Reference: October 2025 | Issue 10 | Vol 11 | Page 4
Highlights from EULAR 2025
Data presented at the European Alliance of Associations for Rheumatology (EULAR) 2025 Congress in Barcelona looked at the potential benefit of using biologic disease-modifying anti-rheumatic drugs (bDMARD) early in more severe psoriatic arthritis (PsA). EULAR currently recommends a treat-to-target approach, and suggests more intensive therapy for people with poor prognostic factors, depending on the disease presentation.
Two recent studies suggest there is no significant benefit of early biologics over standard step-up care with methotrexate, but these did not select for poor prognosis.
The aim of the Severe Psoriatic arthritis Early intervention to control Disease (SPEED) trial – which was funded by the National Institute for Health Research – was to compare disease activity in 192 PsA patients with poor prognostic factors when treated with one of three regimens: Standard step-up with conventional synthetic DMARD (csDMARD), combination csDMARD, or early induction with a tumour necrosis factor inhibitor (TNFi). The primary endpoint was the mean PsA Disease Activity Score (PASDAS) at 24 weeks.
At week 24, a difference was found in PASDAS mean scores between treatment groups, with both the combination csDMARD and early TNFi groups showing evidence of a difference when compared to standard step-up care. Of note, there was no evidence of a difference between the early TNFi and combination csDMARD groups.
However, by week 48 the benefit compared to standard step-up care was seen only for early TNFi therapy.
Presenting the work, co-author Dr Laura Coates from the University of Oxford said: “These data show that initial intensive therapy with early biologics or combination csDMARDs are superior for rapid control of early moderate-to-severe PsA. Even with only six months of early biologic therapy, better outcomes are maintained at one year in those initially receiving a TNF inhibitor.”
A case series also presented at the Congress aimed to describe real-world safety and effectiveness of combined biologic and targeted synthetic DMARD therapy in PsA. The researchers analysed prospectively collected data from the University of Toronto PsA cohort, which included 22 people treated with combinations of a bDMARD and either JAKi or TYK2i, with some patients trying multiple combinations.
The primary indications for combination therapy were active peripheral arthritis and skin disease, including palmoplantar psoriasis. Results showed numerical improvement across multiple disease-activity measures. In the bDMARD plus JAKi group, the most frequent combination was an IL-17i plus JAKi.
During 10.5 patient-years of exposure, one case of mild infectious stomatitis was reported, which did not result in treatment discontinuation. Additionally, IL-23i plus JAKi were used for 3.7 patient-years with no reported safety events.
For the bDMARD plus TYK2i group, IL-17i plus TYK2i were used for 8.5 patient-years. Combinations of bDMARD plus apremilast were also reported. Overall, the safety profile of bDMARD combinations with JAKi, TYK2i, and apremilast appear favourable. All reported infections were mild, managed without hospitalisation, and rarely led to treatment discontinuation.
Furthermore, patients achieved short-term responses, with improvements in both musculoskeletal and skin domains. However, as this is an observational study with short-term follow-up, there is a need for randomised clinical trials to further explore and validate these findings.
