Pipeline Psoriatic Arthritis Therapies that Have Efficacy in Psoriasis

Arthur Kavanaugh, MD

 

There are many potential therapies currently under development for the treatment of psoriatic arthritis (PsA) and appear to fall under two categories: biologic agents and oral agents (kinase/enzyme inhibitors).

 

Th Cell Development

Th17 cells are elevated in PsA patients. One of the exciting areas of research now is that of additional subsets of Th cells. This is leading to the development of new products in the pipeline for inflammatory diseases such as PsA.

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Ustekinumab in PsA

This data was just presented a few months ago at the American College of Rheumatology looking at ACR scores and PASI scores both of which demonstrated improved response versus placebo.  It is important to keep in mind the effect of weight on therapeutic response as heavier patients experience a lower response in therapy. Obesity seems to be very proinflammatory and it effects how people are responding to their current therapies.

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What do we do with patients who have been on TNF inhibitors already and are not responding?

This group of patients is tough and demonstrates the need for more research.

 

Emerging Molecules Under Development for Psoriatic Arthritis
  • Secukinumab (IL-17a receptor)
  • Abatacept- (T cell inhibitor)
    • In PsA, you don’t see a great response, particularly in those who have been previously exposed to a TNF inhibitor
    • Tofacitinib
      • Quite effective and lots of data for the RA patients; Safety issues are of concern
    • Apremilast
      • Physicians want patients to do the best that they can on the drug
      • There are rather respectable results with apremilast
      • The skin response was significantly better than placebo, but not robust (about 20% at PASI 75)
      • Few discontinuations due to mild AEs
        • Laboratory parameters appeared rather normally. Lab tests probably won’t have to be done as a part of reevaluation.

 

 CZP in PsA

Data on certolizumab (CZP) (RAPID-PsA) was presented at ACR and rapid improvements in the signs and symptoms of PsA, as well as skin manifestations and nail disease of psoriasis, were observed among both CZP doses (200mg q2W/400 mg q2W). Similar ACR response rates with CZP were also seen in patients with and without prior anti-TNF exposure.

 Final Thoughts
  • Obesity is a major issue in PsA patients and encouraging patients to lose weight is important to therapeutic response
  • The biosimilar (CT-P13) will be coming soon and it seems to demonstrate similar efficacy, safety, and a PK similar to that of infliximab