That is according to a presentation at the recent European Congress of Rheumatology (EULAR) annual meeting in Vienna, Austria.
The EULAR guidelines, which were published late last year in Annals of the Rheumatic Diseases, also stated that in patients with peripheral arthritis, rapid initiation of conventional synthetic disease-modifying antirheumatic drugs is recommended and methotrexate is the preferred medication.
“If the treatment target is not achieved with this strategy, a biological disease-modifying antirheumatic drug (bDMARD) should be initiated, without preference among modes of action,” the guidelines panel wrote. “Relevant skin psoriasis should orient towards bDMARDs targeting interleukin (IL)-23p40, IL-23p19, IL-17A and IL-17A/F inhibitors. In the case of predominant axial or entheseal disease, an algorithm is also proposed. Use of Janus kinase inhibitors is proposed primarily after bDMARD failure, taking relevant risk factors into account, or in case bDMARDs are not an appropriate choice.”
The authors cautioned that drug choices should be influenced by inflammatory bowel disease and uveitis, with monoclonal tumor necrosis factor inhibitors proposed.
The guidelines also address drug switches and tapering in sustained remission.
“These updated recommendations integrate all currently available drugs in a practical and progressive approach, which will be helpful in the pharmacological management of PsA,” according to the panel, which added, “New modes of action and more data on the efficacy and safety of existing drugs in psoriatic arthritis (PsA) required an update of the EULAR 2019 recommendations for the pharmacological treatment of PsA.”
Guideline development involved a systematic literature review and a consensus meeting of 36 international experts in April 2023. Levels of evidence and grades of recommendations were determined.
Background information in the article pointed out that PsA is a disease which has benefited from notable progress over recent years. “Concepts have evolved, such as very early diagnosis and pre-PsA, as well as defining treatment targets and applying a holistic approach to comorbidity management,” according to the authors. “Pharmacological options have extended, with the approval of new agents targeting various modes of action for PsA (as well as skin psoriasis).”
The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.
