TY - JOUR
T1 - Tumor necrosis factor (TNF) inhibitors for psoriatic arthritis
AU - Cagnotto, Giovanni
AU - Bruschettini, Matteo
AU - Stróżyk, Agata
AU - Scirè, Carlo Alberto
AU - Compagno, Michele
PY - 2025/2
Y1 - 2025/2
N2 - BackgroundPsoriatic 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.ObjectivesTo assess the benefits and harms of TNFi in adults with psoriatic arthritis.Search methodsWe searched CENTRAL, MEDLINE, Embase, ClinicalTrials.gov and the World Health Organization trials portal up to 28 March 2024.Selection criteriaWe 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 analysisWe 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 resultsWe 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.
AB - BackgroundPsoriatic 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.ObjectivesTo assess the benefits and harms of TNFi in adults with psoriatic arthritis.Search methodsWe searched CENTRAL, MEDLINE, Embase, ClinicalTrials.gov and the World Health Organization trials portal up to 28 March 2024.Selection criteriaWe 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 analysisWe 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 resultsWe 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.
U2 - 10.1002/14651858.CD013614.pub2
DO - 10.1002/14651858.CD013614.pub2
M3 - Article
C2 - 39945386
SN - 1361-6137
VL - 13
JO - Cochrane Database of Systematic Reviews
JF - Cochrane Database of Systematic Reviews
IS - 2
M1 - CD013614
ER -
