Tumor necrosis factor (TNF) inhibitors for psoriatic arthritis
Cagnotto, Giovanni LU
; Bruschettini, Matteo
LU
; Stróżyk, Agata
; Scirè, Carlo Alberto
and Compagno, Michele
LU
(2025)
In Cochrane Database of Systematic Reviews
13(2).
- Abstract
Background
Psoriatic arthritis (PsA) is a chronic arthritis affecting people with psoriasis. If untreated, it may lead to disability. Recommended drugs are non‐steroidal anti‐inflammatory drugs (NSAIDs), corticosteroids, conventional synthetic disease‐modifying anti‐rheumatic drugs (csDMARDs), biologic DMARDs (bDMARDs), and targeted synthetic DMARDs (tsDMARDs). Tumour necrosis factor inhibitors (TNFi) are the first choice bDMARDs.
Objectives
To assess the benefits and harms of TNFi in adults with psoriatic arthritis.
Search methods
We searched CENTRAL, MEDLINE, Embase, ClinicalTrials.gov and the World Health Organization trials portal up to 28 March 2024.
Selection criteria
We included... (More)
Background
Psoriatic arthritis (PsA) is a chronic arthritis affecting people with psoriasis. If untreated, it may lead to disability. Recommended drugs are non‐steroidal anti‐inflammatory drugs (NSAIDs), corticosteroids, conventional synthetic disease‐modifying anti‐rheumatic drugs (csDMARDs), biologic DMARDs (bDMARDs), and targeted synthetic DMARDs (tsDMARDs). Tumour necrosis factor inhibitors (TNFi) are the first choice bDMARDs.
Objectives
To assess the benefits and harms of TNFi in adults with psoriatic arthritis.
Search methods
We searched CENTRAL, MEDLINE, Embase, ClinicalTrials.gov and the World Health Organization trials portal up to 28 March 2024.
Selection criteria
We included randomized controlled trials (RCTs) in adults with PsA, comparing TNFi to placebo, physiotherapy, NSAIDs, corticosteroids, and cs/b/tsDMARDs. Major outcomes included clinical improvement, minimal disease activity, physical function, health‐related quality of life, radiographic progression, serious adverse events, and withdrawals due to adverse events.
Data collection and analysis
We used standard Cochrane methods. The primary comparison was TNFi versus placebo. The primary time point was 12 weeks for clinical improvement; 24 weeks for minimal disease activity, function, quality of life, and radiographic progression; and the end of the trial period for serious adverse events and withdrawals due to adverse events.
Main results
We included 25 RCTs randomizing 7857 participants. Four studies compared TNFi to methotrexate and one to ustekinumab in DMARD‐naïve participants. In csDMARD‐inadequate responders, 11 studies compared TNFi to placebo; four studies compared TNFi to placebo and ixekizumab, bimekizumab, tofacitinib, or upadacitinib; and three studies compared TNFi to ixekizumab, secukinumab, and ustekinumab. Two studies compared different TNFi. We found no studies with b/tsDMARD‐inadequate responders (b/tsDMARD‐IR). No studies compared TNFi to NSAIDs, corticosteroids, or physiotherapy. Performance (32%), detection (56%) and reporting (80%) biases were at high or unclear risk across studies. Only one study had a low risk of bias in all domains.
We limit reporting to the primary comparison, TNFi versus placebo. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/b201ef97-aa9d-4d0f-8d4c-830744b17a22
- author
- Cagnotto, Giovanni
LU
; Bruschettini, Matteo
LU
; Stróżyk, Agata
; Scirè, Carlo Alberto
and Compagno, Michele
LU
- organization
- publishing date
- 2025-02
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Cochrane Database of Systematic Reviews
- volume
- 13
- issue
- 2
- article number
- CD013614
- publisher
- John Wiley & Sons Inc.
- external identifiers
-
- pmid:39945386
- scopus:85218352269
- ISSN
- 1361-6137
- DOI
- 10.1002/14651858.CD013614.pub2
- language
- English
- LU publication?
- yes
- id
- b201ef97-aa9d-4d0f-8d4c-830744b17a22
- date added to LUP
- 2024-12-17 08:53:16
- date last changed
- 2025-07-31 17:38:45
@article{b201ef97-aa9d-4d0f-8d4c-830744b17a22,
abstract = {{<br/>Background<br/><br/>Psoriatic arthritis (PsA) is a chronic arthritis affecting people with psoriasis. If untreated, it may lead to disability. Recommended drugs are non‐steroidal anti‐inflammatory drugs (NSAIDs), corticosteroids, conventional synthetic disease‐modifying anti‐rheumatic drugs (csDMARDs), biologic DMARDs (bDMARDs), and targeted synthetic DMARDs (tsDMARDs). Tumour necrosis factor inhibitors (TNFi) are the first choice bDMARDs.<br/>Objectives<br/><br/>To assess the benefits and harms of TNFi in adults with psoriatic arthritis.<br/>Search methods<br/><br/>We searched CENTRAL, MEDLINE, Embase, ClinicalTrials.gov and the World Health Organization trials portal up to 28 March 2024.<br/>Selection criteria<br/><br/>We included randomized controlled trials (RCTs) in adults with PsA, comparing TNFi to placebo, physiotherapy, NSAIDs, corticosteroids, and cs/b/tsDMARDs. Major outcomes included clinical improvement, minimal disease activity, physical function, health‐related quality of life, radiographic progression, serious adverse events, and withdrawals due to adverse events.<br/>Data collection and analysis<br/><br/>We used standard Cochrane methods. The primary comparison was TNFi versus placebo. The primary time point was 12 weeks for clinical improvement; 24 weeks for minimal disease activity, function, quality of life, and radiographic progression; and the end of the trial period for serious adverse events and withdrawals due to adverse events.<br/>Main results<br/><br/>We included 25 RCTs randomizing 7857 participants. Four studies compared TNFi to methotrexate and one to ustekinumab in DMARD‐naïve participants. In csDMARD‐inadequate responders, 11 studies compared TNFi to placebo; four studies compared TNFi to placebo and ixekizumab, bimekizumab, tofacitinib, or upadacitinib; and three studies compared TNFi to ixekizumab, secukinumab, and ustekinumab. Two studies compared different TNFi. We found no studies with b/tsDMARD‐inadequate responders (b/tsDMARD‐IR). No studies compared TNFi to NSAIDs, corticosteroids, or physiotherapy. Performance (32%), detection (56%) and reporting (80%) biases were at high or unclear risk across studies. Only one study had a low risk of bias in all domains.<br/><br/>We limit reporting to the primary comparison, TNFi versus placebo.}},
author = {{Cagnotto, Giovanni and Bruschettini, Matteo and Stróżyk, Agata and Scirè, Carlo Alberto and Compagno, Michele}},
issn = {{1361-6137}},
language = {{eng}},
number = {{2}},
publisher = {{John Wiley & Sons Inc.}},
series = {{Cochrane Database of Systematic Reviews}},
title = {{Tumor necrosis factor (TNF) inhibitors for psoriatic arthritis}},
url = {{http://dx.doi.org/10.1002/14651858.CD013614.pub2}},
doi = {{10.1002/14651858.CD013614.pub2}},
volume = {{13}},
year = {{2025}},
}