Adalimumab, etanercept and infliximab are equally effective treatments for patients with psoriatic arthritis

In a recent meta-analysis of the risks and benefits of anti-tumour necrosis factor (TNF) therapies in patients with psoriatic arthritis, Saad et al. found that adalimumab, etanercept and infliximab were all significantly more effective than placebo for all outcome measures analyzed. There were no differences between these anti-TNF inhibitors in achieving the American College of Rheumatology criteria for 20% improvement (ACR20) response for joint disease. A difference in the efficacy of the anti-TNF agents for treatment of skin manifestations was reported; however, this difference did not reach statistical significance. Analysis of other disease manifestations would have been interesting, as there is a clinical perception of a better response to treatment with anti-TNF antibodies (i.e. adalimumab and infliximab) versus the TNF receptor (i.e. etanercept). When comparing the anti-TNF agents with placebo in terms of safety, the only significant difference was an increased incidence of injection-site reactions associated with etanercept therapy. As all three drugs were shown to be equally effective in the management of psoriatic arthritis, patients should be allowed to make treatment choices based on whether they prefer the flexibility of self injection or whether they find repeated injections unacceptable.