Benefits of early biologic treatment in psoriatic arthritis examined in studies

Two studies suggest there is no significant benefit of early biologics over standard step-up care with methotrexate, but these did not select for poor prognosis. The aim, therefore, of the SPEED trial (Severe Psoriatic arthritis—Early intervEntion to control Disease)—was to compare disease activity in 192 PsA patients with poor prognostic factors when treated with one of three regimens: standard step-up with conventional systemic disease-modifying antirheumatic drugs (csDMARD), combination csDMARD, or early induction with a tumor necrosis factor inhibitor (TNFi). The primary endpoint was the mean PsA disease activity score (PASDAS) at 24 weeks. Data were presented at the 2025 annual EULAR congress in Barcelona.

At Week 24, a difference was found in PASDAS mean scores between treatment groups, with both the combination csDMARD and early TNFi groups showing evidence of a difference when compared to standard step-up care. Of note, there was no evidence of a difference between the early TNFi and combination csDMARD groups. However, by Week 48 the benefit compared to standard step-up care was seen only for early TNFi therapy.

Presenting the work, Laura Coates said, “These data show that initial intensive therapy with early biologics or combination csDMARDs are superior for rapid control of early moderate-to-severe PsA. Even with only 6 months of early biologic therapy, better outcomes are maintained at 1 year in those initially receiving a TNF inhibitor.”

A case series also presented at the congress aimed to describe real-world safety and effectiveness of combined biologic and targeted synthetic DMARD therapy in PsA. Andre Lucas Ribeiro and colleagues analyzed prospectively collected data from the University of Toronto psoriatic arthritis cohort, which included 22 people treated with combinations of a bDMARD and either JAKi or TYK2i, with some patients trying multiple combinations. The primary indications for combination therapy were active peripheral arthritis and skin disease, including palmoplantar psoriasis.

Results showed numerical improvement across multiple disease-activity measures. In the bDMARD plus JAKi group, the most frequent combination was IL-17i plus JAKi, and over 10.5 patient–years of exposure only one case of mild infectious stomatitis was reported, which did not result in 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.

Overall, 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. Furthermore, 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.

Provided by
European Alliance of Associations for Rheumatology (EULAR)

Two studies suggest there is no significant benefit of early biologics over standard step-up care with methotrexate, but these did not select for poor prognosis. The aim, therefore, of the SPEED trial (Severe Psoriatic arthritis—Early intervEntion to control Disease)—was to compare disease activity in 192 PsA patients with poor prognostic factors when treated with one of three regimens: standard step-up with conventional systemic disease-modifying antirheumatic drugs (csDMARD), combination csDMARD, or early induction with a tumor necrosis factor inhibitor (TNFi). The primary endpoint was the mean PsA disease activity score (PASDAS) at 24 weeks. Data were presented at the 2025 annual EULAR congress in Barcelona.

At Week 24, a difference was found in PASDAS mean scores between treatment groups, with both the combination csDMARD and early TNFi groups showing evidence of a difference when compared to standard step-up care. Of note, there was no evidence of a difference between the early TNFi and combination csDMARD groups. However, by Week 48 the benefit compared to standard step-up care was seen only for early TNFi therapy.

Presenting the work, Laura Coates said, “These data show that initial intensive therapy with early biologics or combination csDMARDs are superior for rapid control of early moderate-to-severe PsA. Even with only 6 months of early biologic therapy, better outcomes are maintained at 1 year in those initially receiving a TNF inhibitor.”

A case series also presented at the congress aimed to describe real-world safety and effectiveness of combined biologic and targeted synthetic DMARD therapy in PsA. Andre Lucas Ribeiro and colleagues analyzed prospectively collected data from the University of Toronto psoriatic arthritis cohort, which included 22 people treated with combinations of a bDMARD and either JAKi or TYK2i, with some patients trying multiple combinations. The primary indications for combination therapy were active peripheral arthritis and skin disease, including palmoplantar psoriasis.

Results showed numerical improvement across multiple disease-activity measures. In the bDMARD plus JAKi group, the most frequent combination was IL-17i plus JAKi, and over 10.5 patient–years of exposure only one case of mild infectious stomatitis was reported, which did not result in 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.

Overall, 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. Furthermore, 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.

Provided by
European Alliance of Associations for Rheumatology (EULAR)