A systematic literature review of drug therapies for the treatment of psoriatic arthritis: current evidence and meta-analysis informing the EULAR recommendations for the management of psoriatic arthritis
- Zoe Ash1,2,
- Cécile Gaujoux-Viala3,
- Laure Gossec4,
- Elizabeth MA Hensor1,2,
- Oliver FitzGerald5,
- Kevin Winthrop6,
- Désirée van der Heijde7,
- Paul Emery1,2,
- Josef S Smolen8,9,
- Helena Marzo-Ortega1,2
- 1Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK
- 2Leeds NIHR Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- 3Pierre et Marie Curie University-Paris VI, APHP, Rheumatology, Pitié-Salpétrière Hospital, Paris, France
- 4Paris Descartes University, Medicine Faculty, APHP, Rheumatology B Department, Cochin Hospital, Paris, France
- 5Department of Rheumatology, St Vincent's University Hospital and Conway Institute, University College Dublin, Ireland
- 6Department of Infectious Diseases, Public Health and Preventive Medicine, Oregon Health and Science University, Portland, Oregon, USA
- 7Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- 8Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- 92nd Department of Medicine, Hietzing Hospital, Vienna, Austria
- Correspondence to Helena Marzo-Ortega, Section of Musculoskeletal Disease, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK;
- Received 27 January 2011
- Accepted 23 June 2011
- Published Online First 28 July 2011
Objectives To review the available evidence for the efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs), synthetic and biological drug therapies for the different clinical manifestations of psoriatic arthritis (PsA) in order to provide data for the development of treatment recommendations by the European League Against Rheumatism (EULAR) taskforce.
Methods A systematic literature review (SLR) of available treatments for PsA was performed using the largest electronic databases (MEDLINE, EMBASE and COCHRANE) by two working groups formed within the EULAR taskforce. This comprised a comprehensive sample of rheumatologists, dermatologists, epidemiologists and patients. The available evidence was reviewed for NSAIDs, synthetic disease modifying antirheumatic drugs (DMARDs), local and systemic corticosteroids and biologic drugs. All articles and abstracts published between 1962 and January 2010 were reviewed and considered and a meta-analysis of data on biological therapies was performed.
Results While little data are available on NSAIDs, glucocorticoids and synthetic DMARDs, the available evidence suggests an acceptable efficacy and safety profile of both NSAIDs and synthetic DMARDs (methotrexate, cyclosporine A, sulfasalazine and leflunomide) in PsA. More evidence is available (level 1B) supporting the efficacy of anti-tumour necrosis factor (anti-TNF) agents (adalimumab, etanercept, golimumab and infliximab) in treating the signs and symptoms of PsA as well as reducing radiographic progression. Registry data show no new safety concerns, although the numbers studied to date are relatively small.
Conclusions This SLR reveals some evidence to support the use of NSAIDs and synthetic DMARDs and good evidence for the efficacy of anti-TNF therapy in PsA.
ZA and CG-V have contributed equally to the study (joint first authors).
See the EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies by Gossec L et al in the January issue (Ann Rheum Dis 2012;71:4–12.)
Competing interests ZA has received an unrestricted educational grant from MSD, and speaking fees and conference expenses from Abbott, Chugai, MSD and Pfizer. LG has received speaking fees from Abbott, BMS, Chugai, MSD, Pfizer, Roche, Schering Plough, and UCB. OF receives grant support from Abbott and BMS, is on an international advisory board for UCB and also gives lectures at pharmaceutical sponsored meetings for Abbott, Pfizer, Amgen and UCB. KW has received consulting fees from Genentech and Amgen. DvdH has received consulting fees and/or research grants from Abbott, Amgen, AstraZeneca, BMS, Centocor, Chugai, Eli-Lilly, GSK, Merck, Novartis, Osuka, Pfizer, Roche, Sanofi-Aventis, Schering-Plough, UCB and Wyeth. PE has undertaken clinical trials and provided expert advice for Merck, Pfizer, Abbott, UCB Roche and BMS. JSS has received consulting fees, speaking fees and/or grants from Abbott, BMS, Chugai, MSD, Pfizer, Roche and UCB. HMO has received speaking honoraria and/or consulting fees from Abbott, MSD and Pfizer. CG-V and EMAH have nothing to declare.
Provenance and peer review Not commissioned; externally peer reviewed.