Adalimumab in Psoriatic Arthritis
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Adalimumab in Psoriatic Arthritis A Viewpoint by Eric Ruderman Division of Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
Psoriatic arthritis is an inflammatory arthritis associated with psoriasis that only became recognised as a distinct entity a little more than 30 years ago. In recent years, a number of new therapies have become available for this condition, including several tumour necrosis factor (TNF) antagonists. As described in the accompanying manuscript, two randomised, placebo-controlled studies have now shown that adalimumab, a fully human anti-TNF antibody, is clinically effective for the symptoms of psoriatic arthritis. In the larger, pivotal trial (ADEPT; ADalimumab Effectiveness in Psoriatic arthritis Trial), adalimumab significantly improved levels of disability and skin psoriasis, and reduced the progression of structural joint damage. Overall, the safety profile of adalimumab in psoriatic arthritis clinical trials is similar to that seen in trials in rheumatoid arthritis. In both cases, the most common adverse events were minor infections. Serious adverse events have been uncommon in clinical trials of adalimumab, and generally comparable to those seen with placebo therapy. However, a recent meta-analysis[1] of rheumatoid arthritis clinical trials with adalimumab and infliximab, another anti-TNF antibody, indicated that both serious infections and malignancies were more common with active therapy. Clinical experience with TNF antagonists in
rheumatoid and psoriatic arthritis has suggested that the risks asociated with these agents are quite reasonable in light of their sometimes remarkable clinical benefit. The finding of these safety signals, however, highlights the need to balance risks and benefits for any individual course of therapy. Although NSAIDs and conventional diseasemodifying therapies are not always effective in treating psoriatic arthritis, some patients will respond to such treatments, which should be considered prior to using adalimumab or other TNF antagonists. Some, but not all, patients with psoriatic arthritis will develop progressive joint destruction. Adalimumab and other TNF antagonists that inhibit structural damage may be of particular value in this population. Patients with existing joint damage or evidence of very active clinical disease have been shown to be at risk for progressive damage. Ongoing epidemiological studies and clinical trials may help to identify other risk factors that can define the subset of patients that stands to benefit the most from adalimumab and other new therapies. Finally, pharmacoeconomic studies will be needed to show that the high costs of these newer therapies are justified by corresponding reductions in disability and other health care costs, as well as improvements in long-term quality of life. ▲ Reference 1. Bongartz T, Sutton AJ, Sweeting MJ, et al. Anti-TNF antibody therapy in rheumatoid arthritis and the risk of ser
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