REAL-WORLD data have shown comparable short-term effectiveness and long-term persistence across biologic disease-modifying antirheumatic drugs (DMARDs) in psoriatic arthritis, according to an emulated multicentre clinical trial that has revealed partially distinct response patterns.
Multiple lines of evidence have supported the efficacy of biologic DMARDs in psoriatic arthritis, largely derived from randomised controlled trials. However, these findings may be constrained by the disease’s heterogeneity, and Phase III trials conducted for regulatory approval predominantly enrolled patients with peripheral arthritis, limiting representativeness of routine practice. Before this study, structured real-world comparative evidence on long-term outcomes often not captured in conventional trials was limited.
Consecutive patients with moderate-to-high psoriatic arthritis disease activity initiating a biologic DMARD between January 2022 and June 2025 were prospectively enrolled in a multicentre Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale study.
Real-world data were analysed using target trial emulation to compare tumour necrosis factor (TNF) inhibitors, interleukin (IL)-17 inhibitors and IL-23-pathway inhibitors, with propensity score weighting for measured baseline characteristics.
Effectiveness was assessed by changes in the Disease Activity Index for Psoriatic Arthritis (DAPSA) over 6 months, and long-term drug retention by a 6-month landmark analysis of patients remaining on the index treatment.
In total, 990 patients were included: 342 initiated TNF inhibitors, 313 initiated IL-17 inhibitors and 335 initiated IL-23-pathway inhibitors. DAPSA decreased significantly over 6 months in all three groups, with no statistically significant differences in adjusted longitudinal trajectories between classes.
Among patients who remained on the index treatment through month 6, adjusted analyses did not identify statistically significant between-class differences in subsequent drug retention.
Shorter disease duration was associated with more favourable outcomes in selected exploratory analyses, whereas associations with previous biologic DMARD exposure were inconsistent.
Adverse-event-related discontinuations were described, but the study was not designed to support formal comparative safety conclusions.
In this emulated trial, biologic DMARDs have shown comparable short-term effectiveness and long-term persistence in psoriatic arthritis. Partially distinct response patterns may support a more individualised approach to treatment selection, although class-specific findings remain exploratory.
Reference
Ruscitti P et al. Real‑world assessment of the effectiveness and response profiles of biologic DMARDs in psoriatic arthritis: findings from an emulated multicentre clinical trial. Annals of the Rheumatic Diseases. 2026;DOI:10.1016/j.ard.2026.09.008.
Featured image: nuzza11 on Adobe Stock
Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.
