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The objective of this report is to perform a systematic review of the beneficial and harmful effects of ustekinumab 45 mg or 90 mg for the treatment of active psoriatic arthritis in adults, alone or in combination with methotrexate. Ustekinumab is a fully human IgG1 kappa monoclonal antibody that binds to the shared p40 subunit of interleukin (IL)-12 and IL-23 and is administered by subcutaneous injection of 45 mg or 90 mg at weeks 0 and 4 and every 12 weeks thereafter.
Psoriatic arthritis (PsA) is a chronic inflammatory arthritis that can be associated with psoriasis, a skin disease. This seronegative form of arthritis can cause inflammation of the peripheral and axial joints, enthesitis, dactylitis, psoriatic skin lesions, and symptoms such as fatigue that are linked to systemic inflammation. Several classes of drugs are employed in the treatment of PsA, including nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs; i.e., methotrexate, sulfasalazine, and leflunomide), immunosuppressives (cyclosporine), and tumour necrosis factor (TNF) alpha inhibitors (i.e., etanercept, infliximab, golimumab, adalimumab, and certolizumab). Methotrexate remains the most frequently used DMARD despite limited evidence (two small controlled trials of inadequate power) that evaluated methotrexate for PsA.
Contents
- Clinical Review Report
- ABBREVIATIONS
- EXECUTIVE SUMMARY
- 1. INTRODUCTION
- 2. OBJECTIVES AND METHODS
- 3. RESULTS
- 4. DISCUSSION
- 5. CONCLUSIONS
- APPENDIX 1. PATIENT INPUT SUMMARY
- APPENDIX 2. LITERATURE SEARCH STRATEGY
- APPENDIX 3. EXCLUDED STUDIES
- APPENDIX 4. DETAILED OUTCOME DATA
- APPENDIX 5. VALIDITY OF OUTCOME MEASURES
- APPENDIX 6. SUMMARY AND APPRAISAL OF MANUFACTURER-SUBMITTED MIXED TREATMENT COMPARISON
- REFERENCES
- Pharmacoeconomic Review Report
- ABBREVIATIONS
- EXECUTIVE SUMMARY OF THE PHARMACOECONOMIC SUBMISSION
- 1. INTRODUCTION
- 2. METHODS
- 3. RESULTS
- 4. DISCUSSION
- 5. CONCLUSIONS
- APPENDIX 1. COST COMPARISON TABLE FOR BIOLOGICS USED FOR THE TREATMENT OF PSORIATIC ARTHRITIS
- APPENDIX 2. DISCREPANCIES BETWEEN THE MTC RESULTS AND THE DATA USED IN THE MODEL
- APPENDIX 3. SUMMARY OF KEY OUTCOMES
- APPENDIX 4. SUMMARY OF OTHER HEALTH TECHNOLOGY ASSESSMENT DECISIONS
- APPENDIX 5. ADDITIONAL INFORMATION
- REFERENCES
- CDEC FINAL RECOMMENDATION
This report was prepared by the Canadian Agency for Drugs and Technologies in Health (CADTH). In addition to CADTH staff, the review team included a clinical expert in rheumatology who provided input on the conduct of the review and the interpretation of findings.
Through the CADTH Common Drug Review (CDR) process, CADTH undertakes reviews of drug submissions, resubmissions, and requests for advice, and provides formulary listing recommendations to all Canadian publicly funded federal, provincial, and territorial drug plans, with the exception of Quebec.
The report contains an evidence-based clinical and/or pharmacoeconomic drug review, based on published and unpublished material, including manufacturer submissions; studies identified through independent, systematic literature searches; and patient group submissions. In accordance with CDR Update — Issue 87, manufacturers may request that confidential information be redacted from the CDR Clinical and Pharmacoeconomic Review Reports.
The information in this report is intended to help Canadian health care decision-makers, health care professionals, health systems leaders, and policy-makers make well-informed decisions and thereby improve the quality of health care services. The information in this report should not be used as a substitute for the application of clinical judgment with respect to the care of a particular patient or other professional judgment in any decision-making process, nor is it intended to replace professional medical advice. While CADTH has taken care in the preparation of this document to ensure that its contents are accurate, complete, and up-to-date as of the date of publication, CADTH does not make any guarantee to that effect. CADTH is not responsible for the quality, currency, propriety, accuracy, or reasonableness of any statements, information, or conclusions contained in the source documentation. CADTH is not responsible for any errors or omissions or injury, loss, or damage arising from or relating to the use (or misuse) of any information, statements, or conclusions contained in or implied by the information in this document or in any of the source documentation.
This document is intended for use in the context of the Canadian health care system. Other health care systems are different; the issues and information related to the subject matter of this document may be different in other jurisdictions and, if used outside of Canada, it is at the user’s risk. This disclaimer and any questions or matters of any nature arising from or relating to the content or use (or misuse) of this document will be governed by and interpreted in accordance with the laws of the Province of Ontario and the laws of Canada applicable therein, and all proceedings shall be subject to the exclusive jurisdiction of the courts of the Province of Ontario, Canada.
CADTH takes sole responsibility for the final form and content of this document, subject to the limitations noted above. The statements and conclusions in this document are those of CADTH and not of its advisory committees and reviewers. The statements, conclusions, and views expressed herein do not necessarily represent the views of Health Canada or any Canadian provincial or territorial government. Production of this document is made possible by financial contributions from Health Canada and the governments of Alberta, British Columbia, Manitoba, New Brunswick, Newfoundland and Labrador, Northwest Territories, Nova Scotia, Nunavut, Ontario, Prince Edward Island, Saskatchewan, and Yukon.
- NLM CatalogRelated NLM Catalog Entries
- Review New targets in psoriatic arthritis.[Rheumatology (Oxford). 2016]Review New targets in psoriatic arthritis.Braun J. Rheumatology (Oxford). 2016 Dec; 55(suppl 2):ii30-ii37.
- Review Treatment of psoriasis and psoriatic arthritis.[BioDrugs. 2013]Review Treatment of psoriasis and psoriatic arthritis.Papoutsaki M, Costanzo A. BioDrugs. 2013 Jan; 27 Suppl 1:3-12.
- Review Psoriatic arthritis: treatment strategies using anti-inflammatory drugs and classical DMARDs.[Reumatismo. 2012]Review Psoriatic arthritis: treatment strategies using anti-inflammatory drugs and classical DMARDs.Lubrano E, Scarpa R. Reumatismo. 2012 Jun 5; 64(2):107-12. Epub 2012 Jun 5.
- Targeted systemic therapies for psoriatic arthritis: a systematic review and comparative synthesis of short-term articular, dermatological, enthesitis and dactylitis outcomes.[RMD Open. 2022]Targeted systemic therapies for psoriatic arthritis: a systematic review and comparative synthesis of short-term articular, dermatological, enthesitis and dactylitis outcomes.McInnes IB, Sawyer LM, Markus K, LeReun C, Sabry-Grant C, Helliwell PS. RMD Open. 2022 Mar; 8(1).
- Review Ustekinumab (Stelara)[ 2017]Review Ustekinumab (Stelara). 2017 Apr
- Ustekinumab (Stelara) InjectionUstekinumab (Stelara) Injection
- Finerenone (Kerendia)Finerenone (Kerendia)
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