TNF-α, IL-17A Inhibitors Achieve Superior Arthritis, Skin Responses in PsA

A recent literature review evaluated the efficacy of various psoriatic arthritis (PsA) treatments and determined that tumor necrosis factor-α (TNF-α) inhibitors and interleukin 17A (IL-17A) inhibitors are the best available.

Psoriatic arthritis is a complicated disease, affecting roughly 30% of all psoriasis patients. Diagnosis is usually conducted by identifying inflammatory features, as there are no diagnostic tests available. There is also little knowledge as to how psoriasis develops into PsA, although some experts believe it may occur in stages.2

“Since the year 2000, biological synthetic disease-modifying anti-rheumatic drugs (bDMARDs) and targeted synthetic disease-modifying anti-rheumatic drugs (tsDMARDs)…are used to treat PsA, improving the prognosis of the disease,” wrote Siming Gao, department of rheumatology, Beijing Jishuitan Hospital, and colleagues. “But there are few head-to-head studies that directly compare all these drugs to evaluate and compare the relative efficacy of these treatments, and few meta-analyses are about long-term efficacy of these drugs.”1

The team collected all randomized controlled trials in PubMed, Web of Science, and Embase, published up to December 2024. Inclusion criteria included the following:

• Participants ≥18 years
• Participants with active psoriasis (≥3 swollen joints and ≥3 tender joints)
• Participants with active plaque psoriasis (>1 plaque >2 cm in diameter)
• Participants with nail changes consistent with psoriasis or plaque psoriasis
• Nonsteroidal anti-inflammatory drugs (NSAIDs) usable before or at collection date1

After collecting an initial total of 3072 publications, two authors screened the studies and narrowed the total to 25, enrolling a collective 11,375 patients. Mean age among participants ranged from 44.2-54.1 years; mean disease durations ranged from 3.4-11.0 years.1

Gao and colleagues then scored each drug based on its attainment of ≥20% improvement in American College of Rheumatology Score (ACR20), ACR50, and ACR70 for reduction in arthritis, ≥75% reduction in Psoriasis Area and Severity Index (PASI75), and PASI90 for reduction in psoriasis. The rankings are based on surface under the cumulative ranking curve (SUCRA) scores.1

In comparison of ACR20, results showed secukinumab 300 mg exhibits the best score (97%), followed by golimumab 50 mg (86.4%) and adalimumab 40 mg (86.1%). In comparison of ACR50, infliximab 5 mg/kg holds the highest ranking (95.2%), followed by secukinumab 300 mg (92%) and adalimumab 40 mg (84.7%). In comparison of ACR70, adalimumab 40 mg has the highest score (92.1%), followed by infliximab 5 mg/kg (87.1%) and ixekizumab 80 mg (71.2%).1

In PASI75, adalimumab 40 mg claims the highest score (92.9%), followed by infliximab 5 mg/kg (92.7%) and golimumab 50 mg (89.3%). PASI90 comparison marks secukinumab 300 mg at the top (96.5%), followed by adalimumab 40 m (83.9%) and infliximab 5 mg/kg (78%).1

Gao and colleagues noted that, in concordance with previous studies, adalimumab 40 mg, infliximab 5 mg/kg, and secukinumab 300 mg are the most effective agents for joint and skin symptoms of PsA. However, where some studies have cited TNF-α treatments as exacerbating symptoms of PsA, investigators indicated that TNF-α treatments exhibited a therapeutic effect for skin symptoms.1

The team does note one limitation of this study. All collected literature only examined results of treatment out to 24 weeks, as few studies have compared the efficacy of these treatments so far. They believe more valuable results will be discovered in the future as similar studies are conducted.1

“Even though our study has these limitations, it provides the most recent and comprehensive summary of the bDMARDs or tsDMARDs used in clinical practice in the PsA treatments, which help us make a better decision about which medication to choose in the treatment of active PsA,” wrote Gao and colleagues. “Further meta-analysis or further head-to-head studies or long-time studies may provide stronger evidences to prove which drug is better.”1

References

1. Gao S, Song H. Efficacy of biological or targeted synthetic disease‐modifying anti‐rheumatic drugs in active psoriatic arthritis: A network meta‐analysis of Randomized Controlled Trials. Journal of Clinical Pharmacy and Therapeutics. 2025;2025(1). doi:10.1155/jcpt/6541156

2. FitzGerald O, Ogdie A, Chandran V, et al. Psoriatic arthritis. Nature Reviews Disease Primers. 2021;7(1). doi:10.1038/s41572-021-00293-y