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Combination treatments in Psoriatic Arthritis

Antoni Chan, MD, PhD

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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Secukinumab promise in PMR is real

David Liew, FRACP

Choice is not just good, it is often necessary, and secukinumab promises just that in both PMR and GCA.

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Secukinumab Use in Refractory Giant Cell Arteritis

Jack Cush, MD

In 2023, the phase 2 TitAIN study showed that the effectiveness and safety of secukinumab in 52 patients with giant cell arteritis (GCA) who had an inadequate response to tocilizumab.

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Secukinumab for PMR? -post hoc analysis of the TitAIN study (phase 2 RCT on new onset/relapsing GCA) showed: -Numerical reduction in patients experiencing PMR symptoms when treated with secukinumab compared to placebo. -Safety profile was similar to the overall GCA study

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

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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

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Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Precision immunotherapy in axial spondyloarthritis: TRBV9xCD3 bispecific antibodies selectively depleted autoreactive TRBV9+ T cells from HLA-B27+ AS patient samples while sparing over 95 percent of the T cell repertoire. TRBV9xCD3 bispecific antibodies selectively depleted https://t.co/8UXqEaDYnS

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Antoni Chan MD (Prof) synovialjoints ( View Tweet)
VEGF-Grab (PB101/PB102), dual VEGF/PlGF decoy receptor, inhibited angiogenesis, RA-FLS invasion, and Th17 cell differentiation in RA and MS models. PB102 reduced IL-17 and GM-CSF co-expressing Th17 cells, suppressed pannus and joint destruction in CIA, and outperformed IFN-β in https://t.co/qhVRYT4RbK

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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)
❓️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

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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)

IL-17 inhibition for PMR? In the secukinumab ph2 in GCA (TitAIN), patients with PMR did really well, seemingly outperforming steroid taper in the placebo arm. Real promise, will be great to see how the ph3 in PMR (REPLENISH) goes OP0062 #EULAR2025 @RheumNow https://t.co/cisA0GiUx1

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David Liew drdavidliew ( View Tweet)
Xeligekimab in AS: -IL-17A blocker -Phase 3 study on Chinese pts showed sustained efficacy until week 48. -Significant improvement on DAI measures as well. -Fully humanized IgG4 mab may last longer in system and possible less ADAs. Abstract #OP0102 #EULAR2025 @RheumNow https://t.co/vyNHZ9ssFt

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Adela Castro AdelaCastro222 ( 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

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Jiha Lee JihaRheum ( 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

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Jiha Lee JihaRheum ( View Tweet)
Case series of 22 PsA pts treats w/ combination bioDMARDs & JAKi,TYK2i or APR IL17i + JAKi 10.5 PY = 1 mild infectious stomatitis IL23i + JAKi 3.7 PY = no AE IL-17i + TYK2i 8.5 PY = 2 mild upper respiratory infections IL-23i + TYK2i 8.3 PY = 2 mild URIs, 1 folliculitis TNFi + https://t.co/Qg9HIwuslJ

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Aurelie Najm AurelieRheumo ( View Tweet)
Can IL-17F signalling be modulated by treatment with TNFi? In PsA pts non responders to previous TNFi, there was increased expression of IL17F-related gene signature. Suggesting a potential mechanism for the consistent level of clinical response observed with BKZ. Abstract https://t.co/D6fvp18UTz

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Adela Castro AdelaCastro222 ( View Tweet)
Early intensive therapy in PsA. STAMP RCT in early PsA: •ACR50 at 3mo: 43% (early secukinumab) vs 22% (SoC) •MDA at 3mo: 48% vs 25% •PASI90 at 3mo: 60% vs 22% By 12months: outcomes similar, but early secukinumab led to faster control and fewer therapy escalations. https://t.co/TKa5z24NQX

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Antoni Chan MD (Prof) synovialjoints ( View Tweet)
STAMP RCT early SEC vs. SoC 120pts Retention 58% vs 30% ACR 20, 50, 70 and MDA: better outcome at Month 3 but no difference at Month 6 Dactylitis no difference Of note here SoC was a tight T2T strategy! @RheumNow #OP0092 #EULAR2025 https://t.co/8zHs5CRFV5

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Aurelie Najm AurelieRheumo ( View Tweet)
Swiss Registry study of PsA outcomes when started on either TNFi (N 503) or IL-17i (n 341), latter w/ more severe PSO. IL-17i durability superior to TNFi (median 828 vs 445 d, P<.001), w/ less D/C in women (HR 0.57); but ACR 20 (14 v 33%) & ACR50 (7 v 24%) favored TNFi use https://t.co/R33bwSeB3E
Dr. John Cush RheumNow ( View Tweet)
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