ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 7L

Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA): Treatment Recommendations for Psoriatic Arthritis 2015

Laura C Coates1,2, Arthur Kavanaugh3, Philip J. Mease4, Enrique R. Soriano5, M Laura Acosta-Felquer6, April W Armstrong7, Wilson Bautista-Molano8, Wolf-Henning Boehncke9, Willemina Campbell10, Alberto Cauli11, Luis Espinoza12, Oliver FitzGerald13, Dafna D. Gladman14, Alice B. Gottlieb15, Philip S. Helliwell2, M. Elaine Husni16, Thorvardur Love17,18, Ennio Lubrano19, Neil J McHugh20, Peter Nash21, Alexis Ogdie-Beatty22, Ana-Maria Orbai23, Andrew Parkinson24, Denis O'Sullivan25, Cheryl F Rosen26, Sergio Schwartzman27, Evan Siegel28, Sergio Toloza29, William Tuong30 and Christopher T. Ritchlin31, 1Medicine, University of Rochester, Rochester, NY, 2Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom, 3University of California San Diego, La Jolla, CA, 4Rheumatology Research, Swedish Medical Center, Seattle, WA, 5Rheumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, 6Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, 7Keck School of Medicine, University of Southern California, Los Angeles, CA, 8Department of Rheumatology, Faculty of Medicine HMC/UMNG, Bogota, Colombia, Bogotá, Colombia, 9Department of Dermatology,, Geneva University Hospital, Geneva, Switzerland, 10Toronto Western Hospital, Toronto, ON, Canada, 11University of Cagliari, Cagliari, Italy, 12Medicine-Section of Rheumatology, LSU Medical Center, New Orleans, LA, 13Department of Rheumatology, St. Vincent’s University Hospital, UCD School of Medicine and Medical Sciences and Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland, 14Division of Rheumatology, Toronto Western Hospital and University of Toronto, Toronto, ON, Canada, 15Tufts Medical Center, Boston, MA, 16Rheumatology Dept A50, Cleveland Clinic, Cleveland, OH, 17Faculty of Medicine, University of Iceland, Reykjavik, Iceland, 18Landspitali University Hospital, Reykjavík, Iceland, 19Cattedra di Reumatologia, Università del Molise, Campobasso, Italy, 20Royal National Hospital for Rheumatic Diseases, Bath, United Kingdom, 21Department of Medicine, University of Queensland, Brisbane, Australia, 22Medicine/Rheumatology, Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, 23Rheumatology, Johns Hopkins University, Baltimore, MD, 24Chapel Allerton Hospital, Leeds, United Kingdom, 25St. Vincent’s University Hospital, Dublin, Ireland, 26Division of Dermatology, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada, 27Rheumatology, Hospital for Special Surgery, New York, NY, 28Arthritis & Rheumatism Assoc, Wheaton, MD, 29Rheumatology, Ministry of Health, San Fernando del Valle de Catamarca, Argentina, 30Department of Dermatology, University of California David, Davis, CA, 31Allergy, Immunology and Rheumatololgy Division, University of Rochester Medical Center, Rochester, NY

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: October 27, 2015

Keywords: , , ,

Session Information

Date: Tuesday, November 10, 2015

Title: ACR Late-breaking Abstract Poster Presentations

Session Type: ACR Late-breaking Abstract Session

Session Time: 9:00AM-11:00AM

Background/Purpose:  Since
the 2009 GRAPPA treatment recommendations were published, therapeutic options
and management strategies for psoriatic arthritis (PsA) have advanced considerably.
We updated and improved these recommendations through development of
overarching management principles and evidence based guidance for treatment of
the different manifestations of PsA including associated comorbidities.

 

Methods:  GRAPPA
rheumatologists, dermatologists, and patient research partners (PRPs) drafted
overarching principles for the management of adult PsA patients by consensus.  We
updated systematic literature reviews based on data publicly available through
November 2014.  Six separate literature reviews were performed covering
treatment for the key clinical manifestations of PsA (arthritis, spondylitis,
enthesitis, dactylitis, skin, and nail disease), and we reviewed a new topic
(PsA related comorbidities).  Evidence was assessed, and the GRADE system was
applied to generate strong or conditional recommendations for therapies within
the domain groups and for the management of comorbidities.  These
recommendations were then incorporated into an overall treatment schema.  Consensus
for the overarching principles and treatment recommendations was obtained among
GRAPPA members with an online questionnaire.

Results: GRAPPA members
voted on six overarching principles developed through multiple iterations with significant
agreement among both health care professionals (HCPs; n=135, agreement
83.7-92.6% for individual principles) and PRPs (n=10, agreement 80-100%).  Evidence
was assessed from the published literature reviews and formally evaluated with
the GRADE system to provide treatment recommendations (table 1).  Based on the evidence,
individual groups developed treatment recommendations which were incorporated
into an overall schema including principles for management of arthritis,
spondylitis, enthesitis, dactylitis, skin, and nail disease, and comorbidities in
PsA (figure 1).  Consensus amongst the GRAPPA members was 87.2% agreement
(n=176) for the treatment recommendations and 87.9% (n=176) for the schema.

