Elaine Husni, MD, MPH: Just highlighting on therapeutics for psoriatic arthritis: we now have these new head-to-head clinical trials, where instead of having a specific drug for psoriatic arthritis compared to placebo, we now actually have drug against drug in psoriatic arthritis. This is really new for us.
We're hoping that this will bring a lot of new information to help the clinicians with treatments. Just like in rheumatoid arthritis, we have oral disease-modifying agents—methotrexate being our anchor, our most comfortable, sort of go to medication. However, many patients don't respond completely on methotrexate, and then we need to look at the biologics and the synthetic compounds that are used in psoriatic arthritis. Anti-TNF therapy, for example, is one of our tried and true. It has been really good for the skin and the joints. And then we can go on to the IL-17 inhibitor class; we also have the JAK inhibitors, we also have PDE-4 inhibitors. And then we have some much newer ones that are approved in psoriasis, not psoriatic arthritis quite yet, such as the IL-23 inhibitors. So, we're really expanding our toolbox for this disease. And I think it's important to note that now with these head-to-head trials...they do have some mixed results. So it's not so clear cut.
I think we do have to personalize our care, and really input our clinical judgment into these patients, because not everybody is like a clinical trial patient. So, we really need to look at them in terms of what other comorbidities they might have, what have they tried, Is this a TNF-naive population, is this a methotrexate-naive population. There's lots of questions about how a patient presents and the treatments that we should be offering them.