on onset of psoriasis with psoriatic arthropathy during rituximab treatment of non-Hodgkin lymphoma”: http://www.ncbi.nlm.nih.gov/pubmed/18556453.

Secukinumab – no study on psoriatic arthritis.

Tofacitinib – no study on psoriatic arthritis.

Ustekinumab – look at http://rheumatologe.blogspot.de/2012/07/ustekinumab-and-other-options-in.html


Does this look promising? There remains quite a lot of research to be done. The only drug that might come to market within reasonable time is ustekinumab. Let’s wait and see…