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Tumor necrosis factor (TNF) inhibitors for psoriatic arthritis

Cagnotto, Giovanni LU orcid ; Bruschettini, Matteo LU orcid ; 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:
author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Cochrane Database of Systematic Reviews
volume
13
issue
2
article number
CD013614
publisher
Wiley-Blackwell
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
2025-04-04 13:55:44
@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    = {{Wiley-Blackwell}},
  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}},
}