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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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MTX Fails Knee OA (6.6.2025)
Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com
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POS0150: From 12 RA registries, JAKi starts fell by ~13% after FDA safety alerts.
Tofa & bari took biggest hits; upa growth slowed but offset losses.
Real-world prescribing adapts—but doesn’t abandon.
@RheumNow #EULAR2025 https://t.co/QZ5haW2vhX
Jiha Lee JihaRheum ( View Tweet)
Fascinating to see JAKi uptake in European JAK-pot centres
- tofa was already on the decline pre-ORAL Surveillance
- JAKi use (driven by upadacitinib) continues to grow, although maybe it’s slowed
Hopefully rational JAKi has its place #EULAR2025 POS0150 @RheumNow https://t.co/XRyHJVw821
David Liew drdavidliew ( View Tweet)
New dual-action RA drug?
OP0193: CPL’116 targets both JAK & ROCK.
In 12-wk RCT, highest dose improved DAS28-CRP, joint counts & pain, with clean labs.
Is this a future option for RA-ILD or patients with comorbid CVD risk?
#EULAR2025 @RheumNow
Jiha Lee JihaRheum ( View Tweet)
Ph 2 RCT CPL'116 dual inhibition JAK/ROCK
106 MTX IR pts
wk12 primary endpoint met (DAS28-CRP decrease) in 240mg arm vs. PBO
75% >= AEs, SAE 2: 1 MI, 1 bladder cancer
Authors suggest absence of lipids/LFTs disruption compared to other JAKs
Ph3 is awaited!!
#OP0193 #EULAR2025 https://t.co/TnnM410LfM
Links:
Aurelie Najm AurelieRheumo ( 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)
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)
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)
❓️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)
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)
Comparative efficacy of tofacitinib vs. adalimumab in RA - metanalysis of 9 RCTs, 24,643 pts finds Tofa signif superior to ADA for ACR20 (RR 1.28), HAQ-DI, VAS, but no difference in adverse events (RR 0.96) or DAS28-CRP improvement https://t.co/5mVY2Qvdms https://t.co/czxnlYHEAl
Dr. John Cush RheumNow ( View Tweet)
Ph 2 open label RCT TOFA in RA-ILD 52 wks
39pts 92% AE 8% 3 deaths FVC decline -69 ml
No diff between UIP, NSIP or antifibrotic
No control group
#POS0619 #EULAR2025 @RheumNow https://t.co/3lqEUfObG9
Aurelie Najm AurelieRheumo ( View Tweet)
What’s worse for infection in GCA: tail end steroid taper, or a JAK inhibitor?
This is exactly SELECT-GCA in the second 6mo. What happened?
upa skews better on serious infection, worse on HZ
JAKi might have infection risk, but not like steroids. OP0057 #EULAR2025 @RheumNow https://t.co/FigxviOW3e
David Liew drdavidliew ( 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
Aurelie Najm AurelieRheumo ( View Tweet)
Worried about cancer risk with ts/bDMARDs in RA?
Real-world data from over 4,600 patients says: don’t be. No increased risk of cancer (incl. NMSC) for JAKi, IL6i, CD20i, or CTLA4-A vs TNFi in long-term registry follow-up.
Abstract#OP0065
@RheumNow #EULAR2025
Jiha Lee JihaRheum ( View Tweet)
While there are trials in progress, there is no RCT data on the use of JAK inhibitors in Noninfectious Uveitis (NIU). But there is this metanalysis of many small case reports suggesting their potential efficacy in NIU. https://t.co/pBNsSmVjOz https://t.co/JrIGQGZjHt
Dr. John Cush RheumNow ( View Tweet)
Review of Emerging Treatments for Vitiligo an immune mediated dz that affects QOL & has psychosocial impact. JAKi only ruxolitinib is FDA-approved, but Tofa & Bari show promise. Emerging therapies include simvastatin, afamelanotide, and metformin https://t.co/Rp2yYx6SyZ https://t.co/3RbDFVtJR5
Dr. John Cush RheumNow ( View Tweet)
Metanalysis of 12 trials, 12 902 adults hospitalized w/ COVID betw May, 2020 & March, 2022 (7 Bari, 3 Tofa, 2 Ruxo). Fewer deaths in those on JAKi (11·7% vs 13·2%; aOR 0·67 [95% CI 0·55–0·82]; high-certainty evidence); 39 fewer deaths/1000. JAKs had less mechanical ventilation https://t.co/QSMRo3RcRr
Dr. John Cush RheumNow ( View Tweet)
Systematic review of JAK inhibitor use in systemic sclerosis - 18 articles/87 SSc pts (80%F; ages 13–78 yrs). JAKi (83% tofa) mostly used for ILD & Skin Dz (45%) or GI+Skin Dz (39%). 87.5% improved, w/ 6% relapsed. Adverse events in 50% (20% infx). We need RCTs! This could be a https://t.co/lNFEX08Vn3
Dr. John Cush RheumNow ( View Tweet)
