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Combination treatments in Psoriatic Arthritis
Despite the advances in the treatment of PsA with biologic (bDMARD) and targeted synthetic (tsDMARD), less than half of patients with this condition achieved remission or low disease activity. Combination DMARD treatment is often used in order to achieve remission or minimal disease activity. The standard practice is to use a conventional synthetic (csDMARD) with a bDMARD. The use of the combination of bDMARD with a tsDMARD such as a JAKi or TYK2i is a new order in the treatment of PsA.
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Data from Dutch registry SpA-Net explored prevalence using new definitions for D2M axSpA.
-Smoking and psoriasis were characteristics associated with D2M disease.
-In the three variations explored, the lowest prevalence was observed in the variation based purely on objective https://t.co/h3f4ORQl0F
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Adela Castro AdelaCastro222 ( View Tweet)
Sex differences in biologic response in PsA.
DISCOVER-2 post hoc analysis showed:
•Radiographic progression at Week
♂️: 2.22 units
♀️: 1.10 units
•Early ACR-like response (cDAPSA LDA at 8wks) linked to less damage in men (0.39 vs 2.24)
Women less likely to progress https://t.co/NhBkXbuLjO
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Exciting results from ARGO trial:
-Phase 2 of Sonelokimab (dual IL-17A-IL17F) nanobody in PsA.
-Met primary endpoint of ACR50 at week 12 vs PBO.
-62% achieved MDA
-48% achieved composite of ACR 70+PASI 100
Looking forward to phase 3 results!!!
Abstract #OP0096 #EULAR2025 https://t.co/1D52eG8ReS
Links:
Adela Castro AdelaCastro222 ( View Tweet)
Biomarker data suggest TNFi non-responders in PsA exhibit upregulation of IL-17F gene signatures after treatment failure. Supports IL-17A/F blockade rationale with bimekizumab in TNFi-experienced patients Abstract#OP0091 @RheumNow . #EULAR2025 https://t.co/CWR6ArDRRW
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Real-world study on dual bDMARD plus JAKi or TYK2i combinations in refractory PsA. 22 PsA patients on dual bDMARD + JAKi/TYK2i:
•Most common: IL-17i + TYK2i
•Total exposure: 8.5–10.5 pt-years
•Only mild URIs/stomatitis
•Clinical improvements seen in joint/skin domains https://t.co/waDReDqSDE
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
SPEED RCT: In early PsA with poor prognostic factors, PASDAS at 24wks:
•Early TNFi: 3.7
•Combo csDMARDs: 4.1
•Step-up csDMARDs: 4.7
Early TNFi beat step-up by -1.09 (p<0.001); combo csDMARDs also superior (-0.69, p=0.02). Early TNFi benefit sustained at 48wks. Abstract#OP0089 https://t.co/MpazF8BIr2
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Hepcidin detected in synovial membrane and fluid in RA, PsA, and OA. Monocytes were the main source. IL-6, IL-10, IL-17, M-CSF induced hepcidin via JAK-STAT pathway. Hepcidin reduced osteoclastogenesis but correlated with synovial neutrophils and CXCL1 induction. Functional dual https://t.co/ZjUtTYPre8
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Cool technology reduces dose interval of #IL17AFi
To…every 6 to 12 months!
#Antibody ORKA-002 has end of arms w YTE substitution prolonging circulation of drug
Lasts longer than #bimekizumab
Easier for adherence!
#EULAR2025 @RheumNow @eular_org #abstPOS0016 https://t.co/KcKaIe0WMs
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Janet Pope Janetbirdope ( View Tweet)
Phase 3 of POETYK-PsA-2:
-Deucravacitinib (oral TyK2i) met the primary endpoint of ACR20 at week 16 and was superior to placebo in multiple PsA domains.
-Clinical efficacy maintained until week 52.
-No major safety signals reported.
-Notably high placebo response rates.
