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Research Review - Final – Jun. 1, 2012
Drug Therapy for Psoriatic Arthritis in Adults: Update of a 2007 Report
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Notice of Erratum: Tables 2, 3, and 4 were corrected in June 2012.
Archived: This report is greater than 3 years old. Findings may be used for research purposes, but should not be considered current.
To compare the benefits and harms of corticosteroids and oral and biologic disease-modifying antirheumatic drugs (DMARDs) for adults with psoriatic arthritis (PsA).
English language articles from 1980 to February 2011 identified through PubMed, Embase, Cochrane Library and International Pharmaceutical Abstracts; unpublished literature including dossiers from pharmaceutical companies.
Two people independently selected relevant head-to-head trials of any sample size, observational studies with at least 100 participants, and relevant good- or fair-quality meta-analyses that compared benefits or harms of 14 drug therapies. Observational studies were included only for harms. For biologic DMARDs, placebo-controlled, double-blind randomized controlled trials (RCTs) also were included. We required trials and observational studies to be at least 12 weeks in duration. Literature was synthesized qualitatively within and between the two main drug classes (oral and biologic DMARDs).
No head-to-head controlled trials meeting inclusion criteria existed for any drugs in this review for treating patients with PsA. The available evidence was limited to two head-to-head cohort studies and placebo-controlled trials. For oral DMARDs, including sulfasalazine and methotrexate, the sparse data available involved placebo comparisons. For biologic DMARDs, evidence supported the efficacy of adalimumab, etanercept, golimumab, and infliximab for the treatment of PsA when compared with placebo. Qualitatively, these biologic DMARDs appeared to achieve similar improvements in disease activity, functional capacity, and health-related quality of life (American College of Rheumatology 20 percent improvement from baseline to endpoint, Health Assessment Questionnaire, and Short Form 36 Physical Component scores) in these trials. No difference in treatment response was found between the combination of an anti-tumor necrosis factor (TNF) (adalimumab, etanercept, or infliximab) with methotrexate compared with anti-TNF only. Evidence was insufficient to draw conclusions about the comparative harms for oral DMARDs. Among biologics, low evidence indicated that etanercept had a lower rate of withdrawals due to adverse events compared with infliximab. Compared with placebo, adalimumab and etanercept had more injection site reactions and adalimumab had few events of aggravated psoriasis. No comparative evidence was identified for subgroups.
Overall, the data are quite limited and the evidence is insufficient to draw firm conclusions on comparative efficacy, effectiveness, and harms of either oral or biologic DMARDs for PsA. This report's findings did not reveal any differences with current standard of care. Head-to-head (RCTs) are needed to establish the comparative efficacy and safety of different treatments with and without corticosteroids, oral DMARDs, and biologic DMARDs, to determine the best therapy to prevent or minimize debilitating joint damage and optimize quality of life for people with PsA.