Effect of Biologics on Fatigue in Psoriatic Arthritis: A Systematic Literature Review with Meta-analysis

Objectives: Fatigue is a significant issue in psoriatic arthritis. The objective was to assess the effect of biological disease modifying antirheumatic drugs and apremilast on fatigue in psoriatic arthritis randomised controlled trials and to compare this effect with the effect in the same trials, on pain, through a systematic literature review and meta-analysis.

Methods: A systematic literature review was performed up to January 2017 in PubMed, Embase and Cochrane databases. All randomized controlled trials in psoriatic arthritis of biological disease modifying antirheumatic drugs or apremilast, assessing fatigue (whatever the score used), were included. Data were collected by 2 assessors regarding levels of fatigue and pain at baseline and at the time point closest to 24 weeks after the treatment introduction. Pooled standardized mean differences were calculated using RevMan.

Results: After screening 295 publications, 7 randomised controlled trials were analysed: they pertained to adalimumab (n=2), certolizumab pegol (n=1), secukinumab (n=2), ustekinumab (n=1) and apremilast (n=1), compared to placebo. The studies included 2341 patients: weighted mean±standard deviation age: 48.6±1.3years, disease duration: 7.7±1.6years, 51.6% were females. Fatigue levels were high at baseline (Functional Assessment of Chronic Illness Therapy score: 28.7±2.4). The pooled standardized mean difference was, for fatigue -0.44 (95% confidence interval: -0.54, -0.35) and for pain, -0.62 (-0.73, -0.52).

Conclusions: Biological disease modifying antirheumatic drugs and apremilast had a small effect on fatigue at 24 weeks in psoriatic arthritis randomized controlled trials and a higher effect on pain. These results are important to take into account in shared decision-making.