What’s new and what’s next for biological and targeted synthetic treatments in psoriatic arthritis?

ABSTRACT

Introduction

Psoriatic arthritis (PsA) is a chronic arthritis typically associated with cutaneous psoriasis (PsO). Its pathogenesis is connected to an innate and acquired immune response, as well as genetic risk alleles. The extent of immunopathogenic mechanisms and the heterogenicity of clinical manifestation make the identification of patient-targeted therapies a critical issue, and the treatment decision challenging in patients’ management.

Areas covered

This review includes a brief overview of biological and small-molecule therapies, focusing on evidence from clinical trials and real-world data that support their use in PsA. We summarize novel and future possible therapeutic strategies, the importance that comorbidities have on selection of therapy and discuss the adverse event of each drug. Relevant papers for up to 1 August 2022 (trials, real-life studies, and reviews) regarding biologics and/or small molecules were summarized.

Expert opinion

In recent years, the treatment of PsA has been revolutionized by new targeted therapies, which offer the opportunity to perform a tailored-tail management, considering risk factors, comorbidities, and the different PsA phenotypes. Growing experience with these new agents allows novel treatment approaches that may improve clinical outcomes for PsA patients, in terms of remission/low disease activity and quality of life.

KEYWORDS:

• Psoriatic arthritis
• biological therapies
• targeted synthetic treatments
• treatment approach

Article highlights

• Currently, the management of PsA is mainly based on the phenotypic presentation of the patients.

• Nevertheless, treatment outcomes for both skin and joints, as well as associated comorbidities, are not achieved in a considerable number of patients, making it necessary to expand the available therapies at disposal.

• p40 IL-23i and IL-17Ai have been used for several years in PsA with good results, and promising data on safety and tolerability are emerging about the use of p19 IL-23i and inhibitors of other isoforms of IL-17, especially IL-17F.

• JAKi represent a class of small molecules capable of interfering at the intracellular level with signaling pathways and which offer the potential to modulate the activity of numerous cytokines implicated in the pathogenesis of PsA simultaneously.

• Among novel therapies, nanobodies seem the most intriguing ones in treating PsA patients.

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.