1
|
Abedalweli R, Nguyen M, Deodhar A. Combination biologics or targeted synthetic disease-modifying anti-rheumatic drugs in the treatment of spondyloarthritis: a systematic literature review. Expert Rev Clin Immunol 2024:1-9. [PMID: 38512065 DOI: 10.1080/1744666x.2024.2327589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 02/23/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION The advent of biologic and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) have transformed the management of immune-mediated rheumatic diseases, including spondylarthritis (SpA). However, the data about combining b/ts DMARDs in the treatment of SpA are scarce. The study objectives were to assess the efficacy and safety of combination b/tsDMARD in SpA. METHODS We conducted systematic literature review (PubMed and Medline) with two independent reviewers, one adjudicator, exploring the efficacy and safety of combination b/tsDMARDs in the treatment of SpA. Inclusion criteria were studies published in last 20 years, English language, interventions included use of two b/tsDMARDs, and minimal three-month follow-up. RESULTS Out of 1936 initial hits, 28 manuscripts fulfilled the inclusion criteria. Two were randomized controlled trials, and the remaining were retrospective cohort studies or case series. Combination of apremilast with bDMARD, or TNF inhibitor plus IL12/23 inhibitor were the commonest and reported good efficacy with no increased safety signal. CONCLUSIONS There is not enough data to fully evaluate efficacy and safety of combination b/tsDMARDs in SpA treatment. Limited information shows apremilast plus bDMARD, or TNF inhibitor plus IL12/23 inhibitor combination to be efficacious and safe. Randomized controlled trials and larger cohort with a longer follow-up are required.
Collapse
Affiliation(s)
- Rand Abedalweli
- Department of Medicine, Oregon Health & Science University/Hillsboro Medical Center, Portland, OR, USA
| | - Michelle Nguyen
- Department of Medicine, Providence St. Vincent Hospital, Portland, OR, USA
| | - Atul Deodhar
- Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|
2
|
Sfikakis PP, Vassilopoulos D, Katsifis G, Vosvotekas G, Dimitroulas T, Sidiropoulos P, Vounotrypidis P, Bogdanos DP, Georgountzos AΙ, Bounas AG, Georgiou P, Gazi S, Kataxaki E, Liossis SN, Theodorou E, Papagoras C, Theotikos E, Vlachoyiannopoulos P, Voulgari PV, Kekki A, Antonakopoulos N, Boumpas DT. Apremilast for biologic-naïve, peripheral psoriatic arthritis, including patients with early disease: results from the APROACH observational prospective study. Rheumatol Int 2023; 43:889-902. [PMID: 36856816 PMCID: PMC10073163 DOI: 10.1007/s00296-022-05269-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/29/2022] [Indexed: 03/02/2023]
Abstract
To evaluate the effect of the phosphodiesterase 4 inhibitor apremilast in biologic-naïve patients with early peripheral PsA in terms of disease activity, clinical manifestations, patient-perceived outcomes, as well as apremilast's safety profile in routine care settings of Greece. Non-interventional, multicenter, 52-week prospective cohort study, enrolling biologic-naïve patients with early active peripheral PsA who started apremilast after intolerance or inadequate response (within the first 12 months of treatment) to an initial conventional synthetic (cs)DMARD treatment. Non-responder imputation was applied for missing data.In total, 167 consecutive patients (mean age: 52.5 years; median PsA duration: 0.9 years) were analyzed. At baseline, the median (interquartile range) clinical Disease Activity in Psoriatic Arthritis (cDAPSA) score was 22.0 (16.0-29.0), with 86.8% of patients having at least moderate (29.3% high) disease activity; 87.4% had skin psoriasis, 37.7% nail psoriasis, 30.7% enthesitis, and 12.4% dactylitis. At 16, 24, and 52 weeks, 28.7, 42.5, and 48.5% of patients, achieved ≥ 50% improvement in their baseline cDAPSA score, respectively. At week 52, 55.6, 50, and 26.8% of evaluable patients achieved complete resolution of enthesitis, dactylitis and nail psoriasis, respectively. Improvements were also observed in patient's health state assessed by the Psoriatic Arthritis Impact of Disease 12-item questionnaire, and health-related quality of life. The 52-week drug survival rate was 75%, while 13.8% of patients experienced at least one adverse drug reaction.Biologic-naïve patients with early PsA, treated with apremilast experienced significant improvements in disease activity, extra-articular manifestations and patient-centered outcomes, accompanied by a favorable tolerability profile.
