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Cover of Drug Therapy for Psoriatic Arthritis in Adults: Update of a 2007 Report

Drug Therapy for Psoriatic Arthritis in Adults: Update of a 2007 Report

Comparative Effectiveness Reviews, No. 54

Investigators: , MD, MPH, , MD, MPH, , PhD, , MD, , MD, MPH, , MPA, , MD, MPH, , MPH, , BS, , MA, , MA, , PhD, and , MSLS.

RTI International–University of North Carolina Evidence-based Practice Center
Rockville (MD): Agency for Healthcare Research and Quality (US); .
Report No.: 12-EHC024-EF

Structured Abstract

Objectives:

To compare the benefits and harms of corticosteroids and oral and biologic disease-modifying antirheumatic drugs (DMARDs) for adults with psoriatic arthritis (PsA).

Data Sources:

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1980 to February 2011 identified through PubMed, Embase, Cochrane Library and International Pharmaceutical Abstracts; unpublished literature including dossiers from pharmaceutical companies.

Methods:

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).

Results:

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.

Conclusions:

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.

Contents

540 Gaither Road, Rockville, MD 20850; www​.ahrq.gov

Updated June 2012. Errata: Tables 2, 3, and 4 have been corrected.

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract No. HHSA-290-2007-10056-I, Prepared by: RTI International–University of North Carolina Evidence-based Practice Center, Research Triangle Park, NC

Suggested citation:

Donahue KE, Jonas DE, Hansen RA, Roubey R, Jonas B, Lux LJ, Gartlehner G, Harden E, Yuen A, Thieda P, Morgan LC, Crotty K, Van Noord M. Drug Therapy for Psoriatic Arthritis in Adults: Update of a 2007 Report. Comparative Effectiveness Review No. 54. (Prepared by RTI-UNC Evidence-based Practice Center under Contract No. 290-02-0016-I.) Rockville, MD: Agency for Healthcare Research and Quality; April 2012. www.effectivehealthcare.ahrq.gov/reports/final.cfm.

This report is based on research conducted by the RTI International–University of North Carolina (RTI–UNC) Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSA-290-2007-10056-I). The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help healthcare decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.

This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

None of the investigators has any affiliations or financial involvement that conflicts with the material presented in this report.

1

540 Gaither Road, Rockville, MD 20850; www​.ahrq.gov

Bookshelf ID: NBK95257PMID: 22624163
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