Rheumatology and Therapy最新文献

{"title":"Is a Functional Cure Possible in Autoimmune Diseases? Evidence from Trigger Eradication, Transplantation, and Cellular Therapies.","authors":"Jozélio Freire de Carvalho, Carlos Ewerton Maia Rodrigues","doi":"10.1007/s40744-025-00816-z","DOIUrl":"10.1007/s40744-025-00816-z","url":null,"abstract":"<p><strong>Introduction: </strong>Traditionally considered incurable, autoimmune diseases (AIDs) may-in specific circumstances-achieve sustained remission or even a \"functional cure,\" defined as durable clinical and laboratory remission without immunosuppression. This review evaluates evidence across five therapeutic axes: infectious trigger eradication, immune reset via autologous hematopoietic stem cell transplantation (HSCT), cellular therapies (CAR-T, extracorporeal photopheresis), environmental/nutritional strategies, and paraneoplastic syndromes.</p><p><strong>Methods: </strong>Systematic review according to PRISMA guidelines in PubMed/MEDLINE, Embase, Scopus, Web of Science, and Cochrane (up to September 2025). Eligible studies included trials, meta-analyses, cohorts, case series, and reports describing sustained or drug-free remission. Definitions applied were clinical remission, complete remission, sustained remission ≥ 12 months, drug-free remission, and functional cure (complete, off-therapy remission with stable biomarkers and no new organ damage).</p><p><strong>Results: </strong>Strong evidence supports Helicobacter pylori eradication in immune thrombocytopenic purpura, with signals in dermatoses and urticaria. In systemic sclerosis, HSCT outperformed cyclophosphamide in randomized trials, improving survival and reducing prolonged immunosuppression; lupus series reported extended drug-free remissions. Anti-CD19 CAR-T therapies induced deep remission in B-cell-mediated AIDs, normalizing autoantibodies over 12-24 months. Photopheresis showed safety but heterogeneous efficacy. Environmental interventions (vitamin D, plant-based diet, microbiota modulation) suggested benefit, though with limited evidence for cure. In paraneoplastic syndromes, tumor control often coincided with autoimmune remission.</p><p><strong>Conclusions: </strong>Functional cure in AIDs appears achievable in selected cases through trigger removal, immune reset, or profound immune depletion. Advancing this paradigm requires standardized definitions, predictive biomarkers, and long-term controlled trials to integrate these strategies into routine care.</p>","PeriodicalId":21267,"journal":{"name":"Rheumatology and Therapy","volume":" ","pages":"1-25"},"PeriodicalIF":2.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12816497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145820583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness and Safety of Upadacitinib in Treating Oligoarticular and Polyarticular Psoriatic Arthritis: Primary Analysis from the UPJOINT-Study.","authors":"Stephanie Gabriele Werner, Ilka Schwarze, Xenofon Baraliakos, Michael Fiene, Jochen Walter, Tanya Girard, Marie-Claude Laliberté, Katharina Jeromin, Nikola Baschuk, Hugues Allard-Charmard, Louis Bessette, Axel J Hueber","doi":"10.1007/s40744-025-00802-5","DOIUrl":"10.1007/s40744-025-00802-5","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to investigate the effectiveness and safety of upadacitinib in patients with either oligo- or polyarticular active psoriatic arthritis (oPsA/pPsA) in routine clinical practice.</p><p><strong>Methods: </strong>UPJOINT is a post-marketing, multicenter observational study in patients with active psoriatic arthritis (PsA), treated with upadacitinib according to local label over a period of 48 weeks. The decision for treatment initiation with upadacitinib was independent of the study participation. The study's denominated primary endpoint was the proportion of patients achieving minimal disease activity (MDA) at week 24 under continuous treatment with upadacitinib. Furthermore, maintenance of MDA response at week 48 among those who achieved response at week 24 was evaluated. Also, very low disease activity (VLDA), and improvement of the Disease Activity Index for Psoriatic Arthritis (DAPSA) in oPsA/pPsA were further composite outcomes of interest evaluated at baseline and weeks 4, 12, 24, 36, and 48 after treatment initiation. Safety data were collected in a separate dataset using standardized operating procedures regarding the documentation of adverse events, followed by MedDRA hierarchy categorization using system organ classes.</p><p><strong>Results: </strong>A total of 364 patients were included in the effectiveness dataset for an as-observed analysis. The proportion of patients achieving MDA increased from 3.6% (overall) at baseline, 7.1% (oPsA), and 1.3% (pPsA) to 41.5% (overall), 55.8% (oPsA), and 32.0% (pPsA) at week 24, respectively. At week 48, 47.5% of the patients with oPsA and 35.1% of the patients with pPsA achieved MDA. The proportion of MDA responders increased noticeably as early as week 4 in both subgroups (oPsA 38.4%, pPsA 16.3%). The proportion of patients achieving VLDA and DAPSA remission increased from 0% for both outcomes at baseline in patients with oPsA and pPsA to 22.2% and 14.3% and 24.2% and 14.9%, respectively, at week 48. Altogether 127 (33.3%) patients experienced 213 adverse events (AEs) with a reasonable possibility of being related to the study drug. Forty-one serious AEs were reported in 26 patients (6.8%). From the categorized AEs of particular interest, infections were most common. However, in line with previous clinical studies, no new safety signals were identified.