An updated interpretation of 2019 EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies_Chinese Journal of Evidence-Based Medicine

Authors：

 LI Xiu , ZHANG Jihui , NIE Yingkun

Department of Rheumatology, the Second Affiliated Hospital of Harbin Medical University, Harbin 150086, P.R.China;

Corresponding author：

LI Xiu, Email: lili72710@126.com

Keywords：

Psoriatic arthritis; Guideline; Pharmacological therapies; Updated; Interpretation

DOI：

10.7507/1672-2531.202010062

Video：

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Psoriatic arthritis (PsA) is a disease with heterogeneous manifestations in patients who have manifest or latent psoriasis. It comprises both musculoskeletal and non-musculoskeletal manifestations. Active chronic PsA is often accompanied by cardiovascular, psychological and metabolic complications. Although the quantity of disease-modifying antirheumatic drugs (DMARDs) indicated for PsA has increased, clinicians still require some guidance in decision-making. Based on the latest evidence-based research results, the European League Against Rheumatism (EULAR) in 2019 developed the recommendations for the pharmacological management of PsA updated in 2015 with new recommendations. This paper interprets the update contents of the guideline to provide references for the clinical treatment of PsA.

Citation： LI Xiu, ZHANG Jihui, NIE Yingkun. An updated interpretation of 2019 EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies. Chinese Journal of Evidence-Based Medicine, 2021, 21(3): 260-265. doi: 10.7507/1672-2531.202010062 Copy

