When TNF-α Inhibitors Have Not Worked in Plaque Psoriasis with Concomitant Psoriatic Arthritis

Plaque psoriasis becomes a more complex treatment challenge when psoriatic arthritis is also present. This protocol addresses the next therapeutic step for patients in this dual-diagnosis situation who have not achieved adequate skin and joint disease control with an initial TNF-α inhibitor.

Clinical Scenario

Plaque psoriasis with concomitant psoriatic arthritis. Because TNF-α inhibitors are a preferred first-line biologic option when psoriatic arthritis is present alongside psoriasis, the clinical question of what to do next arises when that approach falls short.

Previous Treatment — Goals Not Achieved

Initial biologic therapy with a TNF-α inhibitor — etanercept, infliximab, adalimumab, or certolizumab — did not reach the required treatment targets: at least 75% improvement in the Psoriasis Area Severity Index (PASI 75) and meaningful improvement in psoriatic arthritis signs and symptoms. Adequate response is typically assessed after 12 to 16 weeks of continuous therapy.

Treatment Goal

Achieve at least 75% improvement in the Psoriasis Area Severity Index (PASI 75), together with control of the concomitant psoriatic arthritis.

Next-Line Approach — Partial Overview

The protocol calls for switching to a different biologic agent that holds FDA approval for both plaque psoriasis and psoriatic arthritis. The specific agent and the full evidence-based regimen are detailed in the complete protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.jaad.2018.11.057

Among the biologics TNF-a inhibitors should be considered as a preferred treatment option for patients with concomitant PsA
Secukinumab and ixekizumab are also efficacious and FDA-approved for the treatment of psoriatic arthritis
Ustekinumab has established efficacy and FDA approval for the treatment of PsA; however, it does not have the label for prevention of joint destruction as TNF-a inhibitors do

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