Over 300 thousand people in Italy are diagnosed with psoriatic arthritis, a chronic inflammatory disease that involves the skin, joints and tendons and develops when the immune system attacks healthy tissues and cells. Today these patients have at their disposal new therapeutic opportunity: tofacitinib citrate, the first oral drug Janus kinase inhibitor (Jak) approved for this progressive and debilitating pathology, which occurs in one out of three patients with psoriasis and who, even today, is underdiagnosed and with various unmet medical needs: in fact, satisfactory alternatives are scarce for patients intolerant or non-responsive to (Dmard ), disease-modifying antirheumatic drugs or TNF inhibitors.
The drug is available and refundable in Italy in combination with methotrexate for the treatment of active psoriatic arthritis in adult patients who have responded inadequately or are intolerant to previous Dmard therapy). Tofacitinib citrate, already available in Italy for the treatment of rheumatoid arthritis and ulcerative colitis, is the JAK inhibitor with the largest number of approved indications. “Tofacinitib has been used for many years now: it is the first, the forerunner of this class of JAK-inhibitor drugs,” he says. Francesco Ciccia, full professor of Rheumatology and director of the School of Specialization in Rheumatology, University of Campania Luigi Vanvitelli.
Its “pluses are the oral administration method and the mechanism of action – explains the rheumatologist – which simultaneously blocks several cytokines involved in the inflammatory signal. From a clinical point of view, the results in the treatment of psoriatic arthritis are excellent, with an improvement in joint inflammation, a reduction in the number of swollen and painful joints and above all with an impressive effect on the painful component, as it acts by modulating the nociceptive signal in a negative sense, for which the patient reports a rapid well-being already after the first weeks of administration, with a very significant reduction in pain. We have a new weapon at our disposal to treat our patients, many of whom until now remained ‘active’ despite our therapeutic efforts. Tofacitinib is a different drug than those approved to date and represents an additional opportunity for patients to achieve remission of joint symptoms and a good quality of life “.
Psoriatic arthritis – remember a note – can occur in different clinical manifestations, including peripheral arthritis, enthesitis, dactylitis, spondylitis and psoriasis with skin and nail involvement. It is characterized by pain, stiffness, swelling of the joints that can affect the entire body and, if left untreated, can cause permanent damage to the joints and tissues: functional disability is observed in 20% of patients and, after 10 years, the 55% of patients develop deformation in five or more joints. With the progression of the disease, the impact it may have on patients’ health-related quality of life (HRQoL) is believed to be similar to that of diabetes, heart disease and cancer. Early diagnosis is essential to slow the progression of the disease, the development of any comorbidities and the deterioration of the patients’ quality of life. But even today it is an often underdiagnosed pathology.
“Early diagnosis and prompt treatment are key – explains Roberto Caporali, full professor of Rheumatology at the University of Milan, director of the Department of Rheumatology and Medical Sciences Asst ‘Gaetano Pini’-Cto of Milan – however, an underdiagnosis is still observed today, for various reasons. Firstly, it has only recently been in some Centers that there has been close collaboration between dermatologist and rheumatologist, which is essential to simplify the early identification of those patients who have early stage arthritis. Secondly, it is often difficult for the patient and the general practitioner to understand which specialist is the reference. In fact, it often happens that patients are referred to specialists other than the rheumatologist. Thirdly, rheumatologists themselves should be able to create paths dedicated to these patients with early forms, which should be seen immediately avoiding unnecessary waiting lists that could delay the diagnosis “.
“Our science today is tightly integrated into all aspects of our work and this allows us to have a new approach, more open to collaborations, more focused on objectives – he declares Francesca Cozzolino, Pfizer Director of Inflammation & Immunology in Italy – and in our opinion more effective in responding to the needs of patients. We have concentrated our efforts in areas where we believe we can make a unique contribution and respond to important needs, such as chronic inflammatory autoimmune diseases, and this new indication is certainly an example of this. “