Burden and determinants of multi-b/tsDMARD failure in psoriatic arthritis

Arthritis Research & Therapy 2025;27:46 doi: 10.1186/s13075-025-03518-7

Haberman et al. analysed prescribing patterns and characteristics of PsA patients with
multi-b/tsDMARD failure, defined as requiring ≥4 b/tsDMARDs. Among 960 patients at the NYU Psoriatic Arthritis Centre, 17% met this criterion. These patients were more likely to be female, obese, and have higher rates of axial involvement and depression. They also exhibited greater disease activity, suggesting that both inflammatory and non-inflammatory factors contribute to multiple treatment failures.

Kanda et al. investigated the efficacy of second-line b/tsDMARDs in RA patients unresponsive to first-line b/tsDMARDs. Using data from the FIRST registry, the study assessed 687 patients with RA treated with TNFis, IL-6 receptor inhibitors, cytotoxic T-lymphocyte-associated protein 4 immunoglobulin, or JAKis. After propensity score-based adjustment, JAKi showed the highest persistence rate, greatest improvement in CDAI, and highest remission rates at 24 weeks. Among JAKi, UPA was most effective in achieving remission, with a safety profile comparable to other b/tsDMARDs.

Eberhard et al. investigated the effectiveness of JAKi versus bDMARDs on pain reduction in RA patients, using Swedish national register data. JAKi treatment resulted in a significantly greater reduction in pain at three months compared with TNFis, with a higher proportion achieving low pain at 12 months, particularly in those previously treated with multiple bDMARDs.

February 2025

Miyazaki et al. investigated the efficacy and safety of switching to bDMARDs versus cycling among JAKis in RA patients with inadequate JAKi response. Cycling to another JAKi proved more effective in improving disease activity at 26 weeks compared to switching to a bDMARD, and both groups had similar safety profiles.

Edwards et al. reported that in patients with RA who achieved sustained LDA or remission, tapering baricitinib from 4mg to 2mg allowed most to maintain LDA at 96 weeks. Rescue with 4mg restored control for the majority, demonstrating the feasibility of dose reduction with recovery potential for treatment.

Gladman et al. assessed the impact of bimekizumab over 1 year on patient-reported symptoms, HRQoL, and work productivity in patients with PsA who were bDMARD-naïve or TNF-IR. The study showed that bimekizumab treatment resulted in sustained improvements across multiple domains, including pain, fatigue, physical function, and work impairment.

January 2025

Heutz et al. found that patients requiring bDMARDs rarely achieved DMARD-free remission, while 15–37% of those on non-bDMARDs reached this milestone, underscoring significant differences based on treatment type. This suggests the EULAR recommendation against DMARD cessation may be too generalised.

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November 2024

Impact of treatments on fatigue in axial spondyloarthritis: a systematic review and meta-analysis

Rheumatology (Oxford). 2024 Oct 10:keae549 doi 10.1093/rheumatology/keae549 Epub ahead of print

Delcourt et al. conducted a systematic review and meta-analysis revealing that both pharmacological (DMARDs) and non-pharmacological interventions reduce fatigue in axSpA patients over short and medium terms, with greater efficacy seen when combined.

September 2024

Mease et al. assessed the comparative effectiveness of bimekizumab and risankizumab in patients with PsA over 52 weeks using a matching-adjusted indirect comparison (MAIC). The study included patients who were biologic disease-modifying anti-rheumatic drug (bDMARD) naïve or had a prior inadequate response or intolerance to tumour necrosis factor inhibitors (TNFi-IR).

McInnes et al. reported that bimekizumab demonstrated sustained efficacy and safety over 52 weeks in patients with psoriatic arthritis (PsA), regardless of concomitant methotrexate (MTX) use. Both bimekizumab groups (with and without MTX) showed similar improvements in achieving ACR50 and PASI100 responses.