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Psoriatic Arthritis: Which biologic agent is the best first choice?
A growing arsenal of therapeutic targets in psoriatic arthritis (PsA) has enhanced the landscape of treatment in patients with this disease.
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ROC-SpA study assessed whether changing to an IL-17Ai was superior to rotating to a 2nd TNFi in axSpA pts who failed on a 1st TNFi
At wk 24, no significant diff in ASAS40 rates bet the 2 groups
IL-17Ai not superior to a 2nd TNFi
Rotate or change?
#ACR25 @Rheumnow AbsLB09 https://t.co/4EtNEFTSN9
sheila RHEUMarampa ( View Tweet)
Gladman et al. PsA patients treated with guselkumab in DISCOVER-2. Male patients had more radiographic progression. Males exhibit stronger relationship between early joint response and lower subsequent rates radiographic progression. @RheumNow #ACR25 Abstr#2345 https://t.co/TSNwesvPzj
Richard Conway RichardPAConway ( View Tweet)
Late breaking: secukinumab out-performs ustekinumab in PsA pt who have failed TNF therapy
RCT of 119 pt
57.1% response at wk 28 in SEC
27% response at wk 28 in UST
Numerically lower adverse events leading to d/c in SEC
@RheumNow #ACR25 #ACRBest Abst LB06 https://t.co/wDxtscP2ku
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
To be continued (or discontinued?): Abstract 2360: Compared to TNFi, IL-17i & JAKi users had 🔹 Higher odds of med switching <180 days 🔹 Shorter time to discontinuation @RheumNow #ACR25 #axSpA https://t.co/IOHaFSJqHn
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
Meta-analysis of 3 RCTs (n=1990) shows IL-17i offers comparable joint response but superior skin clearance vs adalimumab in biologic-naive PsA. IL-17i also had fewer discontinuations due to adverse events. Supports sequencing of biologics through different mechanisms of action in https://t.co/SJgFUMxWVb
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Heydari-Kamjani et al. TriNetX study. 28973 PsA patients. IL-17i and IL-23i lower rates stroke, MI, DVT/PE than TNFi. IL-12/23i higher rate of stroke vs TNFi. @RheumNow #ACR25 Abstr#2363 https://t.co/fNHaxyYPCP
Richard Conway RichardPAConway ( View Tweet)
Rotation or Change in Biologic post TNFi failure in axSpA. Switching biologic class after TNFi failure improved outcomes in axial SpA. In a randomized trial of axSpA patients with inadequate response to a first TNFi, switching to an IL-17Ai was not superior to cycling to a second https://t.co/MEsokWeT8e
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Late-Breaking Trials in axSpA and PsA https://t.co/Fw8wiAPLoN
The amazing @Janetbirdope discussing head to head trials in Axial SpA and PsA with primary failure to TNF.
To switch to another TNF or IL17?
IL17 for my PsA patient for sure.
@RheumNow
#ACR25
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
In the SERENA study (n=292), secukinumab reduced PsA incidence to 0.49/100 PY over 5 years in PsO patients with nail involvement, an ~82% drop vs historic non-biologic rates (2.7/100 PY). 98.3% remained PsA-free; PASI 90 achieved in 63%. Abstract#1463 @RheumNow #ACR25 https://t.co/ySOuFJiwge
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Fragoulis et al. Real world study of bimekizumab demonstrates equal efficacy in IL-17i naive and exposed. @RheumNow #ACR25 Abstr#1439 https://t.co/aCcLgnKvFJ
Richard Conway RichardPAConway ( View Tweet)
Gensler et al. Bimekizumab in male and female axSpA patients. Greater benefit in males at week 16, but similar responses at week 52 @RheumNow #ACR25 Abstr#1449 https://t.co/zDYI2zItqT
Richard Conway RichardPAConway ( View Tweet)
Bimekizumab showed sustained 1-year efficacy in axSpA across age, BMI, CRP, and HLA-B27 subgroups. ASAS40, ASDAS, BASDAI, ASQoL, and MRI scores improved in most groups—especially age ≤35, BMI 25–30, CRP >5, and HLA-B27+. Abstract 1451 @RheumNow #ACR25
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Abstract 0878: In PsA pts w/ lateral epicondyle enthesitis on secukinumab (n=11):
🔹 Improved DAPSA & SPARCC scores
🔹 entheseal tissue biopsy showing shift toward pro-resolving fibroblasts (↑DKK3/CD200⁺)
🔹 ↓ osteoblast-related pathways
@RheumNow #ACR25
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
In high-risk psoriasis patients with nail disease, Secukinumab reduced PsA onset over 5 years with a total exposure of 1022 patient-years. Annual incidence dropped from 2.7 to 0.49 per 100 patient-years. Data from the real world SERENA study. Abstract 1463 @RheumNow #ACR25
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
In pooled PsA trials (n=1222), deucravacitinib reduced disease activity–linked proteomic scores in both sexes by Week 16. Proteomic profiling identified 133 unique proteins in males and 177 in females vs sex-matched healthy controls. Females showed greater enrichment in https://t.co/TTAWUtOLP0
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
What is better in #PsA post #TNFi?
#RCT of #secukinumab v #ustekinumab
The big 🤔? #IL17Ai vs IL12/23i
🏆 #Cosentyx
✈️✅PASI
⚜️✅ACR50
Will H2H studies change our #prescribing?🤷♀️
#rheums Rx #IL17i>#IL12i/23i vs #derms
#ACRBest #ACR25 @RheumNow @ACRheum abst#LB06 https://t.co/RpC8ymDc7H
Janet Pope Janetbirdope ( View Tweet)
To #cycle within or go to another drug class I #axSpA?
#RCT of #TNFi-IR
👇
2nd #TNFi v #IL17i
#IJDM it doesn’t matter what choice as
#IL17i WAS NOT superior to TNFi cycling from 1st -2nd
👍 stay in #TNFi class = change to #IL17i
#ACR25 @RheumNow abst#LB09
#ACRBest @ACRheum https://t.co/VCdL5CUYUa
Links:
Janet Pope Janetbirdope ( View Tweet)
PD-1+ effector memory T cells in PsA synovium are functionally active and regulate Th17 cytokines via STAT3/RORγt. Recombinant PD-L1 agonist significantly reduced T cell proliferation and IL-17A/F/IL-22 production highlighting checkpoint agonists as a novel therapeutic strategy https://t.co/I6eNa0j7aa
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Icotrokinra, a first-in-class targeted oral peptide IL-23R inhibitor, cleared scalp (66%), genital (77%), and overall skin (57%) PsO vs placebo at Week 16. Basket trial design enabled targeted evaluation. Safety profile favorable. Abstract 0555 @RheumNow #ACR25
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