Collapse
Affiliation(s)
- Petros P Sfikakis
- Department of Propedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, 17 Agiou Thoma Str., 115 27, Athens, Greece.
- Medical School, Joint Academic Rheumatology Program, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 115 27, Athens, Greece.
| | - Dimitrios Vassilopoulos
- Medical School, Joint Academic Rheumatology Program, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 115 27, Athens, Greece
- Department of Medicine and Clinical Immunology-Rheumatology Unit, Medical School, National and Kapodistrian University of Athens, 114 Vass. Sophias Ave., 115 27, Athens, Greece
| | - Gkikas Katsifis
- Naval Hospital of Athens, 70 Dinokratous Str., 115 21, Athens, Greece
| | - Georgios Vosvotekas
- Euromedica General Clinic of Thessaloniki, 11 Maria Kallas Str., 546 45, Thessaloniki, Greece
| | - Theodoros Dimitroulas
- Department of Internal Medicine, Medical School, Hippokration Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Str., 546 42, Thessaloniki, Greece
| | - Prodromos Sidiropoulos
- Rheumatology, Clinical Immunology and Allergy, Medical School, University of Crete, Voutes, Crete, 711 10, Heraklion, Greece
| | - Periklis Vounotrypidis
- Department of Rheumatology, 424 General Army Hospital, Nea Efkarpia, 564 29, Thessaloniki, Greece
| | - Dimitrios P Bogdanos
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Mezourlo, 411 10, Larissa, Greece
| | | | - Andreas G Bounas
- Olympion Private General Clinic of Patras, Volou & Meilichou Str., 264 43, Patras, Greece
| | - Panagiotis Georgiou
- Rheumatology Unit, Agios Andreas Hospital, 37 Kalavriton Str., 263 32, Patras, Greece
| | - Souzana Gazi
- Department of Rheumatology, KAT General Hospital of Attica, 2 Nikis Str., Kifissia, 145 61, Athens, Greece
| | - Evangelia Kataxaki
- Rheumatology Unit, Thriasio General Hospital of Elefsina, G. Gennimata Ave., 196 00, Magoula, Greece
| | - Stamatis-Nick Liossis
- Division of Rheumatology, Department of Internal Medicine, Medical School, Patras University Hospital, University of Patras, Rio Achaia, 265 04, Patras, Greece
| | - Evangelos Theodorou
- Rheumatology Clinic 251 Hellenic Air Force Hospital, 3 Panagioti Kanellopoulou Ave., 115 25, Athens, Greece
| | - Charalampos Papagoras
- First Department of Internal Medicine, Medical School, University Hospital of Alexandroupolis, Democritus University of Thrace, 681 00, Alexandroupolis, Greece
| | - Evangelos Theotikos
- Rheumatology Department, Asklepieion Voulas General Hospital, 1 Vasileos Pavlou Ave, 166 73, Athens, Greece
| | - Panayiotis Vlachoyiannopoulos
- Medical School, Joint Academic Rheumatology Program, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 115 27, Athens, Greece
- Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, 17 Agiou Thoma Str., 115 27, Athens, Greece
| | - Paraskevi V Voulgari
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 451 10, Ioannina, Greece
| | - Angeliki Kekki
- Genesis Pharma SA, Athens, 274 Kifissias Ave., 152 32, Halandri, Greece
| | | | - Dimitrios T Boumpas
- Medical School, Joint Academic Rheumatology Program, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 115 27, Athens, Greece
- Department of Internal Medicine, Medical School, "Attikon" University Hospital, Athens, National and Kapodistrian University of Athens, 1 Rimini Str., 124 62, Athens, Greece
| |
Collapse
|
3
|
Picchianti-Diamanti A, Spinelli FR, Rosado MM, Conti F, Laganà B. Inhibition of Phosphodiesterase-4 in Psoriatic Arthritis and Inflammatory Bowel Diseases. Int J Mol Sci 2021; 22:ijms22052638. [PMID: 33807944 PMCID: PMC7961737 DOI: 10.3390/ijms22052638] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 02/26/2021] [Accepted: 02/28/2021] [Indexed: 12/16/2022] Open
Abstract