1.	Haroon M, Kirby B, FitzGerald O. High prevalence of psoriatic arthritis in patients with severe psoriasis with suboptimal performance of screening questionnaires. Ann Rheum Dis, 2013, 72(5): 736-740.
2.	Kerschbaumer A, Smolen JS, Dougados M, et al. Pharmacological treatment of psoriatic arthritis: a systematic literature research for the 2019 update of the EULAR recommendations for the management of psoriatic arthritis. Ann Rheum Dis, 2020, 79(6): 778-786.
3.	Ferguson LD, Siebert S, McInnes IB, et al. Cardiometabolic comorbidities in RA and PsA: lessons learned and future directions. Nat Rev Rheumatol, 2019, 15(8): 461-474.
4.	Gudu T, Gossec L. Quality of life in psoriatic arthritis. Expert Rev Clin Immunol, 2018, 14(5): 405-417.
5.	Orbai AM, de Wit M, Mease P, et al. International patient and physician consensus on a psoriatic arthritis core outcome set for clinical trials. Ann Rheum Dis, 2017, 76(4): 673-680.
6.	Kavanaugh A, Husni ME, Harrison DD, et al. Safety and efficacy of intravenous golimumab in patients with active psoriatic arthritis: results through week twenty-four of the GO-VIBRANT study. Arthritis Rheumatol, 2017, 69(11): 2151-2161.
7.	Mease PJ, van der Heijde D, Ritchlin CT, et al. Ixekizumab, an interleukin-17A specific monoclonal antibody, for the treatment of biologic-naive patients with active psoriatic arthritis: results from the 24-week randomised, double-blind, placebo-controlled and active (adalimumab)-controlled period of the phase III trial SPIRIT-P1. Ann Rheum Dis, 2017, 76(1): 79-87.
8.	Mease P, Coates LC, Helliwell PS, et al. Efficacy and safety of filgotinib, a selective Janus kinase 1 inhibitor, in patients with active psoriatic arthritis (EQUATOR): results from a randomised, placebo-controlled, phase 2 trial. Lancet, 2018, 392(10162): 2367-2377.
9.	Gossec L, Smolen JS, Ramiro S, et al. European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update. Ann Rheum Dis, 2016, 75(3): 499-510.
10.	Singh JA, Guyatt G, Ogdie A, et al. Special article: 2018 American College of Rheumatology/National Psoriasis Foundation guideline for the treatment of psoriatic arthritis. Arthritis Rheumatol, 2019, 71(1): 5-32.
11.	Gossec L, Baraliakos X, Kerschbaumer A, et al. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update. Ann Rheum Dis, 2020, 79(6): 700-712.
12.	van der Heijde D, Aletaha D, Carmona L, et al. 2014 Update of the EULAR standardised operating procedures for EULAR-endorsed recommendations. Ann Rheum Dis, 2015, 74(1): 8-13.
13.	Center for Evidence-Based Medicine. Oxford Centre for Evidence-Based Medicine: Levels of Evidence (March 2009). Available from: https://www.cebm.ox.ac.uk/resources/levels-of-evidence/oxford-centre-for-evidence-based-medicine-levels-of-evidence-march-2009.
14.	Mitulescu TC, Popescu C, Naie A, et al. Acute anterior uveitis and other extra-articular manifestations of spondyloarthritis. J Med Life, 2015, 8(3): 319-325.
15.	Peluso R, Iervolino S, Vitiello M, et al. Extra-articular manifestations in psoriatic arthritis patients. Clin Rheumatol, 2015, 34(4): 745-753.
16.	Siegel EL, Orbai AM, Ritchlin CT. Targeting extra-articular manifestations in PsA: a closer look at enthesitis and dactylitis. Curr Opin Rheumatol, 2015, 27(2): 111-117.
17.	Gorlier C, Orbai AM, Puyraimond-Zemmour D, et al. Comparing patient-perceived and physician-perceived remission and low disease activity in psoriatic arthritis: an analysis of 410 patients from 14 countries. Ann Rheum Dis, 2019, 78(2): 201-208.
18.	Gossec L, McGonagle D, Korotaeva T, et al. Minimal disease activity as a treatment target in psoriatic arthritis: a review of the literature. J Rheumatol, 2018, 45(1): 6-13.
19.	van der Heijde D, Ramiro S, Landewé R, et al. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis, 2017, 76(6): 978-991.
20.	Kalyoncu U, Bayindir Ö, Ferhat Öksüz M, et al. The Psoriatic Arthritis Registry of Turkey: results of a multicentre registry on 1081 patients. Rheumatology (Oxford), 2017, 56(2): 279-286.
21.	Mease PJ, Gladman DD, Collier DH, et al. Etanercept and methotrexate as monotherapy or in combination for psoriatic arthritis: primary results from a randomized, controlled phase III trial. Arthritis Rheumatol, 2019, 71(7): 1112-1124.
22.	Nash P, Kirkham B, Okada M, et al. Ixekizumab for the treatment of patients with active psoriatic arthritis and an inadequate response to tumour necrosis factor inhibitors: results from the 24-week randomised, double-blind, placebo-controlled period of the SPIRIT-P2 phase 3 trial. Lancet, 2017, 389(10086): 2317-2327.
