OBJECTIVE: To update the evidence on the efficacy and safety of pharmacological 
agents in psoriatic arthritis (PsA).
METHODS: Systematic literature review of randomised controlled trials comparing 
pharmacological interventions in PsA: non-steroidal anti-inflammatory drugs, 
glucocorticoid, synthetic disease modifying antirheumatic drugs (sDMARDs) either 
conventional or targeted, biologicals (bDMARDs), placebo or any combination. 
Main outcomes were American College of Rheumatology (ACR)20-50, Psoriasis Area 
Severity Index 75, radiographic progression, and withdrawals due to adverse 
events (AEs). Multiple studies of the same intervention were meta-analysed using 
random effects.
RESULTS: In total, 25 papers and 12 abstracts were included. The efficacy of 
tumour necrosis factor inhibitors (including the recently added golimumab and 
certolizumab pegol) was confirmed and 16 articles/abstracts focused on 3 drugs 
with new modes of action: ustekinumab (UST), secukinumab (SEC) and apremilast 
(APR). All were placebo-compared trials and met their primary end point, ACR20. 
In 2 studies with UST ACR20 was met by 50% and 44% of patients with UST 90 mg, 
42% and 44% with UST 45 mg vs 23% and 20% with placebo, respectively. In two 
studies with SEC ACR20 ranged 54% (SEC 300 mg), 50-51% (SEC 150 mg), 29-51% (SEC 
75 mg) and 15-17% (placebo). In four studies with APR, ACR20 ranged 32-43% (APR 
30 mg), 29-38% (APR 20 mg) and 17-20% (placebo). For all three drugs, no more 
withdrawals due to AEs than placebo were seen and, in general, safety appeared 
satisfactory. A strategy trial, TIght COntrol of Psoriatic Arthritis (TICOPA), 
showed better ACR responses with treatment adaptations upon tight control 
compared with standard care.
CONCLUSIONS: UST, SEC and APR are new drugs with efficacy demonstrated for the 
treatment of PsA. No major safety signals arise, but long-term studies are 
needed. This review informed about the European League Against Rheumatism 
recommendations for management of PsA.