New PsA Guidelines Released by ACR and NPF
Tumor necrosis factor (TNF) inhibitors were recommended as first-line therapy in the new guidelines for the management of active psoriatic arthritis by the American Colleges of Rheumatology and National Psoriasis Foundation (NPF).1
This conditional recommendation is one of many included in the new guidelines to help providers and patients decide between available pharmacologic options. In addition, this is the first guideline that specifically recommends trying TNF inhibitors first over oral small molecule (OSM) therapies and other biologics, such as IL-17 inhibitors.
More than 8 million individuals in the United States have psoriasis, with an estimated 30% developing PsA, according to the NPF. Further, PsA is heterogeneous, which can lead to challenges for specialists when considering various treatment options.
The authors of the new guidelines sought to provide evidence-based treatment recommendations for the management of active PsA in adults using pharmacologic and nonpharmacologic therapies in an effort to help guide both clinicians and patients to optimal disease management.
“The available evidence suggested that in the absence of certain conditions, many treatment-naïve patients would benefit from trying a TNF inhibitor first,” said Dr Dafna Gladman, professor of medicine at the University of Toronto, and member of the NPF Medical Board who served as a content expert on the guideline’s core team, in a press release issued by the National Psoriasis Foundation. “This doesn’t hold true once other symptoms and comorbidities are present, so OSMs can continue to be a first-line option for patients that have contraindications to TNF treatment, as well as patients without severe PsA or psoriasis that prefer oral therapy.”2
Gladman added that providers should consider all active disease domains, comorbidities, and patient functional status when electing optimal therapy for a patient at any time.
Other recommendations located on page 2