23.	Mease PJ, Smolen JS, Behrens F, et al. A head-to-head comparison of the efficacy and safety of ixekizumab and adalimumab in biological-naïve patients with active psoriatic arthritis: 24-week results of a randomised, open-label, blinded-assessor trial. Ann Rheum Dis, 2020, 79(1): 123-131.
24.	Deodhar A, Gottlieb AB, Boehncke WH, et al. Efficacy and safety of guselkumab in patients with active psoriatic arthritis: a randomised, double-blind, placebo-controlled, phase 2 study. Lancet, 2018, 391(10136): 2213-2224.
25.	Mease PJ, Kellner H, Morita A, et al. OP0307 efficacy and safety of risankizumab, a selective IL-23p19 inhibitor, in patients with active psoriatic arthritis over 24 weeks: results from a phase 2 trial. Ann Rheum Dis, 2018, 77: 200-201.
26.	Blauvelt A, Papp KA, Griffiths CE, et al. Efficacy and safety of guselkumab, an anti-interleukin-23 monoclonal antibody, compared with adalimumab for the continuous treatment of patients with moderate to severe psoriasis: Results from the phase III, double-blinded, placebo- and active comparator-controlled VOYAGE 1 trial. J Am Acad Dermatol, 2017, 76(3): 405-417.
27.	Reich K, Armstrong AW, Foley P, et al. Efficacy and safety of guselkumab, an anti-interleukin-23 monoclonal antibody, compared with adalimumab for the treatment of patients with moderate to severe psoriasis with randomized withdrawal and retreatment: results from the phase III, double-blind, placebo- and active comparator-controlled VOYAGE 2 trial. J Am Acad Dermatol, 2017, 76(3): 418-431.
28.	Gordon KB, Strober B, Lebwohl M, et al. Efficacy and safety of risankizumab in moderate-to-severe plaque psoriasis (UltIMMa-1 and UltIMMa-2): results from two double-blind, randomised, placebo-controlled and ustekinumab-controlled phase 3 trials. Lancet, 2018, 392(10148): 650-661.
29.	Blauvelt A, Reich K, Tsai TF, et al. Secukinumab is superior to ustekinumab in clearing skin of subjects with moderate-to-severe plaque psoriasis up to 1 year: results from the CLEAR study. J Am Acad Dermatol, 2017, 76(1): 60-69.
30.	Papp KA, Blauvelt A, Bukhalo M, et al. Risankizumab versus ustekinumab for moderate-to-severe plaque psoriasis. N Engl J Med, 2017, 376(16): 1551-1560.
31.	Gladman D, Rigby W, Azevedo VF, et al. Tofacitinib for psoriatic arthritis in patients with an inadequate response to TNF inhibitors. N Engl J Med, 2017, 377(16): 1525-1536.
32.	European Medicines Agency. EMA confirms Xeljanz to be used with caution in patients at high risk of blood clots. Available from: https://www.ema.europa.eu/en/medicines/human/referrals/xeljanz.
33.	Wells AF, Edwards CJ, Kivitz AJ, et al. Apremilast monotherapy in DMARD-naive psoriatic arthritis patients: results of the randomized, placebo-controlled PALACE 4 trial. Rheumatology (Oxford), 2018, 57(7): 1253-1263.
34.	Nash P, Ohson K, Walsh J, et al. Early and sustained efficacy with apremilast monotherapy in biological-naïve patients with psoriatic arthritis: a phase IIIB, randomised controlled trial (ACTIVE). Ann Rheum Dis, 2018, 77(5): 690-698.
35.	ClinicalTrials. gov. Efficacy, safety, and tolerability study of apremilast to treat early Oligoarticular psoriatic arthritis. Available from: https://www.centerwatch.com/clinical-trials/listings/218468/efficacy-safety-and-tolerability-study-of-apremilast-to-treat-early-oligoarticular-psoriatic-arthritis/.
36.	Fan A, Pereira B, Tournadre A, et al. Frequency of concomitant fibromyalgia in rheumatic diseases: monocentric study of 691 patients. Semin Arthritis Rheum, 2017, 47(1): 129-132.
37.	Xenofon B, Laure G, Effie P, et al. Secukinumab in patients with psoriatic arthritis and axial manifestations: results from the double-blind, randomised, phase 3 MAXIMISE trial. Ann Rheum Dis, 2020. Available from: https://ard.bmj.com/content/early/2020/12/16/annrheumdis-2020-218808.
38.	Siebert S, Millar NL, McInnes IB. Why did IL-23p19 inhibition fail in AS: a tale of tissues, trials or translation? Ann Rheum Dis, 2019, 78(8): 1015-1018.
39.	Kristensen LE, Lie E, Jacobsson LT, et al. Effectiveness and feasibility associated with switching to a second or third TNF inhibitor in patients with psoriatic arthritis: a cohort study from Southern Sweden. J Rheumatol, 2016, 43(1): 81-87.
40.	Mease PJ, Gottlieb AB, van der Heijde D, et al. Efficacy and safety of abatacept, a T-cell modulator, in a randomised, double-blind, placebo-controlled, phase III study in psoriatic arthritis. Ann Rheum Dis, 2017, 76(9): 1550-1558.

