Reinisch W, et al. report that the efficacy of RZB induction therapy is independent of CS use, with high rates of CS-free outcomes observed in the overall population and among patients with baseline CS use.

Kaya et al. reported that switching to secukinumab or cycling to another TNFi after first TNFi failure in axSpA led to comparable drug survival, with predictive factors differing by treatment. The study reports that smoking and Achilles enthesitis were associated with higher SEC discontinuation, while high CRP and primary TNFi failure predicted TNFi discontinuation.

The concept of difficult-to-treat disease in rheumatology: where next?

Lancet Rheumatol. 2025;7:e274–89 doi: 10.1016/S2665-9913(24)00340-0

Nagy et al. propose a unifying and holistic framework for understanding and addressing the concept of difficult-to-treat (D2T) disease across rheumatology, integrating cross-disciplinary evidence and recommending its incorporation into future disease management strategies. The D2T state requires a comprehensive, holistic, multidisciplinary approach that considers the specific characteristics of each disease and the personalised needs of the patient.

Di Napoli et al. conducted a global pharmacovigilance analysis comparing MACE between JAKis and anti-TNFα therapies in patients with RA. JAKis were more frequently associated with reported MACE, particularly stroke, and had a shorter median time to onset than
anti-TNFα therapy.

March 2025

Prajapati et al. conducted the PROTOSTAR trial to assess guselkumab in paediatric patients with moderate-to-severe plaque psoriasis. Guselkumab significantly improved skin clearance versus placebo at Wk16, with high response rates sustained through Wk52 and a favourable safety profile.

Floris et al. conducted a monocentric cohort study to assess the impact of biologic treatment on the development of PsA in patients with PsO. Treatment with biologics significantly reduced the likelihood of PsA development, with lower prevalence observed across different biologic classes and patterns of joint involvement.

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.

Sands et al. evaluated tamuzimod, a selective sphingosine 1-phosphate receptor 1 modulator, in patients with moderately-to-severely active UC. At Week 13, clinical remission (defined as an MMS stool frequency subscore of ≤1, rectal bleeding subscore of 0, and endoscopic subscore ≤1, excluding friability) was achieved by 28% and 24% of patients receiving tamuzimod 60 mg and 30 mg, respectively, compared with 11% in the placebo group. The treatment was well tolerated; most AEs were mild or moderate.