Early Intensive Therapy Shows Promise in Treating Psoriatic Arthritis

Strategic Insights -

Researchers have presented data at the 2025 annual EULAR congress in Barcelona suggesting that early intensive therapy with biologics or combination conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) offers superior control of early moderate-to-severe psoriatic arthritis compared to standard step-up care. The SPEED trial, funded by the National Institute for Health Research (NIHR), compared the disease activity of 192 PsA patients with poor prognostic factors in three treatment regimens: standard step-up with csDMARD, combination csDMARD, or early induction with a tumour necrosis factor inhibitor (TNFi). Presenting the work, Laura Coates emphasized the benefits of initial intensive therapy with biologics or combination csDMARDs for rapid control of early PsA, even with only 6 months of early biologic therapy.

Key Takeaways:

  • The SPEED trial found that early intensive therapy with biologics or combination csDMARDs showed evidence of a difference in PsA disease activity scores (PASDAS) compared to standard step-up care at 24 weeks.
  • Both the combination csDMARD and early TNFi groups showed a difference in mean PASDAS scores at 24 weeks when compared to standard step-up care.
  • However, the benefit compared to standard step-up care was only seen for early TNFi therapy by Week 48.
  • Laura Coates stated that even with only 6 months of early biologic therapy, better outcomes were maintained at 1 year in those initially receiving a TNF inhibitor.
  • A case series presented at the congress analysing prospectively collected data from the University of Toronto psoriatic arthritis cohort found that combined biologic and targeted synthetic DMARD therapy in PsA had a numerical improvement across multiple disease-activity measures.
  • Patients in the case series achieved improved musculoskeletal and skin domains with short-term responses, with favourable safety profiles observed.
  • The case series highlighted the need for randomised clinical trials to further explore and validate the findings.

Statistics:

  • The SPEED trial included 192 PsA patients with poor prognostic factors.
  • The primary endpoint was the mean PsA disease activity score (PASDAS) at 24 weeks.
  • By Week 24, the combination csDMARD group and early TNFi group showed a difference in PASDAS scores compared to standard step-up care.
  • By Week 48, only early TNFi therapy showed a continued benefit compared to standard step-up care.
  • The case series included 22 patients treated with combined biologic and targeted synthetic DMARD therapy in PsA.
  • Results showed a numerical improvement across multiple disease-activity measures.
  • Patients achieved improved musculoskeletal and skin domains with short-term responses.

Sources:

  • Massa S, et al. Early intensive therapy with combination csDMARDs or TNF inhibitors are superior to standard step up care for the treatment of moderate to severe psoriatic arthritis: SPEED RCT. Presented at EULAR 2025; OP0089. Ann Rheum Dis 2025; DOI: 10.1136/annrheumdis-2025-eular.B567.
  • Lucas Ribeiro A, et al. Combination of Biological and Targeted Synthetic Disease-Modifying Antirheumatic Drugs in Psoriatic Arthritis. Presented at EULAR 2025; OP0090. Ann Rheum Dis 2025; DOI: 10.1136/annrheumdis-2025-eular.B691.
  • Gossec L, et al. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2023 update. Ann Rheum Dis 2024;83:706-19. DOI: 10.1136/ard-2024-225531.
  • De Marco G, et al. A treatment strategy combining TNF-inhibitor, methotrexate and steroids is not superior to methotrexate and steroids in early Psoriatic Arthritis: results from the GOLMePsA randomised, double-blind clinical trial. Presented at EULAR 2024; OP0184. Ann Rheum Dis 2024;83:153-4. DOI: 10.1136/annrheumdis-2024-eular.544.
  • Koc GH, et al. Treat-to-Target Approaches in Early Psoriatic Arthritis: Early Secukinumab versus Standard Care - 12- and 24-Week Results from a Multicenter, Open-Label, Randomized Controlled Trial. Presented at ACR 2024; 1457. Arthritis Rheumatol 2024;76(suppl 9).