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

Van den Bosch et al. reported that upadacitinib 15 mg once daily led to sustained improvement in nr-axSpA over two years, including disease activity, pain, and quality of life. The study reports that 57.1% achieved ASAS40 response at week 104, with no new safety signals identified.

Zhao et al. found that among patients with PsA or axSpA, JAKi were not associated with increased risk of CVD or common cancers compared to TNFi or IL-17i.

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

Deodhar et al. assessed the long-term safety, tolerability and efficacy of bimekizumab in patients with r-axSpA over five years. The study found that bimekizumab maintained disease control achieved at Wk48 through Wk256, with no new safety signals observed. Adverse events were consistent with previous reports, and clinical benefits, including improvements in disease activity and patient-reported outcomes, were sustained.

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.

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.

Baraliakos et al. evaluated the long-term safety and efficacy of bimekizumab in axSpA through a 2-year analysis of the BE MOBILE 1 and BE MOBILE 2 studies. Bimekizumab was well tolerated, with a consistent safety profile and no new safety signals. Clinical improvements, including ASAS40 response and MRI remission, were sustained through Wk104.