In psoriatic arthritis (PsA) EULAR – The European Alliance of Associations for Rheumatology – recommends a treat-to-target approach, and suggests more intensive therapy for people with poor prognostic factors, depending on the disease presentation. Specifically, treatment should target of remission or, alternatively, low disease activity, by regularly assessing disease activity and adjusting therapy as required.
Two recent studies suggest there is no significant benefit of early biologics over standard step-up care with methotrexate, but these did not select for poor prognosis. The aim therefore of the SPEED trial (Severe Psoriatic arthritis – Early intervEntion to control Disease), funded by the National Institute for Health and Care Research (NIHR), was to compare disease activity in 192 PsA patients with poor prognostic factors when treated with one of three regimens: standard step-up with conventional systemic disease-modifying anti-rheumatic drugs (csDMARD), combination csDMARD, or early induction with a tumour necrosis factor inhibitor (TNFi). The primary endpoint was the mean PsA disease activity score (PASDAS) at 24 weeks. Data were presented at the 2025 annual EULAR congress in Barcelona.
At Week 24, a difference was found in PASDAS mean scores between treatment groups, with both the combination csDMARD and early TNFi groups showing evidence of a difference when compared to standard step-up care. Of note, there was no evidence of a difference between the early TNFi and combination csDMARD groups. However, by Week 48 the benefit compared to standard step-up care was seen only for early TNFi therapy.
Presenting the work, Laura Coates said: 'These data show that initial intensive therapy with early biologics or combination csDMARDs are superior for rapid control of early moderate-to-severe PsA. Even with only 6 months of early biologic therapy, better outcomes are maintained at 1 year in those initially receiving a TNF inhibitor.'