Immunomodulatory Medication Use Among Patients With Psoriatic Arthritis

Anti–interleukin 17 (IL-17) and anti–phosphodiesterase 4 (anti-PDE4) agents made up a significantly higher percentage of initial immunomodulatory medications for patients with psoriatic arthritis (PsA) after 2018, according to study findings published in JCR: Journal of Clinical Rheumatology.

“The significant increase of anti–IL-17 and anti-PDE4 medications as initial treatment after 2018 may reflect their inclusion as potential initial therapy in updated guidelines, along with the importance placed by patients on medication adverse effects,” wrote lead author Monica Schwartzman, MD, and colleagues from the Hospital for Special Surgery in New York City.

The cross-sectional survey included 137 patients from a single-center PsA registry in the summer of 2020. In addition to answering questions about PsA medications, patients ranked their medication preferences using a 5-point Likert scale that ranged from “not at all important” to “extremely important.”

According to study results, the most common first immunomodulatory medications overall were anti-tumor necrosis factor α (35%), methotrexate (19%), and anti-PDE4 (12.4%). The most common immunomodulatory therapies at survey administration were anti-tumor necrosis factor α agents (30%), anti-IL-17 agents (20.4%), and methotrexate (10.2%).

After 2018­­­­—when updated guidelines from the American College of Rheumatology/National Psoriasis Foundation were published—anti-IL-17 agents as first PsA medications increased from 3.5% to 30%, and anti-PDE4 agents as first PsA medications increased from 11.5% to 40%.

When it came to medication preferences, patients ranked the following as “extremely important”: prevention of joint damage (80%), ability to perform daily activities (71%), prevention of pain (70.1%), rheumatologist recommendation (63%), and adverse effects (62%).

“Given the expanding armamentarium of PsA medications,” stated researchers, “it is increasingly important to align patient preferences and therapeutic options to ensure durable use of effective therapy.”

Reference:
Schwartzman M, Abutalib Z, Mandl LA. Current medication practices and preferences among patients with psoriatic arthritis. J Clin Rheumatol. 2022;28(2):55-61. doi: 10.1097/RHU.0000000000001799.