Conclusion:  Based on the
results of the literature review and GRADE assessment of the evidence, we developed
updated comprehensive treatment recommendations for the key manifestations of
PsA, including related comorbidities.  These recommendations are supplemented
by overarching principles developed by consensus of GRAPPA members
(rheumatologists, dermatologists, other HCPs, and PRPs). 

 

 

Indication

Recommended

Strong

Recommended

Weak

Not recommended

Strong

No recommendations as lack of evidence

Peripheral Arthritis DMARD Naïve

DMARDs (MTX, SSZ, LEF), TNFi

NSAIDs, oral CS, IA CS, PDE4i

 

IL12/23i, IL17i

Peripheral Arthritis DMARD Inadequately Responsive

TNFi, ustekinumab, PDE4i

NSAIDs, oral CS, IA CS, IL17i

 

 

Peripheral Arthritis

Biologic Inadequately

Responsive

TNFi

NSAIDs, oral CS, IA CS, IL12/23i, IL17i, PDE4i

 

 

Axial PsA, Biologic Naïve (based on AS literature)

NSAIDs, Physiotherapy, simple analgesia, TNFi

IL17i, CS SIJ injections, bisphosphonates (IL12/23i)

DMARDs, IL6i, CD20i

 

Axial PsA, Biologic Inadequately Responsive (based on AS literature)

NSAIDs, Physiotherapy, simple analgesia

TNFi, IL12/23i, IL17i

 

 

Enthesitis

TNFi, IL12/23i,

NSAIDs, physiotherapy, CS injections (with extreme caution since injecting CS in weight-bearing entheseal sites can lead to rupture of entheses), PDE4i, IL17i

 

 DMARDs

Dactylitis

TNFi (INF, ADM, GOL, CZP)

CS injections, DMARDs (MTX, LEF, SSZ), TNFi (ETN), IL12/23i, IL17i (SEC), PDE4i

 

 

Psoriasis (plaque)

Topical therapies, phototherapy, DMARDs (MTX, LEF, CyA), TNFi, IL12/23i, IL17i, PDE4i

 

 

 

Nail psoriasis

TNFi, IL12/23i

Topical therapies, procedural therapies, DMARDs (CyA, LEF, Acitretin, MTX), IL17i, PDE4i

 

 

Italicized text identifies conditional recommendations for drugs without current regulatory approvals or where recommendations are based on abstract data only. 

Italicized text in brackets identifies a conditional recommendation based only on abstract data from a small open-label proof-of-concept trial.

ADM = adalimumab, AS = ankylosing spondylitis, CD20i = CD20 inhibitor, CS = corticosteroids, CyA = cyclosporin, CZP = certolizumab, DMARDs = disease modifying anti-rheumatic drugs, GOL = golimumab, IA = intra‑articular, IL6i = interleukin 6 inhibitor, IL17i = interleukin 17 inhibitor, IL12/23i = interleukin 12/23 inhibitor, INF = infliximab, LEF = leflunomide, MTX  = methotrexate, NSAIDs = nonsteroidal anti-inflammatory drugs, PDE4i = phosphodiesterase 4 inhibitor (apremilast), SEC = secukinumab, SIJ = sacroiliac injections, SSZ = sulfasalazine, TNFi = tumor necrosis factor inhibitor

 

 

