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From Domains to Decisions: Personalizing PsA Care with Data
At EULAR 2025, Dr. Laura Coates (Oxford) took the plenary stage to reframe how we think about treating psoriatic arthritis. The message was clear: in 2025, PsA treatment is no longer about following a linear algorithm; it’s about understanding the unique constellation of domains, comorbidities, and patient factors that shape each clinical decision.
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Expanding the IL-17 Therapeutic Landscape
IL-17 inhibitors are an effective therapeutic for a broad spectrum of inflammatory and autoimmune diseases and its blockade has revolutionized management of diseases such as psoriasis, psoriatic arthritis and SpA. Is there a need for more medications within the same therapeutic class?
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Putting IL17i into ‘focus’ for SpA-associated uveitis
The longest studied drug for uveitis in SpA has been monocolonal TNFi Abs. Reductions of acute anterior uveitis have been found with etanercept but less impressively than adalimumab, infliximab, and in my opinion less than golimumab and certolizumab pegol.
Other data have emerged for JAKi and IL17i, with respect to acute anterior uveitis.
Putting IL17i into ‘focus’ for SpA-associated uveitis
The longest studied drug for uveitis in SpA has been monocolonal TNFi Abs. Reductions of acute anterior uveitis have been found with etanercept but less impressively than adalimumab, infliximab, and in my opinion less than https://t.co/AUEct0FxmU
Dr. John Cush RheumNow ( View Tweet)
Sonelokimab in PsA
Dr. Adela Castro reports on OP0096, 'Impact of sonelokimab, a novel IL-17A- and IL-17F-inhibiting Nanobody, on multidomain clinical outcomes in active psoriatic arthritis: results from the randomized, double-blind, placebo-controlled Phase 2 ARGO trial,' https://t.co/KmV6Rx4uFT
Dr. John Cush RheumNow ( View Tweet)
Efficacy and Safety of Xeligekimab in AS
Dr. Adela Castro reports on abstract OP0102 at the EULAR 2025 meeting in Barcelona, Spain
https://t.co/xpzeV0oZOr https://t.co/mEYnAFsYQI
Dr. John Cush RheumNow ( View Tweet)
Impact of TNFi on efficacy of Vunakizumab in AS.
-Post hoc analysis of Vunakizumab
(humanized monoclonal IgG1/k antibody targeting IL-17A) trial on AS pts.
-440 total pts, 163 had prior TNFi exposure
- At week 16, no significant differences in ASAS20 b/w TNFi exposed pts https://t.co/O9PFOuLa5l
Adela Castro AdelaCastro222 ( View Tweet)
Biologic switching in PsA:
-Retrospective study on 3,851 PsA pts initiating bDMARDs, 1,848 (48%) switched therapy at least once.
-TNFis were the initial therapy.
-IL17i were the first switch in both single-switch and multi-switch scenarios.
-Subsequent switches: back to TNFi https://t.co/tJDJvPeu9T
Adela Castro AdelaCastro222 ( View Tweet)
Data from COAST-V study (post hoc)
🔹️Ixekizumab in #axSpA
🔹️Efficacy stratified by CRP level
🔹️Better treatment response in the elevated compared to the normal CRP group
OP0699
#EULAR2025
@RheumNow https://t.co/1mVoly3Gws
Nelly ZIADE 🍀 Nellziade ( View Tweet)
🫁 In autoimmune ILD patients from FIBRONEER-ILD (n=325), nerandomilast slowed FVC decline vs placebo and reduced risk of ILD progression events (HR 0.56 for 18 mg BID).
Acceptable safety profile & tolerability.
@RheumNow #EULAR2025 #LB0003 https://t.co/aWsfNOL76n
Mrinalini Dey DrMiniDey ( View Tweet)
Guselkumab in APEX study (PsA, n=1020, biologic-naïve):
🦴 Less joint damage: 0.55 vs 1.35 (placebo)
💪 More responders: 67–68% hit ACR20 on GUS
🛡 Safety: similar to placebo
GUS - selective IL-23i - delivers joint protection and symptom relief
LB0010 @RheumNow #EULAR2025
Jiha Lee JihaRheum ( View Tweet)
APEX study Ph3 RCT Guselkumab
In BioNaive active PsA w/ erosions>=2
wk 24
ACR20 GUS Q4W 67% Q8W 68% vs PBO 47%
Less Rx progression in both Q4W & Q8W vs. PBO
#EULAR2025 @RheumNow LB0010 https://t.co/OVDWWECtOZ
Aurelie Najm AurelieRheumo ( View Tweet)
Hidradenitis suppurativa is newer to us in rheumatology, but it seems like inflamm arthritis is a problem - at least to a similar extent as in psoriasis.
Time for us to look for it & to see what therapies like IL-17 inhibitors do for this arthritis
#EULAR2025 POS1237 @RheumNow https://t.co/b5EQdDEAhq
David Liew drdavidliew ( View Tweet)
👁️Uveitis in axSpA:
-Up to 40% can present before SpA dx
-NMA of 44 RCTs showed tx with TNFi, JAKi and IL-17i protective effects against uveitis
-Low rates of uveitis in axSpA pts on BIME trials suggests its possible beneficial effects.
#EULAR2025
@RheumNow https://t.co/mPuSMnD1Zs
Links:
Adela Castro AdelaCastro222 ( View Tweet)
In real-world PsA, IL-23 inhibitors (guselkumab/risankizumab) showed clinical response in axial/mixed PsA. Best response seen in pts meeting ASAS axial SpA criteria (RR 7.64) & baseline ASDAS-CRP >2.1. Supports role of patient stratification in axial PsA. Abstract#POS0113 https://t.co/qowZZmJOpM
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Efficacy and Safety of Xeligekimab in AS
Dr. Adela Castro reports on abstract OP0102 at the EULAR 2025 meeting in Barcelona, Spain
https://t.co/xpzeV0oZOr https://t.co/wmTnFbFcum
Links:
Dr. John Cush RheumNow ( View Tweet)
In PsA, can we better pick IL-17A inhibitor responders (after TNFi failure)?
Transcriptomic profiling is going to get better at telling us which pathways are truly important for response to specific treatments
POS0232 #EULAR2025 @RheumNow https://t.co/uycuXB0TFK
David Liew drdavidliew ( View Tweet)
In #axSpA post #TNFi-IR
What to use next?
👇
#ATTRA registry
90% #SpA on #bDMARDs are captured
Comparison of
TNFi to ▶️
2nd TNFi vs
#IL17i
▶️No diff in #retention
✅better #BASDAI and other outcomes w TNFi!
❎less safety
🤔
#EULAR2025 @RheumNow @eular_org
Abst#POS0116 https://t.co/7mqFfD4Amf
Janet Pope Janetbirdope ( View Tweet)
2-year #MANDARA data: Benralizumab shows durable remission, eosinophil suppression & OGC-sparing in EGPA. ~62-68% in remission at wk104. Low relapse rate, no loss of asthma control or decline of lung function. No new safety signals.
@RheumNow #EULAR2025 #OP0166 https://t.co/kXh2q2ilJF
Mrinalini Dey DrMiniDey ( 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)
