title: Novel approaches to biological therapy for psoriatic arthritis.
abstract: BACKGROUND
  Improved understanding of the immunopathogenic mechanisms in psoriatic arthritis (PsA) has led to the development of targeted biological therapies, which demonstrate superior clinical efficacy to traditional disease-modifying antirheumatic drugs (DMARDs). There are currently 3 classes of biological agents that are approved for the treatment of psoriatic disease: tumor necrosis factor alpha inhibitors (TNFi), including etanercept, infliximab, adalimumab, golimumab, and certolizumab pegol; ustekinumab, a monoclonal antibody (mAb) directed against interleukin (IL)-12 and IL-23; and secukinumab, a human anti-IL-17A mAb. Other agents are in development. Our growing experience with these medications has revolutionized the approach to disease management in PsA.
  
  
  METHODS
  This article discusses the rationale for using biological therapies in PsA, highlighting clinical trial evidence that supports the use of these agents. We summarize novel treatment approaches using biological therapies in the management of PsA, including early intervention, targeted therapy, TNFi switching, combination therapy, and tapering or discontinuation of biological therapy. We conclude with a discussion of the importance comorbidities have on selection of therapy.
  
  
  CONCLUSIONS
  The advent of highly effective biological therapies has revolutionized the management of patients with PsA. Growing experience with these agents has led to novel treatment approaches that may improve clinical outcomes for PsA patients.
authors.affiliation: a Division of Rheumatology, Schulich School of Medicine & Dentistry , Western University , London , ON , Canada.
authors.forename: Tristan
authors.initials: T
authors.lastname: Boyd
authors.affiliation: b Division of Rheumatology, Allergy, and Immunology, School of Medicine , University of California at San Diego , La Jolla , CA , USA.
authors.forename: Arthur
authors.initials: A
authors.lastname: Kavanaugh
mesh_terms: D000818:Animals; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents / Q000627:therapeutic use; D015535:Arthritis, Psoriatic / Q000175:diagnosis / Q000235:genetics / Q000628:therapy*; D001691:Biological Therapy / Q000379:methods*; D000068582:Certolizumab Pegol / Q000627:therapeutic use; D002986:Clinical Trials as Topic / Q000379:methods; D006801:Humans; D020381:Interleukin-17 / Q000627:therapeutic use; D014409:Tumor Necrosis Factor-alpha / Q000627:therapeutic use
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; C508717:IL17A protein, human; D020381:Interleukin-17; D014409:Tumor Necrosis Factor-alpha; C555450:secukinumab; D000068582:Certolizumab Pegol
keywords: Biological therapy; clinical trials; immunosuppressive agents; interleukin-17 inhibitors; psoriatic arthritis; secukinumab; tumor necrosis factor alpha inhibitors; ustekinumab