Abstract
Adela Castro AdelaCastro222 ( View Tweet)
Data from a German cohort evaluated the frequency of D2M-axSpA using the new D2M definition and showed:
> Female pts
> Peripheral SpA symptoms
< HLAB27 positive
< Education level
< Objective signs: MRI-inflammation in the spine or elevated CRP levels.
also PROs were worse in
Adela Castro AdelaCastro222 ( View Tweet)
❓️How effective and safe is it to combine bDMARDs and tsDMARDS (i.e. TNFi/ IL17i + JAKi/TYKi) in #psoriatic_arthritis?
🅰️ Reassuring data from a case-series study presented by Andre Lucas Ribeiro
#EULAR2025
OP0090
@RheumNow
#Strategy https://t.co/W8fuzSgxbJ
Nelly ZIADE 🍀 Nellziade ( View Tweet)
Ph 2 RCT Sonelokimab (IL-17A- & IL-17F-inhibiting Nanobody) 24wks
207 pts SON 120 MDA 51% vs. 45% ADA
Subgroups: female 52%, weight ≥100kg 53%, ≥3% BSA 55%
Composite ACR70/PASI100 SON 120 48% vs. 19% ADA
No new safety signal
Ph 3 on the way 2 doses SON 60 &120
#OP0096 https://t.co/w5QtpKbi1W
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Aurelie Najm AurelieRheumo ( View Tweet)
Efficacy and safety of deucravacitinib up to week 52 in the POETYK PsA-2 study
•ACR20 at W16: 54.2% (deucravacitinib) vs 39.4% (placebo), p=0.0002
•PASI75: 40.9% vs 15.4%, p<0.0001
•MDA: 25.6% vs 14.7%, p=0.0007
•FACIT-F: +2.5 vs +1.8
•SAE: 1.9% (low)
TYK2 inhibition shows https://t.co/JXTZRk2itA
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
❓️Is early intensive therapy with combination csDMARDs or TNFi superior to standard step care for the treatment of moderate to severe #psoriatic_arthritis?
🅰️ Yes
🔅Check out the SPEED RCT presented by @DrLauraCoates at #EULAR2025
OP0089
@RheumNow
#Strategy https://t.co/24e7wUV2FB
Nelly ZIADE 🍀 Nellziade ( View Tweet)
MONITOR PsA 200+ pts secondary care "real-life" cohort
65 treated w/ combi csDMARDs
48weeks outcome and 96 weeks
49% bioDMARDs, 29% retention and 23% deescalation to 1 csDMARD
‼️reasons for discontinuation was AEs in 60% cases not inefficacy
Caveat: analysis not adjusted for https://t.co/L8EczgZTpP
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Aurelie Najm AurelieRheumo ( View Tweet)
📊 POS0574 @rheumnow #EULAR2025 Real-world data from SERENA shows sustained 5-year effectiveness of secukinumab in PsA. ✔️ 57% had no tender/swollen joints at Year 5 ✔️ PASI90 in ~48% ✔️ Stable low TJC, SJC & PtGA Durability confirmed even in prior biologic users. https://t.co/eNpboTRRu3
Jiha Lee JihaRheum ( View Tweet)
MONITOR-PsA (n=218):
•36.5% had >1 csDMARD
•Of those, 49.2% tried combination (combo) csDMARDs
•63.6% of combo csDMARD users in MDA at 48wks
•61.1% stopped due to side effects—not inefficacy
Real-world support for csDMARD combos where biologics delayed. Abstract#OP0093 https://t.co/3Anme39VXk
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Early PsA? Treat fast, treat hard.
The STAMP RCT showed that early secukinumab + MTX led to faster ACR50 and PASI90 responses vs standard care in a T2T strategy. By 12 months, outcomes were similar, but early SEC needed fewer escalations.
Abstract#OP0092
@RheumNow #EULAR2025 https://t.co/cAZTc9eN16
Jiha Lee JihaRheum ( View Tweet)
Combination therapies in PsA not so far away:
-Case series of 22 patients from large PsA cohort.
-Combination therapy in PsA used when difficult to treat skin and msk involvement.
-Deucravacitinib was the agent mostly used in combination with bDMARDs.
-No major serious adverse https://t.co/YUyvuaJcsE
Links:
Adela Castro AdelaCastro222 ( View Tweet)
