Claim: Drug for refractory psoriatic arthritis shows promise in clinical trial
Verdict: SUPPORTS

Retrieved passages:
title: Psoriatic arthritis
text: tablet form and taken by mouth. Side effects include headaches, back pain, nausea, diarrhea, fatigue, nasopharyngitis and upper respiratory tract infections, as well as depression and weight loss. Patented in 2014 and manufactured by Celgene, there is no current generic equivalent available on the market. A review found tentative evidence of benefit of low level laser therapy and concluded that it could be considered for relief of pain and stiffness associated RA. Retinoid etretinate is effective for both arthritis and skin lesions. Photochemotherapy with methoxy psoralen and long-wave ultraviolet light (PUVA) are used for severe skin lesions. Doctors may use

title: Psoriatic arthritis
text: as the IL-12/IL-23 inhibitor ustekinumab. Biologics may increase the risk of minor and serious infections. More rarely, they may be associated with nervous system disorders, blood disorders or certain types of cancer. A first-in-class treatment option for the management of psoriatic arthritis, apremilast is a small molecule phosphodiesterase-4 inhibitor approved for use by the FDA in 2014. By inhibiting PDE4, an enzyme which breaks down cyclic adenosine monophosphate, cAMP levels rise, resulting in the down-regulation of various pro-inflammatory factors including TNF-α, interleukin 17 and interleukin 23, as well as the up-regulation of anti-inflammatory factor interleukin 10. It is given in

title: Ixekizumab
text: months of treatment (depending on the dosing scheme), and 40% of patients experienced a complete absence of psoriasis symptoms (PASI100). In the placebo group, PASI75 was reached in 4% of patients, and PASI100 in none; in the group of patients receiving etanercept, an older anti-psoriasis drug, PASI75 was reached in 48%. Until the 60th study week, 11–44% of ixekizumab treated patients relapsed (again, depending on the dosing scheme), as compared to 84% under placebo. In December 2017 the US FDA approved it for active psoriatic arthritis. The drug is contraindicated for patients with certain infections such as active tuberculosis. In

title: Psoriatic arthritis
text: sulfasalazine. These immunosuppressant drugs can also reduce psoriasis skin symptoms but can lead to liver and kidney problems and an increased risk of serious infection. The most recent class of treatment is called biological response modifiers or biologics has been developed using recombinant DNA technology. Biologic medications are derived from living cells cultured in a laboratory. Unlike traditional DMARDS that affect the entire immune system, biologics target specific parts of the immune system. They are given by injection or intravenous (IV) infusion. Biologics prescribed for psoriatic arthritis are TNF-α inhibitors, including infliximab, etanercept, golimumab, certolizumab pegol and adalimumab, as well

title: GSK2831781
text: of IMP731 can prevent, for many months, Th1-driven skin inflammation in the tuberculin-induced DTH model in primates. This evidence suggested to GSK the potential of psoriasis as an initial proof-of-concept indication for GSK2831781. GSK2831781's first clinical trial is a Phase I in both psoriasis patients and healthy individuals. The trial is expected to recruit around 63 subjects, half of whom will be healthy and half of whom will have plaque psoriasis. The healthy subjects will be given BCG in order to track DTH and subsequent response to antibody treatment. The study will be randomized, double blind, placebo-controlled, and single ascending

title: Upadacitinib
text: did not appear to be dose-related. A single case of non-melanoma skin cancer was reported in the 24 mg twice daily group. Abbvie has planned a total of six phase III trials that will evaluate over 4,000 patients with moderate to severe rheumatoid arthritis. Two phase III trials are planned studying patients with psoriatic arthritis and one in patients with ulcerative colitis. Filgotinib is also a selective inhibitor of JAK1. Upadacitinib Upadacitinib (code name ABT-494) is a drug which is currently under investigation for the treatment of rheumatoid arthritis, Crohn's disease, ulcerative colitis, atopic dermatitis and psoriatic arthritis. It was

title: Tofacitinib
text: investigational drug in psoriasis. Tofacitinib has demonstrated its effectiveness for plaque psoriasis in Phase 3 randomized, controlled trials in comparison to placebo and to etanercept. In particular, a 10 mg twice-daily dose of tofacitinib was shown to be noninferior to etanercept 50 mg subcutaneously twice weekly. Based on preclinical studies in a mouse model of the disease, tofacitinib has been investigated for the treatment of alopecia areata. Early case reports suggested potential efficacy, as did a phase II open-label clinical trial, published in tandem with a phase II clinical trial showing the same for ruxolitinib. In a June 2015 case

