A Better TNF Inhibitor for Treating Psoriatic Arthritis?

Certolizumab pegol (CZP) is a safe alternative tumor necrosis factor-a inhibitor (TNFi) which may offer a few benefits to psoriatic arthritis (PsA) patients that other, similar treatments do not, according to a recent review.

The research was conducted by Maria Laura Acosta-Felquer of the Rheumatology Unit, Internal Medical Services, and University Institute at the Italian Hospital of Buenos Aires in Argentina, and was published in Rheumatology: Research and Reviews on March 30, 2016.

According to the authors, PsA was “once thought of as a benign rheumatic disease is nowadays considered a progressive disease, where a substantial number of patients can develop erosions and major structural damage.” The disease impairs quality of life and can lead to cardiovascular disease and other conditions that raise mortality among PsA patients. The authors say that new treatments are emerging, including “early treatment, remission as a therapeutic goal, the assessment of joint and extra-articular involvement of this heterogeneous disease, and frequent measurement of disease activity in order to adjust the treatment according to the principles of Treat to Target.”

Even though much is still unknown about the pathogenesis and etiology of PsA, and an overall lack of clinical trials, biologic agents such as TNFi, are being used to treat it. CZP is one of five TNFi approved by the US Food and Drug Administration to treat PsA. The authors say, “CZP specifically recognizes and neutralizes human TNF, both the soluble and membrane-bound forms, in a dose-dependent manner.” It has been compared to infliximab (IFX), etanercept, and adalimumab (ADA) and was superior to IFX and ADA.

The reviewers conclude by asking if CZP offers anything different from other TNFi already in use.

They answer the question with, “CZP has some features that might make it an attractive option.” Those features include a long half-life, a lack of complement fixation, pegylation that, they say, “improves distribution into inflamed tissues,” and some evidence that it works quickly and with a long lasting efficacy.