A DIFFERENT TUNE:Patient-Centered Treatment of

PSORIASIS AND PSORIATIC ARTHRITIS

ADDITIONAL RESOURCES

This live activity is provided by Forefront Collaborative in collaboration with Interstate Postgraduate Medical

Association. This activity is supported by an educational grant from Lilly. For further information concerning Lilly

grant funding, visit www.lillygrantoffice.com.

ADDITIONAL RESOURCES

Cor

ticos

tero

id In

jecti

ons

as in

dica

ted

NSAIDs

NATIONAL PSORIASIS FOUNDATION: TREAT TO TARGET

RECOMMENDATIONS FOR PSORIATIC ARTHRITIS THERAPIES BY DISEASE DOMAIN1

Armstrong AW, Siegel MP, Bagel J, et al. From the Medical Board of the National Psoriasis Foundation: Treatment targets for plaque psoriasis. J Am Acad Dermatol. 2017;76(2):290-298. doi: 10.1016/j.jaad. 2016.10.017. PubMed PMID: 27908543.

1. Coates LC, Kavanaugh A, Mease PJ, et el. Group for Research and Assessment of Psoriasis and Psoriatic Arthritis 2015 Treatment Recommendations for Psoriatic Arthritis. Arthritis Rheumatol. 2016;68(5):1060-1071.

Which Domains Are Involved?

PeripheralArthritis

Axial Disease Enthesitis Dactylitis Skin Nails

Ass

ess A

ctivi

ty, I

mpa

ct, a

nd P

rogn

ostic

Fac

tors

NSA

IDs

and

IA c

ortic

oste

roid

s as

indi

cate

d

DMARDs (MTX, SSZ, LEF), TNFi or PDE4i

Biologics (TNFi,

IL12/23i, IL17i) or PDE4i

Switch biologics

(TNFi, IL12/23i, or IL17i)

Phys

ioth

erap

y an

d N

SAID

s

TNFi, IL17i or IL12/23i*

NSAIDsonly

Switch biologics

TNFi, IL17i or IL12/23i*)

No direct evidence for therapies in axial PsA,

recommendations based on axial SpA literature

Phys

ioth

erap

y

Biologics (TNFi,

IL12/23i, IL17i) or PDE4i

NSAIDs

Switch biologics

(TNFi, IL12/23i, or IL17i) or PDE4i

CS injections: consider on an individual basis

due to potential for serious side effects; no clear evidence

for efficacy

DMARDs (MTX, SSZ,

LEF) or PDE4i

Biologics (TNFi,

IL12/23i)

Switch biologics

(TNFi, IL12/23i, IL17i) or PDE4i

Topi

cals

as in

dica

ted

Topicals (keratolytics,

steroids, vitamin D analogs,

emollients, calcineurin i)

Phototherapy or DMARDs (MTX, CSA,

acitretin, fumaric acid

esters) or PDE4i

Biologics (TNFi, IL12/23i, IL17i) or PDE4i

Switch biologics

(TNFi, IL12/23i, IL17i) or PDE4i

Biologics (TNFi, IL12/23i, IL17i) or PDE4i

Topical or procedural

or DMARDs (CSA, LEF,

MTX, Acitretin)

Switch biologics

(TNFi, IL12/23i, IL17i) or PDE4i

Consider previous therapy, patient choice, other disease involvement and comorbidities. Choice of therapy should address as many domains as possible.

Treat, periodically re-evaluate, and modify therapy as required.

Standard therapeutic route Expedited therapeutic route

Fuchsia text identifies conditional recommendations for drugs that do not currently have regulatory approvals or for which recommendations are based on abstract data only. CS=corticosteroid. CSA=cyclosporine A. DMARDs=disease-modifying antirheumatic drugs. IA=intraarticular. IL-12/23i=interleukin-12/23 inhibitor. LEF=leflunomide. MTX=methotrexate. NSAIDs=nonsteroidal anti-inflammatory drugs. PDE-4i=phosphodiesterase 4 inhibitor (apremilast). SpA=spondyloarthritis. SSZ=sulfasalazine. TNFi=tumor necrosis factor inhibitor.

ADDITIONAL RESOURCES (CONT.)

REFERENCES

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Aldredge LM, Young MS. Providing guidance for patients with moderate-to-severe psoriasis who are candidates for biologic therapy. J Dermatol Nurses Assoc. 2016;8(1):14-26.

Alwan W, Nestle FO. Pathogenesis and treatment of psoriasis: exploiting pathophysiological pathways for precision medicine. Clin Exp Rheumatol. 2015;33(5 Suppl 93):S2-S6.

Armstrong AW, Siegel MP, Bagel J, et al. From the Medical Board of the National Psoriasis Foundation: treatment targets for plaque psoriasis. J Am Acad Dermatol. 2017;76(2):290-298.

Armstrong AW, Bukhalo M, Blauvelt A. A clinician’s guide to the diagnosis and treatment of candidiasis in patients with psoriasis. Am J Clin Dermatol. 2016;17(4):329-336.