1. Haroon M, Kirby B, FitzGerald O. High prevalence of psoriatic arthritis in patients with severe psoriasis with suboptimal performance of screening questionnaires. Ann Rheum Dis, 2013, 72(5): 736-740.
2. Kerschbaumer A, Smolen JS, Dougados M, et al. Pharmacological treatment of psoriatic arthritis: a systematic literature research for the 2019 update of the EULAR recommendations for the management of psoriatic arthritis. Ann Rheum Dis, 2020, 79(6): 778-786.
3. Ferguson LD, Siebert S, McInnes IB, et al. Cardiometabolic comorbidities in RA and PsA: lessons learned and future directions. Nat Rev Rheumatol, 2019, 15(8): 461-474.
4. Gudu T, Gossec L. Quality of life in psoriatic arthritis. Expert Rev Clin Immunol, 2018, 14(5): 405-417.
5. Orbai AM, de Wit M, Mease P, et al. International patient and physician consensus on a psoriatic arthritis core outcome set for clinical trials. Ann Rheum Dis, 2017, 76(4): 673-680.
6. Kavanaugh A, Husni ME, Harrison DD, et al. Safety and efficacy of intravenous golimumab in patients with active psoriatic arthritis: results through week twenty-four of the GO-VIBRANT study. Arthritis Rheumatol, 2017, 69(11): 2151-2161.
7. Mease PJ, van der Heijde D, Ritchlin CT, et al. Ixekizumab, an interleukin-17A specific monoclonal antibody, for the treatment of biologic-naive patients with active psoriatic arthritis: results from the 24-week randomised, double-blind, placebo-controlled and active (adalimumab)-controlled period of the phase III trial SPIRIT-P1. Ann Rheum Dis, 2017, 76(1): 79-87.
8. Mease P, Coates LC, Helliwell PS, et al. Efficacy and safety of filgotinib, a selective Janus kinase 1 inhibitor, in patients with active psoriatic arthritis (EQUATOR): results from a randomised, placebo-controlled, phase 2 trial. Lancet, 2018, 392(10162): 2367-2377.
9. Gossec L, Smolen JS, Ramiro S, et al. European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update. Ann Rheum Dis, 2016, 75(3): 499-510.
10. Singh JA, Guyatt G, Ogdie A, et al. Special article: 2018 American College of Rheumatology/National Psoriasis Foundation guideline for the treatment of psoriatic arthritis. Arthritis Rheumatol, 2019, 71(1): 5-32.
11. Gossec L, Baraliakos X, Kerschbaumer A, et al. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update. Ann Rheum Dis, 2020, 79(6): 700-712.
12. van der Heijde D, Aletaha D, Carmona L, et al. 2014 Update of the EULAR standardised operating procedures for EULAR-endorsed recommendations. Ann Rheum Dis, 2015, 74(1): 8-13.
13. Center for Evidence-Based Medicine. Oxford Centre for Evidence-Based Medicine: Levels of Evidence (March 2009). Available from: https://www.cebm.ox.ac.uk/resources/levels-of-evidence/oxford-centre-for-evidence-based-medicine-levels-of-evidence-march-2009.
14. Mitulescu TC, Popescu C, Naie A, et al. Acute anterior uveitis and other extra-articular manifestations of spondyloarthritis. J Med Life, 2015, 8(3): 319-325.
15. Peluso R, Iervolino S, Vitiello M, et al. Extra-articular manifestations in psoriatic arthritis patients. Clin Rheumatol, 2015, 34(4): 745-753.
16. Siegel EL, Orbai AM, Ritchlin CT. Targeting extra-articular manifestations in PsA: a closer look at enthesitis and dactylitis. Curr Opin Rheumatol, 2015, 27(2): 111-117.
17. Gorlier C, Orbai AM, Puyraimond-Zemmour D, et al. Comparing patient-perceived and physician-perceived remission and low disease activity in psoriatic arthritis: an analysis of 410 patients from 14 countries. Ann Rheum Dis, 2019, 78(2): 201-208.
18. Gossec L, McGonagle D, Korotaeva T, et al. Minimal disease activity as a treatment target in psoriatic arthritis: a review of the literature. J Rheumatol, 2018, 45(1): 6-13.
19. van der Heijde D, Ramiro S, Landewé R, et al. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis, 2017, 76(6): 978-991.
20. Kalyoncu U, Bayindir Ö, Ferhat Öksüz M, et al. The Psoriatic Arthritis Registry of Turkey: results of a multicentre registry on 1081 patients. Rheumatology (Oxford), 2017, 56(2): 279-286.
21. Mease PJ, Gladman DD, Collier DH, et al. Etanercept and methotrexate as monotherapy or in combination for psoriatic arthritis: primary results from a randomized, controlled phase III trial. Arthritis Rheumatol, 2019, 71(7): 1112-1124.
22. Nash P, Kirkham B, Okada M, et al. Ixekizumab for the treatment of patients with active psoriatic arthritis and an inadequate response to tumour necrosis factor inhibitors: results from the 24-week randomised, double-blind, placebo-controlled period of the SPIRIT-P2 phase 3 trial. Lancet, 2017, 389(10086): 2317-2327.
