What is New in Psoriatic Arthritis?

In this episode, Arthur Kavanaugh, MD, explains what is new in psoriatic arthritis (PsA) in 2022, including new treatments, new treatment approaches, updates in the diagnosis PsA, and in safety considerations. Dr Kavanaugh presented this topic at the Congress of Clinical Rheumatology in Destin, Florida on May 11, 2022. ​​​​​​

Arthur Kavanaugh, MD, is a professor of medicine in the Division of Rheumatology, Allergy, and Immunology at the University of California, San Diego (San Diego, CA).

For more information about CCR East and West 2022, visit https://www.ccrheumatology.com/

TRANSCRIPTION:

Jessica Bard: Hello everyone, and welcome to another installment of Podcast360, your go-to resource for medical news and clinical updates. I'm your moderator, Jessica Bard, with Consultant360 Specialty Network.

Psoriasis affects about 7 million people in the United States, and about 30% of those people have psoriatic arthritis. According to the Cleveland Clinic. Dr Arthur Kavanaugh is here to speak with us today, about his session at Congress of Clinical Rheumatology, titled “Psoriatic Arthritis: What's New in 2022.”

Dr Kavanaugh is a Professor of Medicine at the University of California, San Diego. Thank you for joining us today, Dr Kavanaugh. Can you please give us an overview of your session?

Dr Arthur Kavanaugh: Well, the recent years have seen tremendous progress in psoriatic arthritis, in really, all aspects of it. I think, we focus on the treatments, and there's been a lot of work in treatments, and new treatments, and new treatment approaches. But the success of the new treatments has also meant that, been great interest in looking at other aspects of diagnosis, stratification, and safety considerations. So, there's really been a tremendous amount of new information, even over the past year. So, I'm going to touch on some of the bits of it, that I think are the most relevant to those of us in the clinic.

Jessica Bard: Sure. And what are some of those bits, and how do those updates impact clinical practice?

Dr Arthur Kavanaugh: Well, there are newer agents available to us. For example, the TNF inhibitors have been around for a while. Other biologics that we have now, though, in addition to the 1223, we have two IL-17s, and another one in late-phase development. We have 23 inhibitors. There are now 2 that are approved for the treatment of psoriatic arthritis. We have the JAK inhibitors, there are 2 approved for psoriatic arthritis. We have the targeted synthetic apremilast. And of course, we still have our traditional disease-modifying drugs. So, we have a whole armamentarium of different mechanisms of action of therapies that can help patients with psoriatic arthritis.

Jessica Bard: What are the gaps in research for psoriatic arthritis, would you say?

Dr Arthur Kavanaugh: Well, the ultimate would be that we would... Still, they have a biggest unmet need is to find the right drug for the right patient. So, in psoriatic arthritis, we can do some selection, based on the most prominent domains of involvement that patients have. And we know that, some agents work across all, or most of the domains, some do better in other domains than others. For example, the IL-17 inhibitors, and the IL-23 inhibitors, are even more efficient than the TNF inhibitors for the treatment of skin psoriasis. So, if that's an important domain of involvement, that can help us get to the right choice for the right patient.

Some of it is driven by safety, or tolerability considerations. All our therapies are generally well tolerated. But we take into consideration individual comorbidities, and how that might impact the ultimate tolerability of the medication for an individual patient. So, that's really, the biggest challenge is, when a patient comes in and they say, "Well, what treatment is best?" Honestly, we don't know which specific treatment is going to be best for that patient. There's still a little bit of trial and error. And I think, that's kind of, that's probably the biggest unmet need.

Jessica Bard: So, keeping that gap in mind, what's next for research, and what's on the horizon for the future of the management of psoriatic arthritis?

Dr Arthur Kavanaugh: Well, an idea that had, once had sort of a black eye, but now seems to be coming back, is combination biologic therapy. Which, there's a recent positive study in ulcerative colitis. And for years, people had been a bit scared off about combination biologic therapy, because of some very negative data, many years ago in rheumatoid arthritis, when that approach was tried. But, this looks as if the idea may be something that we're seeing back again. The idea that you can perhaps use combinations of these agents. Ideally, of course, we'd like all of our patients to be in complete remission. Although we do very well for a lot of patients, we're not really putting every single patient in remission. So it'd be nice to be able to think of additional approaches, and combination biologic therapy certainly comes to the top of my mind.

Jessica Bard: What are the overall take-home messages from your session at CCR-East, and from our conversation today?

Dr Arthur Kavanaugh: Overall, I think it's been a very exciting time for the healthcare providers who take care of patients with psoriatic arthritis. We have lots of new agents, amazing amount of new agents, compared to how things were 15 years ago. We're learning somewhat, about how to really use them for individual patients, in some cases, based on the domains of involvement. And there's a lot of interest. The success with the therapies has really helped spawn additional research into disease stratification and management issues. Looking at the most important outcomes to the patient, looking at highly sensitive imaging, looking at biomarkers. So the positive results from treatment have really generated a lot more interest in research into the field.

Jessica Bard: Well, Dr Kavanaugh, it was a real pleasure speaking with you today. Is there anything else that you'd like to add, that you think that we missed?

Dr Arthur Kavanaugh: No. No. I think that covers it. It covers it pretty well, I hope.

Jessica Bard: Well, thank you very much. I appreciate it.

Dr Arthur Kavanaugh: All right. You take care.