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A New Medicine for Psoriatic Arthritis?

Summary and Comment |
June 11, 2014

A New Medicine for Psoriatic Arthritis?

  1. Jeffrey P. Callen, MD

Brodalumab may well become available as a new therapy for our patients with psoriatic arthritis.

  1. Jeffrey P. Callen, MD

Psoriatic arthritis continues to be associated with morbidity and deformity despite multiple agents for its management (e.g., tumor necrosis factor inhibitors, other biologic agents, the recently approved oral agent apremilast). Therefore, development of new agents with alternate mechanisms of action remains necessary. To that end, investigators tested the benefits for psoriatic arthritis of brodalumab, a human monoclonal antibody against the interleukin-17 receptor A that is currently under development for psoriasis. In a multi-institutional, randomized, placebo-controlled phase 2 study, 168 patients received placebo or brodalumab 140 mg or 280 mg weekly for the first 2 weeks, then biweekly (total, 7 doses). At week 12, remaining participants could join an open-label extension trial of 280 mg every other week for up to 52 weeks. Patients were allowed to continue low doses of corticosteroids and methotrexate.

Brodalumab significantly improved psoriatic arthritis at week 12 compared with placebo, as measured by the primary end point — 20% improvement in the American College of Rheumatology response criteria (ACR 20). Rates of 50% improvement were also significantly higher in the treatment groups. Efficacy continued throughout the extension period, but improvement ceased or declined near the end of the extension in patients who had received 280 mg from study onset. Changes in methotrexate or corticosteroid doses during the study were not mentioned. This study did not assess the response of associated skin disease. Serious adverse reactions occurred in 3% of the patients on active drug versus 2% of those on placebo.

Comment

Brodalumab improvement scores compare to those of other currently available agents. Adverse reactions were uncommon and occurred in roughly equal numbers of active treatment and placebo recipients. However, this study was not designed to assess safety, as its numbers are small. These results suggest that brodalumab may well become available as a new therapy for our patients with psoriatic arthritis.

  • Disclosures for Jeffrey P. Callen, MD at time of publication Consultant / Advisory board XOMA; Eli Lilly Equity Various trust accounts Editorial boards JAMA Dermatology; UpToDate; Journal of Rheumatology; Psoriasis Forum; Journal of Drugs in Dermatology; eMedicine

Citation(s):

Reader Comments (2)

ebrahimi ali asghar Physician, Rheumatology, Tabriz- IRAN ( Emam Reza theaching Hospital)

Thanks for your nice & new work about old disease( psoriasis).
please let me tow Q:
1- Your cases were advanced or new Psoriasis
2- what about serious adverse reactions

Dr. Malik, MD Resident, Cardiology, Foundation University College

Great new prospect in psoriasis but still needs some work done.

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