Blauvelt A, Reich K, Tsai TF, et al. Secukinumab is superior to ustekinumab in clearing skin of subjects with moderate-to-severe plaque psoriasis up to 1 year: results from the CLEAR study. J Am Acad Dermatol. 2017;76(1):60-69.

Coates LC, Kavanaugh A, Mease PJ, et el. Group for Research and Assessment of Psoriasis and Psoriatic Arthritis 2015 Treatment Recommendations for Psoriatic Arthritis. Arthritis Rheumatol. 2016;68(5):1060-1071.

Coates LC, FitzGerald O, Helliwell PS, Paul C. Psoriasis, psoriatic arthritis, and rheumatoid arthritis: is all inflammation the same? Semin Arthritis Rheum. 2016;46(3):291-304.

Gaspari AA, Tyring S. New and emerging biologic therapies for moderate-to-severe plaque psoriasis: mechanistic rationales and recent clinical data for IL-17 and IL-23 inhibitors. Dermatol Ther. 2015;28(4):179-193.

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Gordon KB, Duffin KC, Bissonnette R, et al. A phase 2 trial of guselkumab versus adalimumab for plaque psoriasis. N Engl J Med. 2015;373(2):136-144.

Gottlieb AB, Gerdes S, Lacour JP, et al. Ixekizumab in patients with moderate to severe psoriasis who have or have not received prior biologic therapies: an integrated analysis of 2 phase 3 studies. 2016 Fall Clinical Dermatology Conference. Las Vegas, Nevada; October 20–23, 2016.

Griffiths CE, Strober BE, van de Kerkhof P, et al; ACCEPT Study Group. Comparison of ustekinumab and etanercept for moderate-to-severe psoriasis. N Engl J Med. 2010;362(2):118-128.

Griffiths CE, Reich K, Lebwohl M, et al; UNCOVER-2 and UNCOVER-3 investigators. Comparison of ixekizumab with etanercept or placebo in moderate-to-severe psoriasis (UNCOVER-2 and UNCOVER-3): results from two phase 3 randomised trials. Lancet. 2015;386(9993):541-551.

ADDITIONAL RESOURCES (CONT.)

Husni ME, Mease PJ. Managing comorbid disease in patients with psoriatic arthritis. Curr Rheumatol Rep. 2010;12(4):281-287.

Kavanaugh A, Antoni C, Krueger GG, et al. Infliximab improves health related quality of life and physical function in patients with psoriatic arthritis. Ann Rheum Dis. 2006;65(4):471–477.

Langley RG, Elewski BE, Lebwohl M, et al. Secukinumab in plaque psoriasis—results of two phase 3 trials. N Engl J Med. 2014;371(4):326-338.

Lebwohl M, Strober B, Menter A, et al. Phase 3 studies comparing brodalumab with ustekinumab in psoriasis. N Engl J Med. 2015;373(14):1318-1328.

Mak RK, Hundhausen C, Nestle FO. Progress in understanding the immunopathogenesis of psoriasis. Actas Dermosifiliogr. 2009;100(Suppl 2):2-13.

Mease P, van der Heidje D. Joint damage in psoriatic arthritis: how is it assessed and can it be prevented? Int J Adv Rheumatol. 2006;4(2):38-48.

Mease PJ. Infliximab (Remicade) in the treatment of psoriatic arthritis. Ther Clin Risk Manag. 2006;2(4):389-400.

Menter A, Gottlieb A, Feldman SR, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 1. overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol. 2008;58(5):826-850.

Mishra S, Kancharla H, Dogra S, Sharma A. Comparison of four validated psoriatic arthritis screening tools in diagnosing psoriatic arthritis in patients with psoriasis (COMPAQ Study). Br J Dermatol. 2017;176(3):765-770.

Schacht A, Petto H, Brnabic A, Kadziola Z, Mallbris L, Wilhelm S, Dutronc Y, Hartz S, Wood W. Comparison of efficacy of ixekizumab and ustekinumab in the treatment of plaque psoriasis: An indirect comparison via etanercept. J Am Acad Dermatol. 2016;74(5 Suppl 1):AB241.

Tinazzi I, Adami S, Zanolin EM, et al. The early psoriatic arthritis screening questionnaire: a simple and fast method for the identification of arthritis in patients with psoriasis. Rheumatology (Oxford). 2012;51(11):2058-2063.

van de Kerkhof PC, Griffiths CE, Reich K, et al. Secukinumab long-term safety experience: A pooled analysis of 10 phase II and III clinical studies in patients with moderate to severe plaque psoriasis. J Am Acad Dermatol. 2016;75(1):83-98.

Veale D, Rogers S, Fitzgerald O. Classification of clinical subsets in psoriatic arthritis. Br J Rheumatol. 1994;33:133-138.

Wilson FC, Icen M, Crowson CS, et al. Incidence and clinical predictors of psoriatic arthritis in patients with psoriasis: a population-based study. Arthritis Rheum. 2009;61:233-239.

REFERENCES (CONT.)