Psoriatic Arthritis with Uveitis: What to Do After Anti-TNF Monoclonal Antibody Failure
This protocol applies to patients with psoriatic arthritis and concurrent uveitis who did not achieve an adequate response to a first-line anti-TNF monoclonal antibody.
Defining comorbidity — Uveitis
Uveitis shapes treatment selection in this population. Among available mechanisms of action, only TNF inhibition through monoclonal antibodies carries direct evidence of efficacy on uveitis itself. This constraint must be considered when deciding what comes next.
Prior line — inadequate response
Patients reached this protocol after treatment with an anti-TNF monoclonal antibody (adalimumab or infliximab, the preferred agents when uveitis is present). The required targets were not met: improvement at 3 months and remission or low disease activity at 6 months.
Next-line approach (partial overview)
Following inadequate response or intolerance to the first biologic agent, the protocol considers a therapeutic switch — with specific guidance on switching options, including movement within the same class. The full eligibility criteria, preferred agents, and sequencing are available in the structured regimen.
Treatment targets: Improvement at 3 months; remission or low disease activity at 6 months.
References
- With uveitis to an anti-TNF monoclonal antibody.
- Currently, the only mode of action with direct proof of efficacy on uveitis is TNF inhibition through monoclonal antibodies (ie, adalimumab and infliximab).
- In patients with an inadequate response or intolerance to a bDMARD or a JAKi, switching to another bDMARD or JAKi should be considered, including one switch within a class.
- Treatment should be aimed at reaching the target of remission or, alternatively, low disease activity, by regular disease activity assessment and appropriate adjustment of therapy.
DOI: 10.1136/ard-2024-225531
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