Are TNF-α inhibitors Infliximab and Certolizumab pegol effective in treating adults with Psoriatic Arthritis (PsA) or PsA patients who have previously failed disease-modifying anti-rheumatic drug (DMARD) therapy?

Objective: The objective of this selective EBM review is to determine whether TNF-α inhibitors Infliximab and Certolizumab pegol are effective in treating adults with Psoriatic Arthritis (PsA) or PsA patients who have previously failed disease-modifying anti-rheumatic drug (DMARD) therapy Study Design: Review of three randomized, double-blind, placebo controlled clinical trials published after 2006. Data sources: Three articles were found on PubMed and chosen based upon patient oriented outcomes relevant to the patient population. The population study was adults with psoriatic arthritis (PsA) and patients with PsA who failed prior DMARD therapy. Infliximab and certolizumab pegol were analyzed for treatment efficacy. Outcomes: There were three outcomes measured, looking at different angles to assess the efficacy of infliximab and/or certolizumab pegol. ACR 20 response was the endpoint chosen in one study, household productivity was chosen for another study, and PASI 75 response was the primary outcome in the last study. Results: Atteno et al showed a statistically significant ACR 20 response in patients treated with infliximab. Kavanagh et al demonstrated a statistically significant increase in household productivity in patients treated with certolizumab pegol. Torii et al evidenced a statistically significant PASI 75 response in patients treated with infliximab. Conclusions: The evidence shows that TNF-α inhibitors infliximab and certolizumab pegol are effective in treating adults with psoriatic arthritis as well as PsA patients with prior failure of DMARD therapy. They have been shown in these trials to effectively reduce symptoms of arthritis and psoriasis, and improve quality of life with minimal adverse events compared to control. Prompt treatment of PsA with TNF-α inhibitors may impact the disease progression and joint destruction in patients with PsA