Advantages of Early Biologic Therapy in Psoriatic Arthritis: Insights from Recent Research

Recent studies have explored the impact of initiating biologic treatments early in the course of psoriatic arthritis (PsA), a chronic inflammatory disease affecting joints and skin. While some earlier research indicated no significant benefits of early biologics over traditional step-up care involving methotrexate, these studies often did not focus on patients with a poor prognosis. To address this, the SPEED trial specifically targeted 192 PsA patients exhibiting poor prognostic factors, comparing three distinct treatment approaches: standard step-up therapy with conventional disease-modifying antirheumatic drugs (csDMARDs), combination csDMARD therapy, and early induction with a tumor necrosis factor inhibitor (TNFi). The primary measure of disease activity was the Psoriatic Arthropathy Disease Activity Score (PASDAS) assessed at 24 weeks.

Results demonstrated significant differences in disease activity scores among treatment groups. Both the combination csDMARD and early TNFi groups showed improved outcomes compared to standard care at the 24-week mark, with no notable difference between the two intensified therapies. By 48 weeks, the advantages persisted only in the group receiving early TNFi therapy, highlighting its sustained effectiveness. This suggests that an initial aggressive approach using biologics or combination therapy can provide faster control over disease activity in patients with moderate-to-severe PsA.

Further real-world research was presented through a case series examining the safety and effectiveness of combined biologic and targeted synthetic DMARD therapy. Data from the University of Toronto cohort involving 22 patients indicated that combination treatments, such as IL-17 inhibitors with JAK inhibitors or TYK2 inhibitors, were associated with meaningful clinical improvements and manageable safety profiles. Mild adverse events, primarily infections, did not necessitate discontinuation of therapy, underscoring the potential of these strategies in routine clinical practice. However, as these findings are based on short-term observational data, dedicated randomized controlled trials are essential to confirm long-term safety and efficacy.

Overall, current evidence points toward the benefits of early, intensive biologic therapy for certain PsA patients, potentially leading to better disease management and improved quality of life. Medical professionals should weigh these options carefully, considering individual prognostic factors and treatment responses.

For more detailed insights, refer to the original studies presented at the 2025 EULAR congress.

Source: https://medicalxpress.com/news/2025-06-benefits-early-biologic-treatment-psoriatic.html