title: Tildrakizumab
text: $80 million. Upon product approval, Sun Pharmaceutical will be responsible for regulatory activities, including subsequent submissions, pharmacovigilance, post approval studies, manufacturing and commercialization of the approved product. As of March 2014, the drug was in phase III clinical trials for plaque psoriasis. The two trials enrolled nearly 2000 patients. In 2016, tildrakizumab became the first IL-23p19 inhibitor to demonstrate positive results in Phase-3 clinical trials for the treatment of moderate-to-severe plaque psoriasis, further validating the importance of the role of IL-23 in psoriasis. Sun Pharma signed a licensing pact with Spain's Almirall for marketing tildrakizumab in Europe In March 2018,

title: Ponesimod
text: Ponesimod Ponesimod (INN, codenamed ACT-128800) is an experimental drug for the treatment of multiple sclerosis (MS) and psoriasis. It is being developed by Actelion. In a 2009–2011 Phase II clinical trial including 464 MS patients, ponesimod treatment resulted in fewer new active brain lesions than placebo, measured during the course of 24 weeks. In a 2010–2012 Phase II clinical trial including 326 patients with psoriasis, 46 or 48% of patients (depending on dosage) had a reduction of at least 75% Psoriasis Area and Severity Index (PASI) score compared to placebo in 16 weeks. Common adverse effects in studies were temporary

title: Adalimumab
text: and older, and is approved for the treatment of that condition. In RA, it has been approved for use alone, or with methotrexate or similar medicines, in the U.S. since 2002. In 2003, adalimumab began undergoing trials for use in treating psoriasis and psoriatic arthritis. Adalimumab has been shown to reduce the signs and symptoms of, and is approved for treatment of, ankylosing spondylitis in adults. Adalimumab has been shown to reduce the signs and symptoms of moderate to severe Crohn's disease. It has been approved for that use in the UK since 2009. Adalimumab may be effective and well

title: TNF inhibitor
text: guidelines for the treatment of severe psoriasis using the anti-TNF drugs etanercept (Enbrel) and adalimumab (Humira) as well as the anti-IL12/23 biological treatment ustekinumab (Stelara). In cases where more conventional systemic treatments such as psoralen combined with ultraviolet A treatment (PUVA), methotrexate, and ciclosporin have failed or can not be tolerated, these newer biological agents may be prescribed. Infliximab (Remicade) may be used to treat severe plaque psoriasis if aforementioned treatments fail or can not be tolerated. In 2010 The National Institute of Clinical Excellence (NICE) in the UK issued guidelines for the treatment of severe Crohn's Disease with Infliximab

title: Ustekinumab
text: psoriasis. On September 24, 2013, the FDA approved the use of ustekinumab for the treatment of psoriatic arthritis. On December 12, 2008 the Canadian Health Authority approved the use of ustekinumab for the treatment of chronic moderate to severe plaque psoriasis in adult patients who are candidates for phototherapy or systemic therapy. The FDA approved the drug on September 25, 2009 for the treatment of adult patients with moderate to severe plaque psoriasis. The FDA approved the drug in September 2016 for the treatment of Crohn's disease. In September 2008, Centocor released result of a study comparing etanercept and ustekinumab.

title: Rheumatology
text: Drugs), monoclonal antibodies, such as infliximab and adalimumab, and the soluble TNF receptor etanercept and Methotrexate for moderate to severe Rheumatoid arthritis. Biologic agent Rituximab (Anti-B-Cell Therapy) is now licensed for use in refractory Rheumatoid Arthritis. Physiotherapy is vital in the treatment of many rheumatological disorders. Occupational therapy can help patients finding alternative ways for common movements which would otherwise be restricted by their disease. Patients with rheumatoid arthritis often need a long term, coordinated and a multidisciplinary team approach towards management of individual patients. Treatment is often tailored according to the individual needs of each patient which is also

