ACR, National Psoriasis Foundation release draft clinical guideline for psoriatic arthritis
SAN DIEGO — The American College of Rheumatology and the National Psoriasis Foundation have presented draft recommendations to be included in their new clinical guideline for the treatment of psoriatic arthritis, which is expected to be published in early 2018.
“In partnership with the [National Psoriasis Foundation (NPF)], the ACR started the process of developing a new treatment guideline for the management of psoriatic arthritis that includes both pharmacologic and nonpharmacologic interventions,” Jasvinder Singh, MD, MPH, a professor at the University of Alabama at Birmingham and the guideline’s principal investigator and voting panel leader, said at the American College of Rheumatology Annual Meeting.
“The management includes people with active psoriatic arthritis, focuses on specific manifestations of active psoriatic arthritis, and addresses the management of patients with active psoriatic arthritis with certain comorbidities — in particular, diabetes and recurrent serious infections,” Singh continued. “It also covers the issue of treatment target and vaccinations, particularly the use of killed or live vaccinations.”
According to Singh, highlights of the new treatment guideline include:
- A recommendation for a treat-to-target strategy, as well as biologic treatment followed by killed vaccines;
- Physicians should delay the start of a biologic if the patient requires a live-attenuated vaccine;
- Regarding treatment-naïve active psoriatic arthritis, physicians should start a TNF inhibitor, rather than an oral small molecule drug (OSM), IL-17 inhibitor, IL-12 inhibitor, or IL-23 inhibitor;
- A conditional recommendation that patients with active psoriatic arthritis, despite OSM therapy, should be switched to a TNF inhibitor rather than to another OSM or any other type of biologic;
- A conditional recommendation that patients with active psoriatic arthritis spondylitis and axial disease, despite treatment with NSAIDs, should be switched to a TNF inhibitor rather than to another biologic; and
- A strong recommendation to promote smoking cessation among patients with psoriatic arthritis.
The guideline’s development team used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to develop the recommendations, according to the ACR.
According to Singh, the vast majority of the guideline’s recommendations are conditional, due to the lack of high-quality evidence. He added that most of the treatment guidelines rely on very low- to moderate-quality evidence.
“This means there needs to be a very active discussion between the physician and the patient with regard to which treatment to choose,” Singh said. “Of course, when you are not choosing the first, more preferred treatment, there are defined conditions regarding when the secondary treatment may be preferred.”
Disclosure: Singh reports income from Bioiberica, Horizon Pharmaceuticals/DINORA, Takeda Pharmaceuticals, WebMD, UBM LLC, Crealta/DINORA and the American College of Rheumatology; Gladman reports income from Amgen, Abbvie, BMS, Celgene, Novartis, Pfizer, UCB, Eli Lilly and Janssen; and Ogdie reports income from Novartis, GRAPPA-SPARTAN, New York University, the National Psoriasis Foundation, MedNet and the Academy for Continued Health Care Learning.