OP0090 Combination of Biological and Targeted Synthetic Disease-Modifying Antirheumatic Drugs in Psoriatic Arthritis

Background: Psoriatic arthritis (PsA) is a complex inflammatory disease where achieving remission remains challenging despite multiple approved biologic DMARDs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs). The low remission rates have spurred interest in combining b/tsDMARDs, but there is still a paucity of data on such combinations. Objectives: This case series aims to describe real-world evidence regarding the safety and effectiveness of combined b/tsDMARD therapy in patients with PsA. Methods: We performed a case series of patients with PsA on combined b/tsDMARD therapy including TNF inhibitors, JAKi, TYK2i, IL17i, IL23i, IL-12/23i for effectiveness and safety. In addition, Apremilast (APR) and b/tsDMARD combinations were analyzed separately for safety. Demographic and clinical data were collected prospectively for patients enrolled in a PsA cohort and supplemented retrospectively via electronic records. Safety outcomes, including infections and non-infectious events, were reviewed. Treatment response was assessed through changes in disease activity scores from baseline to follow-ups at 3-6 and 6-12 months. Measurements included tender and swollen joint counts (TJC/ SJC), Disease Activity in PsA (DAPSA), psoriasis area and severity index (PASI), body surface area (BSA), and patient-reported outcomes (numerical rating scale for pain, skin, and patient global). Results: We identified 22 patients who were treated with combinations of bDMARDs and either JAKi or TYK2i, with some patients trying multiple combinations. Among these, 11 (50%) were female. Complete demographic and clinical data were available for 9 patients (Table 1), while the remaining 13 had partial information, including age, sex, reason for combination therapy, skin activity measures, and side effect annotations. The primary indications for combination therapy were active skin disease, including palmoplantar psoriasis in 3 patients, and peripheral arthritis. Numerical improvements were observed across multiple disease activity measures, with data for patients who attended visits within the prespecified timeframes presented in Figure 1. In the bDMARD + JAKi group (n=6), IL17i with JAKi were the most frequent combinations (n=4), used for 3,832 days (10.5 patient-years (PY)). One case of mild infectious stomatitis was reported, but treatment was not discontinued. IL23i with JAKi (n=2) were used for 1,337 days (3.7 PY), without any side-effects. For the bDMARD + TYK2i group (19 patients), IL-17i with TYK2i (n=9) were used for 3,229 days (8.5 PY). One patient experienced two mild upper respiratory infections (URIs) on bimekizumab and deucravacitinib, prompting a switch for risankizumab with deucravacitinib. IL-23i with TYK2i (n=10) were used for 3,044 days (8.3 PY), with two cases of mild URIs leading to a switch to bimekizumab monotherapy and one case of folliculitis, where therapy was continued. One patient received TNFi with TYK2i for 324 days (0.9 PY), with no adverse events reported. We also identified 15 patients treated with bDMARDs combined with apremilast (APR) for a median duration of 735 days. These combinations included IL12/23 inhibitors or IL23 inhibitors with APR (9 patients, duration range: 360–1890 days), IL17 inhibitors with APR (9 patients, duration range: 90–2790 days), TNFi with APR (7 patients, duration range: 180–2340 days), and JAKi with APR (1 patient, 540 days). Two cases of diarrhea were observed in patients on APR combinations, but no infections occurred. Conclusion: Overall, the safety profile of bDMARD combinations with JAKi, TYK2i, and APR was favorable. Infections, primarily URIs, were the most commonly observed adverse events. All reported infections were mild, managed without hospitalization, and rarely led to therapy discontinuation. Importantly, no severe or life-threatening infections were observed during the follow-up period. Furthermore, short-term response was observed, with improvements in both musculoskeletal and skin domains. However, as this is an observational study with a short-term follow-up, there is a need for randomized clinical trials to further explore and validate these findings. REFERENCES: NIL . Acknowledgements: NIL . Disclosure of Interests: Andre Lucas Ribeiro AbbVie and Johnson & Johnson, Virginia Carrizo Abarza: None declared, Jensen Yeung Abbvie; JAMP; Johnson & Johnson; Amgen; Leo Pharma; Anacor; Eli Lilly; Arcutis; Medimmune; Astellas; Merck; Bausche; Novartis; Baxalta; Pfizer; Boehringer Ingelheim; Bristol Myers Squibb; Regeneron; Celgene; Celltrion; Roche; Centocor; Sanofi Genzyme; Coherus; Sun Pharma; Dermira; Takeda; Forward; Fresenius Kabi; UCB; Galderma; Xenon; Incyte, Abbvie; JAMP; Johnson & Johnson; Amgen; Leo Pharma; Anacor; Eli Lilly; Arcutis; Medimmune; Astellas; Merck; Bausche; Novartis; Baxalta; Pfizer; Boehringer Ingelheim; Bristol Myers Squibb; Regeneron; Celgene; Celltrion; Roche; Centocor; Sanofi Genzyme; Coherus; Sun Pharma; Dermira; Takeda; Forward; Fresenius Kabi; UCB; Galderma; Xenon; Incyte, Khalad Maliyar: None declared, Siddhartha Sood: None declared, Ahmed Bagit: None declared, Muskaan Sachdeva: None declared, Sahil Koppikar AbbVie, Celltrion, Eli Lilly, Fresenius Kabi, JAMP, Janssen, Novartis, Pfizer, UCB, Sandoz, AbbVie, Celltrion, Eli Lilly, Fresenius Kabi, JAMP, Janssen, Novartis, Pfizer, UCB, Sandoz, Dafna D. Gladman AbbVie, Amgen, BMS, Celgene, Eli Lilly, Galapagos, Gilead, Janssen, Novartis, Pfizer, and UCB, AbbVie, Amgen, Celgene, Eli Lilly, Galapagos, Gilead, Janssen, Novartis, Pfizer, and UCB, Vinod Chandran AbbVie/Abbot, Bristol-Myers Squibb, Eli Lilly, Janssen, Novartis, and UCB, AbbVie, Lihi Eder Abbvie, UCB, Novartis, Pfizer, Johnson & Johnson, Eli Lilly, BMS, Moonlake, AbbVie, UCB, Novartis, Pfizer, Fresenius Kabi, Johnson & Johnson, and Eli Lilly. © The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.

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