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PsA All the Way – Unmet Needs

Apr 01, 2022 3:00 am

Throughout the month of April 2022, RheumNow is introducing a new approach to education and information sharing – a Campaign devoted to a single disease entity. For 2022 we intend to have month long devoted campaigns on the following topics: PsA, RA, SpA and SLE.

Our first campaign is aimed at Psoriatic Arthritis (PsA) for several reasons, many of which fall under the heading of "unmet needs":

  • PsA and SpA are plentiful and more prevalent than RA
  • There has been a plethora of advances in the epidemiology, comorbidity associations and impact and the biology of what is going on in the skin and joints.
  • Are Rheums talking more about the challenges of PsA because of these advances or because that’s all the pharma companies seem to want to talk about these days?
  • Drug development skyrocketed after 2004 (TNFi’s and UST), 2014 Apremilast, IL-17 x 3; IL-23 x 3, JAKi x 2 – leaving Rheums to wonder “what am I to do with all these new agents” “Do I even have needy patients enough to consider any or all of these?”
  • Prevalence of psoriasis in adults is 3.0%, indicating that more than 7.5 million adults – extrapolation of PsA (~30%) suggests that 25-30% of PsO patients will develop PSA 
  • While more than half will have milder oligoarticular disease, up to 40% will polyarticular PsA with half of those having severe PsA.
  • Complicated by numerous problematic disease domains Skin (nail, scalp, genitals, palms/soles) and joints (enthesitis, SpA, Dactylitis, arthritis mutilans)
  • Further complicated by high prevalence of comorbidities – obesity, CVD, metabolic disease, depression, alcoholism and psychosocial burden. 
  • On average it takes 10+ years to progress from PsO to PsA. Delays in diagnosis and referral.
  • There is no Dx test, no reliable biomarker for activity or progression, coupled with murky genetic associations that fail to inform we are stuck with a clinical disorder, managed by clinicians without modern tools who have an abundance of firepower to control PsA – is this too much ammo? Too much horsepower? And is this what we clinicians need?

Trying everything and gaining experience isn’t the same as using these targeted tools wisely. There is considerable room for improvement in how we manage PsA – at the individual level.

Would you rather be guided by Evidence based guidelines (largely based on expert opinion) or managed care/PBM guidelines (largely prioritized by financial incentives) or would you prefer guidance on therapies that give your patients greater than a coin flip of a chance of responding?

The good news is the interest, investment and research are moving forward.  Exemplified by worldwide drug sales – in 2019 PsA was a $6 billion market worldwide; by 2026 this will double to over $26 billion in sales

Questions regarding the pathogenesis and treatment of PsA abound in recent years, including issues:

  • Methotrexate’s role
  • Apremilast – an early drug or drug with modest responses that is mistakenly given to modest disease patients?
  • Steroids – Forbidden but heavily relied upon for both skin and joint disease
  • Microbiome – can it be manipulated therapeutically for inflammation control or to improve specific drug responses
  • Comorbidity management – who will wrestle this problem?
  • Genetics: genomic sequencing, transcriptomic analysis, in conjunction
  • Metabolomic, microbiome and proteomic profiling

This campaign on PsA is entitled PsA All the Way – we are pulling out all the stops to advance care.

Campaigns are non-CME, month-long, educational publishing efforts dedicated to advancing knowledge and understanding on a single topic or disease state. Campaigns will feature, highlight and expand the coverage of a single topic of importance to practicing rheumatologists.  As a result of this one month “Campaign” focus on a specific disease state or issue, RheumNow will escalate awareness on this topic, its unmet needs, clarify advances and discuss of key advances and modern disease management.  

RheumNow acknowledges the sponsor for this campaign, Janssen Pharmaceutical. All of the content and contributors for this campaign were solely chosen by RheumNow, its’ contributing faculty and a campaign advisory board that includes 5 US rheumatologists and 1 industry representative.

Campaigns are, by design, independent of commercial bias and non-promotional in nature.  As such, RheumNow is responsible for the genesis, delivery and distribution of all Campaign content.

In addition to our regular and usual delivery of breaking news and important journal articles, we intend to focus our news and social media reporting on PsA, such that 30% or more will be on PsA.  Other features you should look for this month include:

  1. The Future of PsA – our “therapeutic update” will run all month and will feature a series of 8 videos from KOLs who will discuss the future of PsA (diagnosis, care, drugs, biomarkers, precision medicine and more)
  2. Tuesday Nite Rheumatology – returns for PsA exclusives every Tuesday nite at 7pm EST. 2 Journal Clubs and 2 panels (Patient perspectives and Controversies in PsA)
  3. PsA Guest Bloggers – we will publish 3 per week
  4. PsA weekly Survey – to see where you stand on Steroids, Comorbidities & more.
  5. Slide downloads on PsA
  6. Dozens of PsA videos and Podcasts

What is the desired outcome of this PsA All the Way campaign? 

• Goal is to Change thinking, treatment, discussions on that topic

• Create tension, doubt and about predictable treatment patterns and prescriptive complacency

• We will know how this resonates based on the metrics – if his is important to you, our engagement numbers will tell us so.

What does modern management of PsA look like?

What will future management of PsA look like?

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

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