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Abatacept for the treatment of adults with psoriatic arthritis: patient selection and perspectives

机译：Abatacept治疗成人银屑病关节炎的患者选择和观点

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Psoriatic arthritis (PsA) is a heterogeneous disease with several clinical subtypes including peripheral arthritis, dactylitis, enthesitis, nail disease, and axial arthritis. Nonsteroidal anti-inflammatory drugs, glucocorticoids, and conventional disease-modifying agents are used as first line in the treatment of active PsA. For moderate-to-severe PsA failing conventional therapy, antitumor necrosis factor inhibitors have historically been the drugs of choice. In recent years, novel interleukin-23/interleukin-17 pathway targets such as ustekinumab and secukinumab, and phosphodiesterase-4 inhibitor apremilast have been approved for use in the United States and Europe. Two sets of recommendations for the management of PsA were published in 2016 with consideration for these newer therapies. Since then, the results from a Phase III randomized controlled trial demonstrated that abatacept has efficacy in the treatment of PsA. Abatacept, a cytotoxic-T-lymphocyte-associated antigen 4 (CTLA-4)–Ig human fusion protein, acts to prevent na?ve T-cell activation through the inhibition of the critical CD28 co-stimulatory signal. In the 2017 Active Psoriatic Arthritis Randomized Trial (ASTRAEA), 424 participants were randomized 1:1 to receive subcutaneous abatacept 125?mg weekly versus placebo. At week 24, 39.4% of those who received abatacept achieved a minimum of 20% improvement in the American College of Rheumatology (ACR) response compared to 22.3% in the placebo arm, a statistically significant finding ( P 0.001). The 2011 Phase II study published by Mease et?al demonstrated statistically significant improvements in the ACR20 response by week 169 in participants treated with intravenous abatacept 10?mg/kg (48%) and 30/10?mg/kg (42%) when compared with placebo (19%). This article reviews the data supporting the efficacy of abatacept in the management of PsA and attempts to place this agent in the context of other biologic disease-modifying antirheumatic drugs and targeted small molecules used in the treatment of patients with PsA.
机译：银屑病关节炎（PsA）是一种异质性疾病，具有几种临床亚型，包括外周关节炎，齿根炎，皮炎，指甲病和轴突性关节炎。非甾体类抗炎药，糖皮质激素和常规疾病缓解剂被用作治疗活动性PsA的第一线药物。对于常规治疗失败的中重度PsA，抗肿瘤坏死因子抑制剂一直是首选药物。近年来，新的白介素-23 /白介素17途径靶标，如ustekinumab和secukinumab，以及磷酸二酯酶4抑制剂阿普司特已被批准在美国和欧洲使用。考虑到这些较新的疗法，2016年发布了两组针对PsA管理的建议。从那以后，III期随机对照试验的结果表明，阿巴西普具有治疗PsA的功效。 Abatacept是一种细胞毒性T淋巴细胞相关抗原4（CTLA-4）–Ig人融合蛋白，可通过抑制关键的CD28共刺激信号来防止幼稚T细胞活化。在2017年主动型银屑病关节炎随机试验（ASTRAEA）中，与安慰剂相比，将424名参与者按1：1随机分配，每周接受125？mg皮下阿巴西普治疗。在第24周时，接受阿巴西普治疗的患者中39.4％的美国风湿病学会（ACR）反应至少改善了20％，而安慰剂组为22.3％，具有统计学意义（P <0.001）。 Mease等人发布的2011年II期研究显示，在第169周时，接受静脉内阿巴西普10？mg / kg（48％）和30/10？mg / kg（42％）治疗的参与者在ACR20应答方面有统计学显着改善。与安慰剂相比（19％）。本文回顾了支持abatacept在治疗PsA中的功效的数据，并尝试将该药物用于治疗PsA患者的其他可改变生物疾病的抗风湿药和靶向小分子。

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