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Oxford University Press, Rheumatology Advances in Practice, 2020

DOI: 10.1093/rap/rkaa032



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Systematic literature review of non-topical treatments for early, untreated (systemic therapy naïve) psoriatic disease: a GRAPPA initiative

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This paper was not found in any repository, but could be made available legally by the author.

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Abstract Background Psoriatic disease (PsD) is a complex systemic disorder with cutaneous and musculoskeletal (MSK) manifestations. Current evidence on pharmacological interventions –effective Across-The-Spectrum-Of-Clinical-Manifestations (ATSOCM) of early, systemic treatment-naïve PsD- is limited. This review aims to appraise such evidence. Methods This systematic review examined seven Patient-Intervention-Comparator-Outcome (PICO) research questions to address the interventions’ efficacy on: ATSOCM PsD activity; peripheral arthritis; dactylitis; spondylitis; enthesitis; skin; and nails. Early PsD was defined as a disease duration of ≤ 2 years, except for studies investigating outcomes restricted to the skin. Eligible references were clinical trials or well-designed prospective studies/series reporting on: adult humans, untreated, with cutaneous and/or MSK features of PsD. Results Nine references (out of 160 319, publication range 1946–2019) fulfilled the eligibility criteria. No study adopted comprehensive (that is, simultaneous assessment of different PsD manifestations) composite indices as primary outcome measures. Individual studies reported that apremilast and biologics successfully improved outcomes (DAPSA, MDA, PASDAS, PASI, PsARC) when efficacy analyses were restricted to single manifestations of untreated PsD. Only qualitative synthesis of evidence was possible, due to: a) data heterogeneity (disease classification criteria, outcome measures); b) unavailable data subsets -focused on early, untreated PsD- at single study level; c) insufficient data on the participants’ exposure to previous treatment. Conclusions Effective interventions –albeit limited in scope- for early, treatment-naïve PsD were found. No study provided evidence about the management of co-occurring cutaneous and MSK manifestations in early, treatment-naïve PsD. This review highlighted an unmet need in research on early PsD.