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Updated: Jun 17, 2025
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The Goeckerman Regimen for the Treatment of Moderate to Severe Psoriasis
Published on: July 11, 2013
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Treatment with Targeted Therapy in Patients with Psoriatic Arthritis and Inadequate Response to Methotrexate:
Philippe Goupille1, Guillermo Carvajal Alegria2, Frank Verhoeven3
1Rheumatology Department, CHU de Tours, UPR CNRS 4301 CBM, NMNS, University of Tours, 37044, Tours Cedex 9, France. goupille@med.univ-tours.fr.
Rheumatology and Therapy
|August 12, 2024
Summary
For psoriatic arthritis patients who fail methotrexate, continuing it with anti-TNFα therapy is advised. Discontinuing methotrexate may be possible with other targeted therapies like anti-IL-17 or JAK inhibitors.
Area of Science:
- Rheumatology
- Immunology
- Pharmacology
Background:
- Psoriatic arthritis (PsA) treatment options are expanding, necessitating optimal use of targeted therapies.
- Methotrexate (MTX) is a common initial treatment for PsA, but many patients eventually require alternative or additional therapies.
Purpose of the Study:
- To guide the selection of first-line targeted therapy for PsA patients who have not responded adequately to methotrexate.
- To provide a rational strategy for optimizing treatment choices based on drug class and patient response.
Main Methods:
- Literature review of PubMed using keywords related to MTX tolerance, combination therapy efficacy, and immunogenicity of targeted agents.
- Analysis of data on therapeutic maintenance of anti-tumor necrosis factor alpha (TNFα) and anti-interleukin (IL) therapies.
- Evaluation of immunogenicity and maintenance strategies for various targeted therapies in PsA.
Main Results:
- Continuing methotrexate with anti-tumor necrosis factor alpha (TNFα) agents is recommended to prevent immunogenicity and maintain therapeutic effect.
- Discontinuation of methotrexate may be feasible when initiating anti-interleukin (IL)-17, anti-IL-12/23, anti-IL-23 agents, or Janus kinase (JAK) inhibitors, after assessing efficacy.
- The decision to continue or discontinue methotrexate should be guided by the specific targeted therapy and patient response.
Conclusions:
- The study provides a literature-based strategy to guide first-line targeted therapy selection in PsA patients with MTX failure.
- Optimizing targeted therapy choice can improve outcomes and treatment adherence in psoriatic arthritis.
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