Efficacy and safety of pharmacological treatment of psoriatic arthritis: a systematic literature research informing the 2023 update of the EULAR recommendations for the management of psoriatic arthritis

Objectives

To provide an updated overview of the efficacy and safety of pharmacological treatments for psoriatic arthritis (PsA).

Methods

This systematic literature review (SLR) evaluated the efficacy and safety of conventional synthetic (csDMARDs), biological (bDMARDs), and targeted synthetic (tsDMARDs) disease-modifying antirheumatic drugs in PsA patients. A search was conducted across Medline, EMBASE, and Cochrane CENTRAL databases to identify studies published between the previous update in 2019 and December 28, 2022. Efficacy was assessed through clinical trials, while safety data included both trial results and observational studies. Key safety outcomes of interest included infections (e.g., herpes zoster, influenza, tuberculosis), malignancies, major cardiovascular events, venous thromboembolisms, liver conditions, laboratory changes, and psychiatric effects. No meta-analyses were performed.

Results

Out of 3,946 articles screened for efficacy, 38 studies (30 clinical trials) were included. Investigated treatments covered:

- csDMARDs: leflunomide, methotrexate

- bDMARDs targeting:

- IL-17: bimekizumab, brodalumab, ixekizumab, izokibep, secukinumab

- IL-23: guselkumab, risankizumab, tildrakizumab

- IL-12/23: ustekinumab

- TNF: adalimumab, certolizumab-pegol, etanercept, infliximab, golimumab

- JAK inhibitors (JAKi): brepocitinib, deucravacitinib, tofacitinib, upadacitinib

These treatments were shown to effectively reduce PsA symptoms, improve physical function, and enhance quality of life.

For safety, 2,055 abstracts were reviewed, with 24 studies included (15 observational studies and 9 long-term trial follow-ups). The safety review focused on glucocorticoids, TNFi, IL-17i, JAKi, IL-12/23i, and PDE4i (apremilast). Overall, the safety findings were consistent with the 2019 SLR.

Conclusion

This SLR informed the task force responsible for the 2023 update of the European Alliance of Associations for Rheumatology (EULAR) recommendations for the pharmacological management of PsA.