International Treatment Recommendations Update: A Report from the GRAPPA 2016 Annual Meeting

The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) Treatment Recommendations Update

When GRAPPA was founded, a core goal was to establish treatment recommendations for psoriatic arthritis (PsA). The first treatment recommendations were published in 2009¹. Given the significant volume of new research and new therapies available, the recommendations were updated in 2015 and published in 2016². These treatment recommendations incorporated a review of the management of comorbidities for the first time in addition to recommendations for peripheral arthritis, axial disease, enthesitis, dactylitis, and skin and nail disease.

At the 2016 annual meeting of GRAPPA, the treatment recommendations committee summarized its work and presented plans for future updates to the general membership. While the recommendations were in the final stages of development, GRAPPA members were approached by a company called Guideline Central, which proposed a potential partnership. Guideline Central is a United States–based company that specializes in disseminating treatment recommendations in both paper and digital format.

GRAPPA approved of the partnership with Guideline Central, and developed a pocket reference guide to the treatment recommendations as well as a digital application with similar information. The digital recommendations also have links to a toolkit that provides outcome measure calculators and additional information. As part of the agreement with Guideline Central, a free copy of this pocket guide was made available to all attendees at the GRAPPA annual meeting. Pocket guides have now been translated into multiple languages, and will be distributed by pharmaceutical companies globally. A percentage of the income derived from this partnership will be returned to GRAPPA.

The treatment recommendations committee also led a discussion of future updates. The process of literature searches, reviews, and development of new recommendations takes a significant amount of time. For the recommendations finalized in 2015, planning began in 2012 and the first literature search was done in 2013. For this reason, although the current treatment recommendations were just published in 2016, the committee stated the need to start planning for the next update, proposing a goal of updating the recommendations for publication in 2020.

Another suggestion was made at the annual meeting: regular brief updates addressing key new information. The obvious issue with all treatment recommendations is that they are somewhat out of date as soon as they are published. To minimize this, the GRAPPA treatment recommendations committee did a final update of the literature up to March 2015 just before finalizing the recommendations published in 2016. Despite this update, however, we recognize the delay between submission and publication and the ongoing research published during that time. A brief regular literature update would allow a more immediate updating of key information, with a goal of publishing any updates online through the GRAPPA Website, as well as preparing a concise report or letter for publication highlighting key new data.

In a final discussion, a small group was convened to review biosimilars because of their current arrival on the market. The group will address the evidence and potential issues around biosimilars in PsA and present its findings at the GRAPPA meeting in 2017, along with further ideas for updates.

Patient Guide to Treatment Recommendations for PsA

The patient research partners who are active members of GRAPPA outlined the motivations and processes they used to create a Patient Version of the GRAPPA Treatment Recommendations in a separate section of The Journal’s supplement³.

The International League of Associations for Rheumatology (ILAR) Treatment Recommendations for Resource-poor Settings

In 2015, GRAPPA members Vinod Chandran and Laura Coates were awarded an ILAR grant to look at potential adaptations of international treatment recommendations for resource-poor settings. This grant focuses on adaptations of current recommendations (both the GRAPPA recommendations discussed above and the European League Against Rheumatology recommendations published in 2016) for South America and Africa. The process is designed to be complementary to a current initiative by the Asia-Pacific League of Associations that is developing recommendations for the management of PsA in the Asia-Pacific region.

A committee of 134 GRAPPA members representing South and Central America, Africa, India, and Asia-Pacific will look at potential adaptations that may help these regions. A survey of these 134 GRAPPA members was recently answered by 79 of them. This survey collected data on access to specialists, access to drug therapies, barriers to optimal practice, and risks of endemic infections including tropical diseases.

After compiling survey results, the committee will meet again to identify areas of priority for the adaptation of the recommendations and to review available evidence in this area. The output of this process will be a publication in the ILAR journal, Clinical Rheumatology. The committee also plans to join with Guideline Central to aid in dissemination of these recommendations. Plans include digital applications and online seminars in appropriate languages to reach physicians and other healthcare professionals in South America and Africa.

American College of Rheumatology (ACR) Initiative for New PsA Treatment Recommendations

In 2016, the ACR and the National Psoriasis Foundation announced an intention to develop their own treatment guidelines for the management of PsA. The final team was chosen and announced in July 2016 and includes several GRAPPA members; it is chaired by Jasvinder Singh (Birmingham, Alabama, USA). The work on scope for these guidelines has begun with the goal of final publication in 2018.