Phosphodiesterases (PDEs) are a heterogeneous superfamily of enzymes which catalyze the degradation of the intracellular second messengers cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP). Among PDEs, PDE4 is the most widely studied and characterized isoenzyme. PDE4 blocking can lead to increased levels of intracellular cAMP, which results in down-regulation of inflammatory responses by reducing the expression of tumor necrosis factor (TNF), interleukin (IL)-23, IL-17, interferon-γ, while increasing regulatory cytokines, such as IL-10. Therefore, PDE4 has been explored as a therapeutic target for the treatment of different chronic inflammatory conditions such as psoriatic arthritis (PsA) and inflammatory bowel disease (IBD). PsA shares clinical, genetic, and pathogenic features with IBD such as ulcerative colitis (UC) and Crohn’s disease (CD), and enteropathic spondyloarthritis (eSpA) represent a frequent clinical evidence of the overlap between gut and joint diseases. Current therapeutic options in PsA patients and underlying UC are limited to synthetic immunosuppressants and anti-TNF. Apremilast is an oral PDE4 inhibitor approved for the treatment of active PsA patients with inadequate response to synthetic immunosuppressants. The efficacy and a good safety profile observed in randomized clinical trials with apremilast in PsA patients have been confirmed by few studies in a real-life scenario. In addition, apremilast led to significant improvement in clinical and endoscopic features in UC patients in a phase II RCT. By now there are no available data regarding its role in eSpA patients. In view of the above, the use of apremilast in eSpA patients is a route that deserves to be deepened.
Collapse
Affiliation(s)
- Andrea Picchianti-Diamanti
- Department of Clinical and Molecular Medicine, S. Andrea University Hospital, “Sapienza” University, 00189 Rome, Italy;
- Correspondence:
| | - Francesca Romana Spinelli
- Reumatologia, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, “Sapienza” Università di Roma, 00161 Rome, Italy; (F.R.S.); (F.C.)
| | | | - Fabrizio Conti
- Reumatologia, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, “Sapienza” Università di Roma, 00161 Rome, Italy; (F.R.S.); (F.C.)
| | - Bruno Laganà
- Department of Clinical and Molecular Medicine, S. Andrea University Hospital, “Sapienza” University, 00189 Rome, Italy;
| |
Collapse
|
4
|
Abstract
Psoriatic arthritis (PsA) is a seronegative inflammatory arthritis often observed in patients with skin psoriasis. Treatment of PsA, especially peripheral PsA, has typically relied on disease-modifying anti-rheumatic agents (DMARDs); however, these agents have limited efficacy and considerable associated toxicity. More recently, monoclonal antibodies (biologic agents) have revolutionized management of immune-mediated diseases; however, these therapies carry a high cost and require parenteral administration. Apremilast, a novel oral DMARD, was approved by the European Union for psoriatic arthritis in 2015. Apremilast inhibits the function of phosphodiesterase-4, a regulator of cyclic adenosine monophosphate, leading to a broad inhibition of proinflammatory mediators and subsequent reduction in tumour necrosis factor-alpha (TNF-α) response. The PALACE and ACTIVE trials, phase III randomized controlled trials for apremilast, showed that apremilast is effective at improving various clinical and patient-reported outcome measures for psoriatic arthritis in both DMARD-naïve and DMARD-experienced PsA patients. Efficacy was limited in patients with previous biologic DMARD failure and the overall efficacy of apremilast appears to be less than biologics agents, though no head-to-head trials exist comparing apremilast to biologic DMARDs. Apremilast is generally well tolerated, with short-lived gastrointestinal side effects being the most commonly reported adverse events. Guidelines suggest a trial of apremilast in patients who have failed traditional oral DMARDs and for whom, biologics are contraindicated. More studies directly comparing apremilast to conventional DMARDs and biologic DMARDs are needed and will be crucial in informing clinical and economic decisions about apremilast role in management of PsA.
Collapse
Affiliation(s)
- Vijay K Sandhu
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lihi Eder
- Division of Rheumatology, Women's College Hospital, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jensen Yeung
- Department of Medicine, University of Toronto, Toronto, ON, Canada - .,Division of Dermatology, Women's College Hospital, Toronto, ON, Canada.,Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Probity Medical Research Inc., Waterloo, ON, Canada
| |
Collapse
|