Assessing the Efficacy of Biologics and Methotrexate When Treating Psoriatic Arthritis

According to a recent study published in RMD Open, the utilization of methotrexate (MTX) and biologics did not improve American College of Rheumatology (ACR) efficacy outcomes vs biologic monotherapy when treating patients with psoriatic arthritis (PsA).

Researchers aimed to assess the efficacy of combining MTX with biologics compared to biologic monotherapy in treating active PsA. A network meta-analysis (NMA) was conducted, focusing on biologics classified by treatment class (tumor necrosis factor [TNF] inhibitors, IL-23 inhibitors, and IL-17 inhibitors). The systematic literature review identified 31 studies, and 17 of them met feasibility criteria for the NMA, including the ”without MTX” subgroup. Efficacy outcomes, measured by ACR 20%, 50%, and 70% improvement response (ACR20, ACR50, and ACR70), were used for comparison.

The results showed that for ACR20, the most robust assessment, all active treatments, including biologic monotherapy, were significantly more effective than placebo. However, there were no statistically significant differences between biologic monotherapy and combination with MTX for ACR20/50. IL-17 inhibitors were comparable to IL-23 inhibitors, and IL-17 inhibitors were significantly better than TNF inhibitors for ACR20. Although limited by fewer trials, TNF inhibitors, IL-23 inhibitors, and IL-17 inhibitors did not show statistically significant differences for ACR50/70.

“MTX does not appear to be necessary as a background therapy when biologics are used for the achievement of ACR20/50 responses in patients with PsA,” the authors concluded.

Reference
Mease PJ, Reddy S, Ross S, et al. Evaluating the efficacy of biologics with and without methotrexate in the treatment of psoriatic arthritis: a network meta-analysis. RMD Open. Published online January 31, 2024. doi:10.1136/rmdopen-2023-003423