Disclosure: L. C. Coates, Abbvie, 2,Janssen Pharmaceutica Product, L.P., 2,Abbvie, 5,UCB, 5,Pfizer Inc, 5,Boehringer Ingelheim, 5,MSD, 5,Celgene, 5,Janssen Pharmaceutica Product, L.P., 5; A. Kavanaugh, Amgen, 5,Abbvie, 5,Janssen Pharmaceutica Product, L.P., 5,Novartis Pharmaceutical Corporation, 5,Celgene, 5; P. J. Mease, Celgene, 5,Crescendo, 5,Corrona, 5,Genentech and Biogen IDEC Inc., 5,Janssen Pharmaceutica Product, L.P., 5,Lilly, 5,Merck Pharmaceuticals, 5,Novartis Pharmaceutical Corporation, 5,Abbvie, 5,Amgen, 5,Bristol-Myers Squibb, 5,Pfizer Inc, 5,UCB, 5; E. R. Soriano, Abbvie, 5,Pfizer Inc, 5,UCB, 5,Janssen Pharmaceutica Product, L.P., 5,Roche Pharmaceuticals, 5,Novartis Pharmaceutical Corporation, 5,BMS, 5; M. L. Acosta-Felquer, None; A. W. Armstrong, Abbvie, 5,Amgen, 5,Janssen Pharmaceutica Product, L.P., 5,Merck Pharmaceuticals, 5,Lilly, 5,Novartis Pharmaceutical Corporation, 5,Pfizer Inc, 5; W. Bautista-Molano, None; W. H. Boehncke, Abbvie, 5,Allmirall, 5,Amgen, 5,Biogen Idec, 5,Celgene, 5,Covagen, 5,Janssen Pharmaceutica Product, L.P., 5,Lilly, 5,MSD, 5,Novartis Pharmaceutical Corporation, 5,Pfizer Inc, 5; W. Campbell, None; A. Cauli, Abbvie, 5,Celgene, 5,Janssen Pharmaceutica Product, L.P., 5,UCB, 5; L. Espinoza, Pfizer Inc, 5; O. FitzGerald, Pfizer Inc, 5,BMS, 5,Abbvie, 5,Celgene, 5,Lilly, 5,Janssen Pharmaceutica Product, L.P., 5,UCB, 5; D. D. Gladman, Abbvie, 5,Amgen, 5,Celgene, 5,BMS, 5,Janssen Pharmaceutica Product, L.P., 5,Novartis Pharmaceutical Corporation, 5,Pfizer Inc, 5,UCB, 5; A. B. Gottlieb, Amgen, AbbVie, Celgene, Coronado, Eli Lilly, Janssen, Levia, Merck, Pfizer, 2,AbbVie, Actelion, Akros, Amgen, Astellas, Bristol Myers Squibb, Canfite, Catabasis, Celgene, Coronado, CSL Behring Biotherapies for Life, Dermipsor, Eli Lilly, GlaxoSmithKline, Incyte, Janssen, Karyopharm, Novartis, Novo Nordisk, Pfizer, Sanofi Aventix, 5,UCB Pharma, Vertex, Xenoport, 5; P. S. Helliwell, Abbvie, 5,Pfizer Inc, 5,Amgen, 5,Novartis Pharmaceutical Corporation, 5,Janssen Pharmaceutica Product, L.P., 5; M. E. Husni, Abbvie, 5,Amgen, 5,BMS, 5,Celgene, 5,Janssen Pharmaceutica Product, L.P., 5,Lilly, 5,Novartis Pharmaceutical Corporation, 5,Genentech and Biogen IDEC Inc., 5,UCB, 5; T. Love, None; E. Lubrano, None; N. J. McHugh, Abbvie, 5,Pfizer Inc, 5,Celgene, 5,Novartis Pharmaceutical Corporation, 5; P. Nash, Amgen, 5,BMS, 5,Abbvie, 5,Pfizer Inc, 5,Roche Pharmaceuticals, 5,UCB, 5,Janssen Pharmaceutica Product, L.P., 5,Novartis Pharmaceutical Corporation, 5,Lilly, 5; A. Ogdie-Beatty, None; A. M. Orbai, None; A. Parkinson, None; D. O'Sullivan, None; C. F. Rosen, Abbvie, 5,Janssen Pharmaceutica Product, L.P., 5,Celgene, 5,Amgen, 5; S. Schwartzman, Genentech and Biogen IDEC Inc., 5,Janssen Pharmaceutica Product, L.P., 5,Abbvie, 5,Pfizer Inc, 5,UCB, 5,Antares, 5,Medac, 5,Hospira, 5,Novartis Pharmaceutical Corporation, 5,AP Pharma, 5,Pfizer Inc, 1; E. Siegel, Amgen, 5,Janssen Pharmaceutica Product, L.P., 5,Celgene, 5,Abbvie, 5; S. Toloza, None; W. Tuong, None; C. T. Ritchlin, Amgen, 2,UCB, 2,Abbvie, 2,Abbvie, 5,Amgen, 5,Boehringer Ingelheim, 5,Janssen Pharmaceutica Product, L.P., 5,Novartis Pharmaceutical Corporation, 5,Regeneron, 5.

To cite this abstract in AMA style:

Coates LC, Kavanaugh A, Mease PJ, Soriano ER, Acosta-Felquer ML, Armstrong AW, Bautista-Molano W, Boehncke WH, Campbell W, Cauli A, Espinoza L, FitzGerald O, Gladman DD, Gottlieb AB, Helliwell PS, Husni ME, Love T, Lubrano E, McHugh NJ, Nash P, Ogdie-Beatty A, Orbai AM, Parkinson A, O'Sullivan D, Rosen CF, Schwartzman S, Siegel E, Toloza S, Tuong W, Ritchlin CT. Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA): Treatment Recommendations for Psoriatic Arthritis 2015 [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/group-for-research-and-assessment-of-psoriasis-and-psoriatic-arthritis-grappa-treatment-recommendations-for-psoriatic-arthritis-2015/. Accessed .

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