23. Mease PJ, Smolen JS, Behrens F, et al. A head-to-head comparison of the efficacy and safety of ixekizumab and adalimumab in biological-naïve patients with active psoriatic arthritis: 24-week results of a randomised, open-label, blinded-assessor trial. Ann Rheum Dis, 2020, 79(1): 123-131.
24. Deodhar A, Gottlieb AB, Boehncke WH, et al. Efficacy and safety of guselkumab in patients with active psoriatic arthritis: a randomised, double-blind, placebo-controlled, phase 2 study. Lancet, 2018, 391(10136): 2213-2224.
25. Mease PJ, Kellner H, Morita A, et al. OP0307 efficacy and safety of risankizumab, a selective IL-23p19 inhibitor, in patients with active psoriatic arthritis over 24 weeks: results from a phase 2 trial. Ann Rheum Dis, 2018, 77: 200-201.
26. Blauvelt A, Papp KA, Griffiths CE, et al. Efficacy and safety of guselkumab, an anti-interleukin-23 monoclonal antibody, compared with adalimumab for the continuous treatment of patients with moderate to severe psoriasis: Results from the phase III, double-blinded, placebo- and active comparator-controlled VOYAGE 1 trial. J Am Acad Dermatol, 2017, 76(3): 405-417.
27. Reich K, Armstrong AW, Foley P, et al. Efficacy and safety of guselkumab, an anti-interleukin-23 monoclonal antibody, compared with adalimumab for the treatment of patients with moderate to severe psoriasis with randomized withdrawal and retreatment: results from the phase III, double-blind, placebo- and active comparator-controlled VOYAGE 2 trial. J Am Acad Dermatol, 2017, 76(3): 418-431.
28. Gordon KB, Strober B, Lebwohl M, et al. Efficacy and safety of risankizumab in moderate-to-severe plaque psoriasis (UltIMMa-1 and UltIMMa-2): results from two double-blind, randomised, placebo-controlled and ustekinumab-controlled phase 3 trials. Lancet, 2018, 392(10148): 650-661.
29. Blauvelt A, Reich K, Tsai TF, et al. Secukinumab is superior to ustekinumab in clearing skin of subjects with moderate-to-severe plaque psoriasis up to 1 year: results from the CLEAR study. J Am Acad Dermatol, 2017, 76(1): 60-69.
30. Papp KA, Blauvelt A, Bukhalo M, et al. Risankizumab versus ustekinumab for moderate-to-severe plaque psoriasis. N Engl J Med, 2017, 376(16): 1551-1560.
31. Gladman D, Rigby W, Azevedo VF, et al. Tofacitinib for psoriatic arthritis in patients with an inadequate response to TNF inhibitors. N Engl J Med, 2017, 377(16): 1525-1536.
32. European Medicines Agency. EMA confirms Xeljanz to be used with caution in patients at high risk of blood clots. Available from: https://www.ema.europa.eu/en/medicines/human/referrals/xeljanz.
33. Wells AF, Edwards CJ, Kivitz AJ, et al. Apremilast monotherapy in DMARD-naive psoriatic arthritis patients: results of the randomized, placebo-controlled PALACE 4 trial. Rheumatology (Oxford), 2018, 57(7): 1253-1263.
34. Nash P, Ohson K, Walsh J, et al. Early and sustained efficacy with apremilast monotherapy in biological-naïve patients with psoriatic arthritis: a phase IIIB, randomised controlled trial (ACTIVE). Ann Rheum Dis, 2018, 77(5): 690-698.
35. ClinicalTrials. gov. Efficacy, safety, and tolerability study of apremilast to treat early Oligoarticular psoriatic arthritis. Available from: https://www.centerwatch.com/clinical-trials/listings/218468/efficacy-safety-and-tolerability-study-of-apremilast-to-treat-early-oligoarticular-psoriatic-arthritis/.
36. Fan A, Pereira B, Tournadre A, et al. Frequency of concomitant fibromyalgia in rheumatic diseases: monocentric study of 691 patients. Semin Arthritis Rheum, 2017, 47(1): 129-132.
37. Xenofon B, Laure G, Effie P, et al. Secukinumab in patients with psoriatic arthritis and axial manifestations: results from the double-blind, randomised, phase 3 MAXIMISE trial. Ann Rheum Dis, 2020. Available from: https://ard.bmj.com/content/early/2020/12/16/annrheumdis-2020-218808.
38. Siebert S, Millar NL, McInnes IB. Why did IL-23p19 inhibition fail in AS: a tale of tissues, trials or translation? Ann Rheum Dis, 2019, 78(8): 1015-1018.
39. Kristensen LE, Lie E, Jacobsson LT, et al. Effectiveness and feasibility associated with switching to a second or third TNF inhibitor in patients with psoriatic arthritis: a cohort study from Southern Sweden. J Rheumatol, 2016, 43(1): 81-87.
40. Mease PJ, Gottlieb AB, van der Heijde D, et al. Efficacy and safety of abatacept, a T-cell modulator, in a randomised, double-blind, placebo-controlled, phase III study in psoriatic arthritis. Ann Rheum Dis, 2017, 76(9): 1550-1558.

Chinese Journal of Evidence-Based Medicine

An updated interpretation of 2019 EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies

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