New GRAPPA 2021 PsO and PsA Treatment Recommendations Save

The evidence-based recommendations from the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis were presented at #EULAR2021. The goal (as per 2009 recommendations) was “To develop recommendations, based upon the best scientific evidence, for the optimal treatment of patients with PsA” Dr. Laura Coates, Oxford detailed in abstract #OP0229. Since the last update in 2015, there have been multiple changes. I will highlight these for you below. 

• New primary, overarching principle: Treatments should be centered around patient-specific domains, emphasis on shared decision making
• The comorbidities domain has been split into two groups: Related Conditions (Uveitis and IBD) and Comorbidities
• IL17i, IL23i, & JAKi strongly recommended in multiple categories
• Recommendations against IL6i use is expanded
• PDE4i recommendations have expanded to include enthesitis, dactylitis, and nail PsO

This update also includes a position statement on biosimilars detailing that “biosimilars must be approved through a robust regulatory review.” It details that “biomimics” or “intended copies” are not the same as biosimilars. With high member agreement, it also requests pharmacovigilance and periodic re-evaluation to ensure quality of biosimilar products and reminds the audience that there were no biosimilar studies conducted in PsA patients, let alone with regard to drug switches and immunogenicity, and as such data has been extrapolated in this patient population. 

There is also a new position statement regarding tapering/discontinuing treatment. It resolves that the decision to taper therapy should be shared by educating patients, highlighting benefits and potential drawbacks.

As a reminder the GRAPPA experts are rheumatologists, dermatologists, and patient research partners (PRPs) from around the world. These recommendations are for adult PsO and PsA patients. Systematic searches using MEDLINE, EMBASE, and Cochrane CENTRAL were conducted since the 2015 guidelines until August 2020, and conference presentations from 2017 – 2020 were reviewed. Additional searches were completed for comorbidities and related conditions. The methodology remains the GRADE methodology with PICO questions, refined within each domain. This allows for treatment recommendations either for or against with strong or conditional level association with each recommendation.  

Next steps will be to finalize the co-morbidities table and present the data at the GRAPPA July 2021 annual meeting. The final GRAPPA recommendations paper and 8 domain group papers will subsequently be published later this year.