Wednesday, 01 Apr 2020

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Most Psoriatics Go on Biologics

A cohort study of 97 patients with psoriatic arthritis (PsA) examined the prescribing practices in PsA, and found biologics are commonly initiated as the primary mode of therapy in outpatients with PsA. However, treatment modifications can be made regarding patients who are managed with apremilast alone.

Data was collected by a retrospective chart review examining the use of biologics versus oral small molecules (OSMs - methotrexate, sulfasalazine, leflunomide), and apremilast.

Among 97 PsA patients, two-thirds were on biologics, with peak use in those who were 38 to 57 years age. Biologic treated patients had better (superior) disease control (84.4% vs 66.6%; P = 0.0016) compared to OSMs. But OSMs provided slightly better control (69.5% vs 61.5%; P = 0.016) over apremilast monotherapy (13.4% of patients were on apremilast  monotherapy).

This quality improvement project reveals that in most instances, biologics are being appropriately initiated as the primary mode of therapy for patients with PsA; however, treatment modifications can be made regarding patients who are managed with apremilast alone.

Although MTX is commonly presdribed in PsA, biologics are being used consistently in practice, with the exception of use in the elderly.


The author has received compensation as an advisor or consultant on this subject

Rheumatologists' Comments

PSA is often misdiagnosed, and I posit that a some patients with just OA, whom happen to have psoriasis, are inappropriately on biologics

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