Dr. Braulio Gomez is Head of Dermatology Medical Affairs at UCB, a global biopharmaceutical company. In this Q&A, we discuss with Dr. Gomez the connection between psoriasis and psoriatic arthritis, and learn how UCB aims to optimize treatment options for people living with these diseases.
Please see Important Safety Information including Boxed Warning and full Prescribing Information or visit www.Cimziahcp.com.
What is the relationship between psoriasis and psoriatic arthritis—why are the two often related?
Psoriasis is one of the most common inflammatory diseases; an estimated 125 million people globally live with this condition.1 Psoriasis is a chronic skin condition with hereditary and autoimmune pathogenesis factors. Although there are a variety of clinical manifestations, 90% of psoriasis cases are psoriasis vulgaris, or plaque psoriasis, which typically presents as chronic plaques on the trunk, extremities, or scalp.2 An estimated 40% of patients with psoriasis will develop psoriatic arthritis.3 Early psoriatic arthritis detection and treatment are critical for improving long-term patient outcomes.4
While most people are familiar with the externally visible component of psoriasis, the impact of this disease is more than skin deep. Psoriasis is known to have a negative effect on cardiovascular health,5 gastrointestinal health,6 mental health, and quality of life due to its social impacts, and it can lead to the development of psoriatic arthritis.7
Psoriatic arthritis is a chronic inflammatory and musculoskeletal condition that has a range of manifestations—including spondylitis, peripheral arthritis, inflammation of tendons, or inflammation of a whole digit. Symptoms that may occur outside of the joints include uveitis and inflammatory bowel disease.8 Some people with psoriatic arthritis may have symptoms of fatigue, limitations in their physical function, and sleep disturbances. They may also experience reduced work capacity and social participation. Additionally, psoriatic arthritis is associated with several chronic comorbidities, including obesity, metabolic diseases, cardiovascular disease, hypertension, and mental health conditions, which can impact treatment decisions.5,9
Why is early treatment of psoriatic arthritis so important?
In most patients who develop psoriatic arthritis, the skin lesions associated with psoriasis appear prior to or concurrently with the musculoskeletal symptoms of PsA.6,10 However, the severity of skin disease does not have a strong correlation with the severity of the articular disease.10 Patients diagnosed with psoriatic arthritis who began treatment early have been shown to fare better in their disease course.11 Early intervention with systemic therapy is the best approach for achieving the major targets of treating psoriatic arthritis, including the reduction of pain, improvement of function, inhibition of joint damage, and maintenance of quality of life.12 Increasing awareness of the risks of psoriatic arthritis among psoriasis patients may help increase surveillance for this condition, allowing for earlier treatment and potentially reducing symptom burden for patients who have psoriatic arthritis or will progress to having it.6
How are psoriasis and psoriatic arthritis currently managed?
Fortunately, several treatments are available for psoriasis and psoriatic arthritis. Psoriasis therapies include non-pharmacological management, over-the-counter and prescription topicals, phototherapy, biologics, and biosimilars.13 Therapies for psoriatic arthritis include non-pharmacological management, oral small molecules (MTX, sulfasalazine, cyclosporine, leflunomide, apremilast), TNF inhibitors including CIMZIA® (certolizumab pegol), IL-23/23 inhibitors, IL-17A inhibitors, JAK/STAT inhibitors, symptomatic therapies, and psoriasis therapies (including topical and other oral therapies).5,14
CIMZIA is approved for six indications, including the treatment of adult patients with active psoriatic arthritis and the treatment of adults with moderate-to-severe plaque psoriasis who are candidates for systemic therapy or phototherapy. Current treatment guidelines recommend a “treat to target” approach for psoriatic arthritis, in which an objective outcome is followed at each patient visit and therapeutic treatment is adjusted as needed to achieve a state of low disease activity or remission.5 However, a healthcare provider’s treatment determination can be complicated by individual factors, such as non-response to some therapies and heterogeneous presentations of the disease.10 Caring for psoriatic arthritis is complex, requiring practitioners to estimate which of the approved therapies will benefit their patient the most.6
How do we optimize treatment for people with psoriasis and psoriatic arthritis?
