Background: Psoriatic arthritis is a chronic inflammatory joint disease with a great heterogeneity of manifestations both at the musculoskeletal (arthritis, enthesitis, dactylitis, axial skeleton involvement) and dermatological (skin, nail involvement) domain. The main goal of treatment is to maximize quality of life by controlling symptoms and preventing structural damage. For this, multidisciplinary management must be carried out without forgetting non-musculoskeletal manifestations and considering comorbidities.

Regarding pharmacological therapy to control arthritis, non-steroidal anti-inflammatory drugs (NSAIDs) and/or intra-articular corticosteroid injections are proposed as initial therapy. When symptoms are not controlled or there are associated poor prognostic factors, conventional disease-modifying antirheumatic drugs (DMARDs) are recommended, especially methotrexate. When the classic DMARDs do not achieve good control of the disease, the next step will be the biological DMARDs, among which are TNF-alpha inhibitors, interleukin-17 inhibitors or inhibitors of the IL12/IL23 axis. Other molecules such as janus kinase (JAK) inhibitors or phosphodiesterase-4 inhibitors such as Apremilast also continue to be incorporated into treatment alternatives.

Although these drugs provide a promising result, the scarcity of direct comparative studies implies a need for more research to determine better treatment strategies.

Objectives: To analyze the efficacy of IL-17 inhibitors (Secukinumab, Ixekizumab, Brodalumab and Bimekizumab) in the treatment of patients diagnosed with psoriatic arthritis based on data published in randomised clinical trials (RCTs).

Methods: We perform a systematic review of the scientific literature using the Pubmed, Cochrane Library, Embase and Web of Science electronic databases, selecting RCTs evaluating the efficacy of IL-17 inhibitors for the treatment of psoriatic arthritis.

A meta-analysis was performed using the random-effects model for each efficacy measure evaluated at different weeks.

Results: 23 studies met the selection criteria from a total of 2198 references identified in the search. 14 references contained data on the use of Secukinumab from 7 RCTs. Ixekizumab was the second IL-17 inhibitor most identified with 6 references with data from 5 RCTs. Bimekizumab with 2 references and Brodalumab with 1 reference completed the review.

Despite extracting efficacy data in nail, enthesitic and PROs manifestations. We were only able to perform meta-analyses of the ACR 20, AC50, ACR70 and PASI75 response rates at week 12 of treatment, due to the lack of statistically comparable data.

The meta-analysis performed demonstrated that IL-17 inhibitors are effective in psoriatic arthritis, compared to placebo in the different efficacy outcomes evaluated (ACR20 12 wk (OR: 3.60 [95%CI: 2.85-4. 55]), ACR50 12 wk (OR: 10.85 [95%CI: 6.20-18.94]), ACR70 12 wk (OR: 7.94 [95%CI: 4.23-14.91]) and PASI75 12 wk (OR: 21.26 [95%CI: 13.72-32.95])

Conclusion: Our review concluded that IL-17 inhibitors are effective in the treatment of patients who have shown intolerance or had an unsatisfactory response to other lines of treatment in Psoriatic arthritis.

REFERENCES:

[1]Ritchlin CT, Colbert RA, Gladman DD. Psoriatic Arthritis. N Engl J Med. 2017 Mar 9;376(10):957-70.

[2]Gossec L, Baraliakos X, Kerschbaumer A, de Wit M, McInnes I, Dougados M, et al. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update. Ann Rheum Dis. 2020 Jun;79(6):700-12.

Disclosure of Interests: None declared