Dr Ogdie provides updates on new and emerging therapies for psoriatic arthritis, which she presented at the ACR Convergence in Chicago.

Alexis Ogdie, MD, is professor of Medicine and Epidemiology at the University of Pennsylvania in Philadelphia, Pennsylvania.

CLINICAL PRACTICE SUMMARY

• The psoriatic arthritis treatment landscape now includes oral small molecules (methotrexate, sulfasalazine, apremilast, cyclosporine) and biologics such as TNF inhibitors, IL-12/23 inhibitor ustekinumab, IL-17A inhibitors secukinumab and ixekizumab, and dual IL-17A/F inhibitor bimekizumab. Emerging IL-17 agents izokibep and sonelokimab have completed phase 2 trials.
• Interleukin-23 inhibitors guselkumab and risankizumab are approved; tildrakizumab is expected to expand into psoriatic arthritis. JAK inhibitors tofacitinib and upadacitinib and TYK2 inhibitor deucravacitinib are available or in late-stage development for PsA.
• Incretin-based therapies such as semaglutide, shown to promote weight loss and improve osteoarthritis outcomes, are under study for psoriatic disease. Weight reduction is associated with better skin and joint outcomes, supporting its integration into psoriatic disease management strategies.
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Hi, I'm Alexis Ogdie, professor of Medicine and Epidemiology at the University of Pennsylvania in Philadelphia. At this year's ACR, I spoke about current and emerging therapies for psoriatic disease. The first thing I did is reviewed the current landscape for treatment in psoriatic arthritis. This includes oral small molecules like methotrexate, sulfasalazine, apremilast, cyclosporine. In addition, therapies like TNF inhibitors, of which there are 5, I talk a little bit about biosimilars as well; interleukin 12/23, ustekinumab, also a recent biosimilar for that one; interleukin-17 inhibitors are standbys or older therapies now, secukinumab and ixekizumab, the IL-17A inhibitors, and a little bit more time spent on the newest of that class, bimekizumab, which is an IL -17A and F inhibitor.

In addition, there's a lot happening in that space. So I talk about the development of izokibep as well as sonelokimab. Both have completed phase 2 studies. And we talk about some other therapies kind of burgeoning in that IL-17 space.

Next, we talked about interleukin 23 inhibitors. So we have guselkumab and risankizumab since the last few years. But tildrakizumab, available for psoriasis, will probably soon be available for psoriatic arthritis as well. Then we talk about CTLA-4 Ig or abatacept, not as commonly used in psoriatic disease because it doesn't really target the skin much but can help for our patients with inflammatory arthritis. The JAK inhibitors, tofacitinib and upadacitinib, not so new, and the TYK2 inhibitor deucravacitinib, which is new in PsA or coming soon in PsA, but has been around in psoriasis for a while.  And then interleukin 23s, I already mentioned as well, but there's a new therapy coming there that's in development for both psoriatic arthritis, but further along in psoriasis.  In addition to the therapies that are already approved, we talk about some of the newer emerging therapies as well that haven't yet hit phase 2 studies, but we'll probably be on the way soon.

One of the challenges in psoriatic disease with all these different therapies available is what works for what and what works for whom. So there's been a lot of studies ongoing to try to figure out which groups should we be targeting these different therapies for. The GRAPPA treatment recommendations have a nice outline of how to utilize available therapies. And we talk a little bit about how we slot those emerging therapies into those same buckets. In addition, it's also helpful to think about treatment strategies. And there's some newer studies on treatment strategies that are either in progress or recently finished and presented at this meeting and at EULAR this past year as well.

Finally, I finished by talking about a separate set of therapies that aren't really our psoriatic disease therapies, but are increasingly commonly used in our patients. These are the incretins. Incretins have increasing evidence that weight loss improves osteoarthritis. We saw this with a semaglutide paper from the New England Journal, but there are ongoing studies examining the use of incretins in patients with psoriatic disease. We know that weight loss works for psoriatic disease in terms of improving skin disease, as well as improving function, patient global assessment, and even overall disease activity in patients with psoriatic arthritis. So it's not surprising that these drugs would also work or not a new idea that these drugs would work, but they may work more quickly and more effectively. And so we'll see what those trials end up telling us about incretins in psoriatic disease.

So in summary, there's a lot happening in psoriatic disease in terms of therapeutics. Check out the session online to learn more about each of these individual therapies and the new therapies available.