Content area
Full Text
Published online: 7 May 2018
© Springer International Publishing AG, part of Springer Nature 2018
Abstract The biological DMARD abatacept (Orencia®), a selective co-stimulation modulator, is an effective and generally well tolerated treatment option for active psoriatic arthritis. It may be administered as a monthly intravenous (IV) infusion or as a weekly subcutaneous (SC) injection via a single-dose pre-filled syringe or ClickJet® autoinjector pen. In phase 2 and 3 trials in patients with or without a history of an inadequate response to tumour necrosis factor (TNF) inhibitors, beneficial effects on musculoskeletal manifestations (including enthesitis, dactylitis, physical function and structural damage), psoriatic skin lesions and health-related quality of life (HR- QOL) were seen with IV or SC abatacept regimens. The clinical benefits of abatacept increased or were maintained with longer term use, and no new safety signals were identified.
What is the rationale for using abatacept in active psoriatic arthritis?
Psoriatic arthritis is an inflammatory disease that shares genetic and clinical features with other forms of spondyloarthritis [1]. It is characterized by psoriasis, peripheral joint disease, axial disease, enthesitis and dactylitis, which lead to impaired physical function and reduced health-related quality of life (HR-QOL). The treatment of psoriatic arthritis may be complicated by its heterogeneous presentation and variable disease course.
The ultimate goals of treatment of psoriatic arthritis are to achieve the lowest possible level of disease activity, optimize functional status, improve HR-QOL and wellbeing, prevent structural damage and avoid or minimize complications [2]. First-line treatment of psoriatic arthritis is often determined by key disease symptoms and generally involves the use of NSAIDs and conventional systemic disease-modifying anti-rheumatic drugs (DMARDs), such as methotrexate (most commonly used first-line DMARD), sulfasalazine, ciclosporin and leflunomide [1, 3]. However, as the effectiveness of such treatment is often limited, treatment with a biological DMARD (bDMARD) may be required. EULAR and GRAPPA guidelines recommend the use of a bDMARD in patients with peripheral psoriatic arthritis and an inadequate response to at least one conventional DMARD [2, 4]. A number of bDMARDs have demonstrated clinical efficacy in psoriatic arthritis, including tumour necrosis factor (TNF) inhibitors (e.g. adalimumab, certolizumab pegol, etanercept, golimumab and infliximab; most commonly used bDMARDs), interleukin (IL)-17 inhibitors (e.g. ixekizumab and secukinumab), IL-12/23 inhibitors (e.g. ustekinumab) and costimulation inhibitors (e.g....