The use of ustekinumab in refractory treatment of psoriatic arthritis

We had the opportunity of read the review article of Goldenstein-Schainberg et al.1 about the most important aspects of psoriatic arthritis (PA) over the years. Related to the therapeutic aspects, it is concluded that biologic agents, especially TNF inhibitors (infliximab, etarnecept, adalimumab and golimumab), are used as drugs of last line in refractory cases of the disease. Then, based on existing literature, we show our agreement in this last statement.2,3 However, we consider important to mention alternative therapies. In the clinical trial of Griffiths et al., the autors studied 900 patients with PA who didn’t respond to treatment with one biologic agent. In order to get a better clinical response, they compared two biologic agents: ustekinumab – last biologic agent (monoclonal antibody) approved in 2009 – and etanercept. As a result, they found that patients with ustekinumab had a better and faster clinical response, with both dermatological and joint improvement.4 Cuchacovich reported the same comparison in 2011 and reassured the findings of Griffiths with ustekinumab.2 Furthermore, in the case report of Cuchacovich, the clinical improvement was demonstrated with the use of the combination of the two biologic agents mentioned earlier: ustekinumab and etanercept.3 Above all, to demonstrate the safety of ustekinumab, Cuchacovich reported its use in patients who were refractory to phototherapy, systemic corticosteroids and biologic therapy (including TNF inhibitors). The result not only was favorable but also improved the clinical response in the psoriasis area and in the severity index.2
Authors: Vega-Villanueva, Karen; Cortez-Bazán, Nathaly; Alvarado-Molina, Angela
Source: Rev. Bras. Reumatol
URL: http://hdl.handle.net/10757/314834