Next I'm listening to @StefanSiebert1 presenting on Psoriatic Arthritis - what are the management options in 2021? He highlights that new therapies mean we don't need to just treat it as RA, or borrow meds from RA #BSR21

Dermatologists taught us that IL23/IL17 pathway is key in this disease. IL17a present at high levels in skin lesions. This gradually became evident to contribute to joint disease as well.
#BSR21 @StefanSiebert1

IL23 inhibition:
*Excellent effect on skin psoriasis (with studies using PASI 90/100 in their trials - setting high hurdles!)
*For PsA both p40 (uste; PSUMMIT) and p19 (gusel; DISCOVER) subunit blockade reduce IL17 but more prolonged reduction with gusel
#BSR21 @StefanSiebert1

Suggestion from head to head studies that sek (anti-IL17) has a more rapid effect on PASI but guselkumab has a more pronounced effect long term. This may reflect escape pathways or the earlier blockade in the pathway.
#BSR21 @StefanSiebert1

EXCEED study: sek Vs adalimumab, ACR 20 comparison, minimal difference up to 16 weeks, but at 52 weeks data favoured sek (although just missing statistically significance)
#BSR21 @StefanSiebert1

Nice comparator slide of treatments on different diseases #BSR21 @StefanSiebert1

Did we really expect the medications to have the same effects across multiple tissues? Studies demonstrate a different cytokine hierarchy in different tissues (eg skin Vs joint Vs entheses Vs axial) even in the same patient.
#BSR21 @StefanSiebert1

Is there an opportunity to inhibit multiple pathways? Yes - blocking intracellular pathways such as through use of JAK-inhibitors. A concern here with off target effects (eg the recent concerns in post-marketing surveillance of tofa).
#BSR21 @StefanSiebert1

TICOPA study: treat to target study definitely showed benefit but more adverse events in those with tight control (97%) Vs standard of care (77%)
#BSR21 @StefanSiebert1

SEAM study:
1. Nice data for MTX monotherapy in ethesitis and reaching MDA
2. No difference between etanercept alone Vs etanercept with MTX for the joints
So...not a must do thing to combine MTX and biologic but consider as an add-on
#BSR21 @StefanSiebert1

Optimising biologics:
Stop smoking
Address obesity
https://pubmed.ncbi.nlm.nih.gov/23771989/ 
#BSR21 @StefanSiebert1

Deciding on treatment in PsA: Try to assess what the main phenotype is for that patient - or what is most troubling for them in terms of deciding what therapy approach is likely to be most effective for them. Difficult - need predictive biomarkers to help
#BSR21 @StefanSiebert1