title: Infliximab
text: medication, compared with 21% of patients who were treated with placebo medication. At two months, the response was 61-69% for patients treated with infliximab, and 31% for those treated with placebo. In psoriatic arthritis (PsA), inhibitors of TNF, such as infliximab, improve the signs and symptoms. Several therapies with modest efficacy have been studied in nail psoriasis. Among available agents, higher quality data are available to support the efficacy of cyclosporine and infliximab. Based on studies in AS, the results suggest infliximab, etanercept, and adalimumab have the potential to reduce the signs and symptoms of moderate to severely active axial

title: Psoriatic arthritis
text: an increased rate of cardiovascular events such as myocardial infarction (MI) or heart attack, and stroke. Both COX-2 inhibitors and other non-selective NSAIDS have potential adverse effects that include damage to the kidneys. These are used in persistent symptomatic cases without exacerbation. Rather than just reducing pain and inflammation, this class of drugs helps limit the amount of joint damage that occurs in psoriatic arthritis. Most DMARDs act slowly and may take weeks or even months to take full effect. Drugs such as methotrexate or leflunomide are commonly prescribed; other DMARDS used to treat psoriatic arthritis include cyclosporin, azathioprine, and

title: Psoriasis
text: to use outside of research settings, which has led to attempts to simplify the index for clinical use. While no cure is available for psoriasis, many treatment options exist. Topical agents are typically used for mild disease, phototherapy for moderate disease, and systemic agents for severe disease. Topical corticosteroid preparations are the most effective agents when used continuously for 8 weeks; retinoids and coal tar were found to be of limited benefit and may be no better than placebo. Greater benefit has been observed with very potent corticosteroids when compared to potent corticosteroids. Vitamin D analogues such as paricalcitol were

title: Development of analogs of thalidomide
text: 2012, where a decision could come as soon as early 2013. EMA has already granted pomalidomide an orphan designation for primary myelofibrosis, MM, systemic sclerosis, post-polycythaemia and post-essential thrombocythaemia myelofibrosis. As of September 2012 apremilast is in phase III trials for psoriasis and phase II trials for rheumatoid arthritis. Efficacy in ankylosing spondylitis is also being tested. As of March 2014 apremilast has been approved for psoriatic arthritis. In September 2014, the U.S. FDA approved apremilast for the treatment of moderate-to-severe plaque psoriasis. The thalidomide molecule is a synthetic derivative of glutamic acid and consists of a glutarimide ring and

title: Psoriasis
text: and ustekinumab were the most effective biologics for treating psoriasis. In general, anti-IL17, anti-IL12/23, anti-IL23, and anti-TNF alpha biologics were found to be more effective than traditional systemic treatments. The immunologic pathways of psoriasis involve TH-9, TH-22, TH-17 and TH-1 lymphocytes, and the above biologics hinder different aspects of these pathways. Another treatment for moderate to severe psoriasis is fumaric acid esters (FAE) which may be similar in effectiveness to methotrexate. Limited evidence suggests removal of the tonsils may benefit people with chronic plaque psoriasis, guttate psoriasis, and palmoplantar pustulosis. Uncontrolled studies have suggested that individuals with psoriasis or psoriatic

title: Psoriasis
text: Data are inconclusive with respect to non-melanoma skin cancer risk, but support the idea that the therapy is associated with an increased risk of benign forms of sun-induced skin damage such as, but not limited to, actinic elastosis or liver spots. Dead Sea balneotherapy is also effective for psoriatic arthritis. Phototherapy in the form of sunlight has long been used for psoriasis. UVB Wavelengths of 311–313 nanometers are most effective, and special lamps have been developed for this application. The exposure time should be controlled to avoid over exposure and burning of the skin. The UVB lamps should have a

title: Infliximab
text: reduce the efficacy of the drug. Combination treatment with methotrexate (an antifolate drug which suppresses the immune system) has been shown to reduce the formation of these antibodies in patients with rheumatoid arthritis and combination therapy with other immunosuppressants has been shown to reduce the likelihood of these antibodies being formed in Crohn's disease. The use of immunosuppressants may not be necessary in all diseases for which infliximab is indicated, and indiscriminant uses of these other immunosuppressants carry their own risks. Infliximab was studied in monotherapy (without concomitant immunosuppressants such as methotrexate or azathioprine) in psoriasis, psoriatic arthritis, and ankylosing