Early Biologics and Combination Therapy Show Promise for Psoriatic arthritis

⁣ ⁤ Updated ⁣June 11, 2025

New research presented​ at the 2025 EULAR congress in Barcelona suggests that early, intensive treatment for psoriatic arthritis‌ (PsA) may lead to better outcomes. One study,⁤ the ⁢SPEED trial,‍ investigated the effectiveness of early biologics and combination therapies⁣ compared to⁤ standard treatment approaches for managing psoriatic⁢ arthritis.

Laura Coates presented data from the SPEED trial,which compared standard step-up care with conventional systemic ​disease-modifying‌ antirheumatic drugs​ (csDMARD),combination csDMARD,and early induction with a tumor necrosis factor inhibitor (TNFi). The trial focused on 192 PsA patients exhibiting poor prognostic factors. The primary goal was to assess the mean PsA disease activity score (PASDAS)‍ at 24 weeks.

The SPEED trial revealed that at 24 weeks, both combination ⁤csDMARD and early TNFi groups demonstrated a significant difference compared to standard ‌step-up​ care. However, no difference was observed between the early ‍TNFi and ​combination csDMARD groups. By week 48, the ⁢advantage over standard ⁣step-up care was sustained only in the ​early⁣ tnfi therapy‍ group, highlighting the potential long-term benefits of early biologic‍ intervention for psoriatic⁣ arthritis.

Coates stated that‌ initial intensive therapy with early biologics or combination ⁣csDMARDs leads to ⁢superior ⁤and rapid control of ⁤early moderate-to-severe PsA. She added that⁤ even a six-month course of early biologic therapy resulted in better outcomes maintained at one year for those initially ​treated with a TNF inhibitor.

Another case series presented at the congress explored the real-world safety and effectiveness ⁣of combined biologic and targeted synthetic DMARD therapy ⁣in PsA. Andre Lucas Ribeiro ‌and colleagues⁢ analyzed data from the University of Toronto psoriatic ‍arthritis ‍cohort, focusing on 22 ⁣individuals ⁤treated with combinations of a bDMARD and either a JAK⁢ inhibitor (JAKi) or a TYK2 ‌inhibitor (TYK2i).​ The primary reasons for combination therapy where active‍ peripheral arthritis and skin disease,including palmoplantar psoriasis.

The results indicated numerical improvements across⁣ multiple disease-activity measures. In the bDMARD plus JAKi group, the most common⁣ combination was IL-17i plus JAKi. Over 10.5​ patient-years ‌of exposure, only one mild case of infectious stomatitis was reported, which did‌ not lead to treatment discontinuation.⁢ additionally, IL-23i plus JAKi were used for 3.7‍ patient-years⁣ without any reported safety events.

For the bDMARD plus TYK2i ⁣group,⁤ IL-17i plus TYK2i were used for 8.5 patient-years, with one person experiencing two‍ mild‍ upper respiratory infections (URI) on bimekizumab plus deucravacitinib, prompting a switch for risankizumab plus‍ deucravacitinib. IL-23i plus TYK2i ⁢were‌ used for 8.3 patient-years, with two cases of ‌mild URI leading⁤ to ‌a switch to bimekizumab monotherapy, and one case of folliculitis where ‌therapy ⁢was continued. One ⁢patient received⁣ tnfi plus TYK2i for 0.9 patient-years with no adverse events reported.

combinations of bDMARD plus apremilast were also​ reported, with two cases of diarrhea observed, but no infections.

the safety ‍profile of bDMARD combinations with JAKi, TYK2i,⁣ and apremilast appears ⁤favorable.All reported infections were mild, managed without hospitalization, and rarely ​led to treatment discontinuation. Moreover, patients achieved short-term responses, with‍ improvements in both ​musculoskeletal and⁤ skin domains. ⁢However, as ⁢this is an observational study with short-term ⁢follow-up, there is a need for randomized clinical trials to ⁤further explore and validate these findings.

What’s next

Further research is needed ‍to⁤ validate these findings through randomized clinical trials and to explore the long-term‍ effects of combination therapies in managing psoriatic ‌arthritis.