Treatment with Targeted Therapy in Patients with Psoriatic Arthritis and Inadequate Response to Methotrexate: Proposal for a Rational Strategy.

IF 2.9 3区医学 Q2 RHEUMATOLOGY

Rheumatology and Therapy Pub Date : 2024-10-01 Epub Date: 2024-08-12 DOI:10.1007/s40744-024-00704-y

Philippe Goupille, Guillermo Carvajal Alegria, Frank Verhoeven, Daniel Wendling

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Abstract

Introduction: The therapeutic arsenal for psoriatic arthritis (PsA) is gradually being expanded, but the use of these targeted treatments must be optimal. Our objective was to guide the choice of targeted therapy to use as first-line treatment in a patient with PsA in whom methotrexate (MTX) has failed.

Methods: We searched for literature data in PubMed with the appropriate keywords for the six points of our argument: (1) the tolerance of MTX; (2) the efficacy of targeted therapies combined with MTX vs monotherapy; (3) immunogenicity of anti-tumor necrosis alpha (TNFα) monoclonal antibodies (mAbs); (4) immunogenicity of anti-interleukin (IL)-17, anti-IL-12/23, and anti-IL-23 mAbs; (5) the therapeutic maintenance of anti-TNFα mAbs when combined or not with MTX; (6) the therapeutic maintenance of anti-IL-17 vs anti-TNFα mAbs as first-line targeted therapy.

Results: The proposed rational strategy is as follows: in case of initiation of an anti-TNFα agent, maintaining treatment with MTX seems preferable, even in the absence of evidence of the superior efficacy of the combination, to avoid immunization and reduced therapeutic maintenance; in case of initiation of anti-IL-17, anti-IL-12/23, anti-IL-23 agents, or Janus kinase (JAK) inhibitors, again in the absence of evidence of the superior efficacy of the combination, discontinuing MTX therapy may be possible, at least in two steps, after verifying the efficacy of the targeted therapy initiated on the joints and skin.

Conclusion: We have data from the literature to guide the choice of targeted therapy to use as first-line treatment in a patient with PsA in whom MTX has failed.

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对甲氨蝶呤反应不佳的银屑病关节炎患者进行靶向治疗：合理策略建议。

导言：银屑病关节炎（PsA）的治疗手段正逐渐增多，但这些靶向治疗的使用必须达到最佳效果。我们的目的是为甲氨蝶呤（MTX）治疗失败的 PsA 患者选择靶向疗法作为一线治疗提供指导：我们在 PubMed 上以适当的关键词搜索了与我们的论点有关的六点文献数据：(1) MTX 的耐受性；(2) 靶向疗法与 MTX 联合治疗与单药治疗的疗效；(3) 抗肿瘤坏死α（TNFα）单克隆抗体（mAbs）的免疫原性；(4) 抗白细胞介素（IL）-17、抗IL-12/23和抗IL-23 mAbs的免疫原性；(5) 抗肿瘤坏死因子α mAbs与MTX联合或不联合的治疗维持效果；(6) 抗IL-17与抗肿瘤坏死因子α mAbs作为一线靶向治疗的治疗维持效果。结果：提出的合理策略如下：在开始使用抗肿瘤坏死因子α药物的情况下，即使没有证据表明联合用药具有更好的疗效，也应继续使用 MTX 治疗，以避免免疫和减少治疗维持时间；如果开始使用抗-IL-17、抗-IL-12/23、抗-IL-23 药物或 Janus 激酶（JAK）抑制剂，同样在没有证据表明联合用药疗效更佳的情况下，也可以停止 MTX 治疗，至少分两步进行，先验证关节和皮肤靶向治疗的疗效。结论我们从文献中获得了一些数据，可用于指导MTX治疗失败的PsA患者选择哪种靶向疗法作为一线治疗。

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来源期刊

Rheumatology and Therapy RHEUMATOLOGY-

CiteScore

6.00

自引率

5.30%

发文量

审稿时长

6 weeks

期刊介绍： Aims and Scope Rheumatology and Therapy is an international, open access, peer reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world and health outcomes research around the discovery, development, and use of rheumatologic therapies. Studies relating to diagnosis, pharmacoeconomics, public health, quality of life, and patient care, management, and education are also welcomed. Areas of focus include, but are not limited to, rheumatoid arthritis, gout, gouty arthritis, psoriatic arthritis, osteoarthritis, juvenile idiopathic/rheumatoid arthritis, systemic lupus erythematosus, axial spondyloarthritis, Pompe’s disease, inflammatory joint conditions, musculoskeletal conditions, systemic sclerosis, and fibromyalgia. The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, case reports, trial protocols, communications and letters. The journal is read by a global audience and receives submissions from all over the world. Rheumatology and Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research. Ethics and Disclosures The journal is a member of the Committee on Publication Ethics (COPE) and subscribes to its principles on how to deal with acts of misconduct thereby committing to investigate allegations of misconduct in order to ensure the integrity of research. Content in this journal is peer-reviewed (Single-blind). 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