Pharmacological treatment of psoriatic arthritis: a systematic literature review for the 2015 update of the EULAR recommendations for the management of psoriatic arthritis

Ann Rheum Dis. 2016 Mar;75(3):490-8. doi: 10.1136/annrheumdis-2015-208466. Epub 2015 Dec 11.


Objective: To update the evidence on the efficacy and safety of pharmacological agents in psoriatic arthritis (PsA).

Methods: Systematic literature review of randomised controlled trials comparing pharmacological interventions in PsA: non-steroidal anti-inflammatory drugs, glucocorticoid, synthetic disease modifying antirheumatic drugs (sDMARDs) either conventional or targeted, biologicals (bDMARDs), placebo or any combination. Main outcomes were American College of Rheumatology (ACR)20-50, Psoriasis Area Severity Index 75, radiographic progression, and withdrawals due to adverse events (AEs). Multiple studies of the same intervention were meta-analysed using random effects.

Results: In total, 25 papers and 12 abstracts were included. The efficacy of tumour necrosis factor inhibitors (including the recently added golimumab and certolizumab pegol) was confirmed and 16 articles/abstracts focused on 3 drugs with new modes of action: ustekinumab (UST), secukinumab (SEC) and apremilast (APR). All were placebo-compared trials and met their primary end point, ACR20. In 2 studies with UST ACR20 was met by 50% and 44% of patients with UST 90 mg, 42% and 44% with UST 45 mg vs 23% and 20% with placebo, respectively. In two studies with SEC ACR20 ranged 54% (SEC 300 mg), 50-51% (SEC 150 mg), 29-51% (SEC 75 mg) and 15-17% (placebo). In four studies with APR, ACR20 ranged 32-43% (APR 30 mg), 29-38% (APR 20 mg) and 17-20% (placebo). For all three drugs, no more withdrawals due to AEs than placebo were seen and, in general, safety appeared satisfactory. A strategy trial, TIght COntrol of Psoriatic Arthritis (TICOPA), showed better ACR responses with treatment adaptations upon tight control compared with standard care.

Conclusions: UST, SEC and APR are new drugs with efficacy demonstrated for the treatment of PsA. No major safety signals arise, but long-term studies are needed. This review informed about the European League Against Rheumatism recommendations for management of PsA.

Keywords: DMARDs (biologic); DMARDs (synthetic); Psoriatic Arthritis; Treatment.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Antirheumatic Agents / therapeutic use*
  • Arthritis, Psoriatic / drug therapy*
  • Glucocorticoids / therapeutic use*
  • Humans
  • Practice Guidelines as Topic
  • Treatment Outcome


  • Anti-Inflammatory Agents, Non-Steroidal
  • Antirheumatic Agents
  • Glucocorticoids