Many treatments for the skin lesions of psoriasis may not be adequate in treating the joint involvement of PsA. Anti-TNF treatment, including CIMZIA, may be effective in treating either condition.9,15 CIMZIA is an anti-TNF that works differently – providing skin improvement while also providing sustained joint symptom relief.16,17,18 For patients with psoriasis, CIMZIA has been shown to deliver rapid skin clearance improvement that lasts, regardless of prior biologic treatment.16, 17,18
The CIMPASI-1 and CIMPASI-2 Phase 3 multicenter, randomized, double-blinded, placebo-controlled trials studied CIMZIA for the treatment of chronic plaque psoriasis. The co-primary end points at Week 16 in the CIMPASI-1 and CIMPASI-2 studies were PASI 75 and PGA 0 or 1, with >70% of patients responding at Week 16 vs. 7.5% of placebo patients.17,18 The primary end point in CIMPACT – a 48-week Phase 3, multicenter, randomized, double-blind, etanercept- and placebo-controlled study – was PASI 75 at Week 12. CIMZIA 400 mg Q2W demonstrated numerically higher efficacy results for psoriasis patients than CIMZIA 200 mg Q2W.17 The PASI 75 analysis is a prespecified pooled efficacy analysis of the CIMPASI-1, CIMPASI-2, and CIMPACT trials. 17,18 The results of the biologic-experienced PASI 90 data were prespecified in the integrated summary of efficacy analysis but not adjusted for multiplicity. 17,18
CIMZIA has also been shown to help prevent the progression of joint damage in patients with psoriatic arthritis and provide powerful relief from joint pain and swelling.16 The primary endpoint of the RAPID-PsA trial was ACR20 at Week 12. The endpoint was achieved in 58% of patients receiving CIMZIA vs 24% of patients receiving placebo (randomized set nonresponder imputation, P<0.001 vs placebo. Imputation is NRI for the primary end point).16 Weeks 48 through 216 were an open-label extension (OLE) phase of the study.16 As with any long-term, uncontrolled OLE, there were several limitations with this portion of the study. In the RAPID-PsA trial, 80% of patients assessed radiographically experienced no progression of joint damage over 4 years (CIMZIA 200 mg Q2W; n=98). 16 The remainder experienced minimal progression. The radiographic primary end point was change from baseline in mTSS at Week 24 (–0.02 with CIMZIA 200 mg Q2W [n=138] vs 0.18 with placebo [n=136] P<0.05).14,19 Patients treated with CIMZIA 400 mg Q4W did not demonstrate greater inhibition of radiographic progression compared with placebo-treated patients at Week 24.16
Visit https://www.cimziahcp.com/dermatology/psoriatic-arthritis to learn more about how CIMZIA can provide relief to patients experiencing psoriasis and psoriatic arthritis.
IMPORTANT SAFETY INFORMATION AND INDICATIONS
IMPORTANT SAFETY INFORMATION
Serious and sometimes fatal side effects have been reported with CIMZIA, including tuberculosis (TB), bacterial sepsis, invasive fungal infections (such as histoplasmosis), and infections due to other opportunistic pathogens (such as Legionella or Listeria). Patients should be closely monitored for the signs and symptoms of infection during and after treatment with CIMZIA. Lymphoma and other malignancies, some fatal, have been reported in children and adolescent patients treated with TNF blockers, of which CIMZIA is a member. CIMZIA is not indicated for use in pediatric patients.
CIMZIA is indicated for:
IMPORTANT SAFETY INFORMATION (CONT)
CIMZIA is contraindicated in patients with a history of hypersensitivity reaction to certolizumab pegol or to any of the excipients. Reactions have included angioedema, anaphylaxis, serum sickness, and urticaria.
Patients treated with CIMZIA are at increased risk for developing serious infections that may lead to hospitalization or death. Most patients who developed these infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids.
Discontinue CIMZIA if a patient develops a serious infection or sepsis.
Reported infections include:
Carefully consider the risks and benefits of treatment with CIMZIA prior to initiating therapy in the following patients: with chronic or recurrent infection; who have been exposed to TB; with a history of opportunistic infection; who resided in or traveled in regions where mycoses are endemic; with underlying conditions that may predispose them to infection. Monitor patients closely for the development of signs and symptoms of infection during and after treatment with CIMZIA, including the possible development of TB in patients who tested negative for latent TB infection prior to initiating therapy.
Lymphoma and other malignancies, some fatal, have been reported in children and adolescent patients treated with TNF blockers, of which CIMZIA is a member. CIMZIA is not indicated for use in pediatric patients.
HEPATITIS B VIRUS REACTIVATION
CIMZIA® is a registered trademark of the UCB Group of Companies. All other trademarks are the property of their respective holders.
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