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Evaluation of the Synovial Effects of Biological and Targeted Synthetic DMARDs in Patients with Psoriatic Arthritis: A Systematic Literature Review and Meta-Analysis

2023; Multidisciplinary Digital Publishing Institute; Volume: 24; Issue: 5 Linguagem: Inglês

10.3390/ijms24055006

1661-6596

Maria Sofia Ciliento, Veronica Venturelli, Natale Schettini, Riccardo Bertola, Carlo Garaffoni, Giovanni Lanza, Roberta Gafà, Alessandro Borghi, Monica Corazza, Alen Zabotti, Sonia Missiroli, Caterina Boncompagni, Simone Patergnani, Mariasole Perrone, Carlotta Giorgi, Paolo Pinton, Marcello Govoni, Carlo Alberto Scirè, Alessandra Bortoluzzi, Ettore Silvagni,

Autoimmune and Inflammatory Disorders Research

The aims of this systematic literature review (SLR) were to identify the effects of approved biological and targeted synthetic disease modifying antirheumatic drugs (b/tsDMARDs) on synovial membrane of psoriatic arthritis (PsA) patients, and to determine the existence of histological/molecular biomarkers of response to therapy. A search was conducted on MEDLINE, Embase, Scopus, and Cochrane Library (PROSPERO:CRD42022304986) to retrieve data on longitudinal change of biomarkers in paired synovial biopsies and in vitro studies. A meta-analysis was conducted by adopting the standardized mean difference (SMD) as a measure of the effect. Twenty-two studies were included (19 longitudinal, 3 in vitro). In longitudinal studies, TNF inhibitors were the most used drugs, while, for in vitro studies, JAK inhibitors or adalimumab/secukinumab were assessed. The main technique used was immunohistochemistry (longitudinal studies). The meta-analysis showed a significant reduction in both CD3+ lymphocytes (SMD −0.85 [95% CI −1.23; −0.47]) and CD68+ macrophages (sublining, sl) (SMD −0.74 [−1.16; −0.32]) in synovial biopsies from patients treated for 4–12 weeks with bDMARDs. Reduction in CD3+ mostly correlated with clinical response. Despite heterogeneity among the biomarkers evaluated, the reduction in CD3+/CD68+sl cells during the first 3 months of treatment with TNF inhibitors represents the most consistent variation reported in the literature.