Pivotal new findings from the SPEED trial and other studies have been presented at the EULAR 2025 Congress in Barcelona.
Early intensive treatment with biologic DMARDs (bDMARDs), particularly tumour necrosis factor inhibitors (TNFi), leads to superior long-term disease control in patients with moderate-to-severe psoriatic arthritis (PsA) and poor prognostic factors, according to new data presented at the European Alliance of Associations for Rheumatology (EULAR) 2025 Congress.
Specifically, treatment should target of remission or, alternatively, low disease activity, by regularly assessing disease activity and adjusting therapy as required.
Two studies presented at EULAR session included the SPEED trial, funded by the UK’s National Institute for Health Research.
The SPEED trial compared three treatment strategies in 192 patients with early PsA and markers of poor prognosis, including standard step-up therapy with conventional synthetic DMARDs (csDMARDs), combination csDMARDs and early induction with a TNFi.
At 24 weeks, both combination csDMARDs and early TNFi therapy demonstrated statistically significant improvements in PsA Disease Activity Score (PASDAS) compared to standard care. However, by 48 weeks, only those receiving early TNFi maintained a significant benefit.
Professor Laura Coates, a Senior Clinical Research Fellow at the University of Oxford’s Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, presented the findings on the first day of the congress, which is currently being held in Barcelona.
“These data show that initial intensive therapy with early biologics or combination csDMARDs are superior for rapid control of early moderate-to-severe PsA,” she said.
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“Even with only six months of early biologic therapy, better outcomes are maintained at one year in those initially receiving a TNF inhibitor.”
The findings support a treat-to-target approach endorsed by EULAR, which advocates early intervention, particularly in patients with poor prognostic indicators.
In a separate presentation, a case series from the University of Toronto’s PsA cohort evaluated real-world outcomes of bDMARDs combined with targeted synthetic DMARDs (tsDMARDs), including JAK and TYK2 inhibitors.
Dr Andre Lucas Ribeiro and colleagues analysed prospectively collected data from 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.
Combinations such as IL-17 inhibitors with JAKi or TYK2i showed numerical improvements in disease activity with a favourable safety profile. Infections were mild, non-serious and infrequent. Notably, over 10.5 patient-years of exposure to IL-17i plus JAKi, only one mild case of stomatitis was reported.
The study also included combinations with apremilast, with minor side effects like diarrhea, and no serious infections, that were managed without hospitalisation and rarely led to treatment discontinuation.
Patients achieved short-term responses, with improvements in both musculoskeletal and skin domains. However, as this was an observational study with short-term follow-up, the authors stressed the need for randomised clinical trials to confirm efficacy and long-term safety of these combinations.
References available on request
EULAR 2025 runs from 11 to 14 June in Barcelona, Spain.