</p><p><strong>Conclusion: </strong>Our data confirm that the effectiveness of upadacitinib in routine clinical practice is consistent with previous phase 3 trials for the treatment of active PsA, independent of the disease phenotype. Fast treatment effects reflected MDA achievement after 4 weeks of treatment in both PsA subgroups, similar to what is known from clinical studies.</p><p><strong>Trial registration: </strong>NCT04758117 (ClinicalTrials.gov).</p>","PeriodicalId":21267,"journal":{"name":"Rheumatology and Therapy","volume":" ","pages":"45-64"},"PeriodicalIF":2.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12816421/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145445742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methotrexate Maintenance After Initiation of Biological or Targeted Synthetic DMARDs in Rheumatoid Arthritis: Results from the 2-Year Longitudinal Prospective Non-interventional STRATEGE2 Study.","authors":"Cécile Gaujoux-Viala, Emmanuelle Dernis, Eric Senbel, Hélène Herman-Demars, Jennifer Becker, René-Marc Flipo","doi":"10.1007/s40744-025-00806-1","DOIUrl":"10.1007/s40744-025-00806-1","url":null,"abstract":"<p><strong>Introduction: </strong>The primary objective was to describe the therapeutic approach to methotrexate (MTX) use at the initiation of the first biologic or targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD) in the treatment of rheumatoid arthritis (RA). Secondary objectives included characterising participants initiating b/tsDMARD treatment, examining treatment strategies over time, monitoring disease progression, and identifying factors influencing treatment choices.</p><p><strong>Methods: </strong>This longitudinal, prospective, non-interventional, multicentre study (STRATEGE2) enrolled adult participants with RA who had been treated with MTX for at least 3 months and required b/tsDMARD treatment due to persistent disease activity. Outcomes were assessed at 12 months (M12) and 24 months (M24) after initiating b/tsDMARD treatment.</p><p><strong>Results: </strong>At baseline, 173 participants with RA had a mean (SD) disease duration of 5.6 (7.3) years and a mean Disease Activity Score in 28 joints (DAS28) score of 4.3 (1.2). Approximately two-thirds had been on MTX for over a year, with a mean weekly dose of 18.8 (4.2) mg (median 20.0), and 72.3% received it subcutaneously. MTX was continued at the initiation of b/tsDMARD therapy in 97.7% of participants. By M12, 83.2% of participants remained on MTX, with 39.9% (95% CI 32.5-47.6) maintaining the same dosage and route of administration. Discontinuation of MTX was primarily due to participant choice or adverse events. At M24, the mean change in DAS28 score was - 2.0 (1.3), with 66.0% of participants achieving remission. On the basis of European Alliance of Associations for Rheumatology (EULAR) classification criteria, 65.2% had a good response, 19.1% a moderate response, and 15.6% an inadequate response.</p><p><strong>Conclusion: </strong>The STRATEGE2 study investigators adhered to current clinical guidelines by continuing MTX in combination with b/tsDMARD initiation for the management of RA.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov: Therapeutic Strategy Associated with bDMARDs or tsDMARDs in Rheumatoid Arthritis and Psoriatic Arthritis (STRATEGE2), NCT05082805.</p>","PeriodicalId":21267,"journal":{"name":"Rheumatology and Therapy","volume":" ","pages":"157-177"},"PeriodicalIF":2.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12816463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145669722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Therapeutic Windows Across the Psoriatic Arthritis Spectrum.","authors":"Ji-Hyoun Kang, Laura C Coates","doi":"10.1007/s40744-025-00818-x","DOIUrl":"10.1007/s40744-025-00818-x","url":null,"abstract":"<p><strong>Introduction: </strong>Psoriatic arthritis (PsA) is a heterogeneous, progressive inflammatory disease that often arises in patients with psoriasis. Increasing evidence highlights potential critical windows of opportunity during which early recognition and appropriate therapeutic intervention can alter long-term outcomes.</p><p><strong>Methods: </strong>This review summarizes evolving treatment strategies for PsA across the disease continuum-from psoriasis and very early PsA through to established disease-focusing on the rationale for rapid intervention and risk-stratified use of biologics and emerging therapies.</p><p><strong>Results: </strong>Data from many recent trials support the principle that earlier use of effective targeted therapy can improve outcomes, including controlling psoriasis and arthritis, inducing remission and even drug-free remission. Treat-to-target strategies, with close monitoring and timely escalation, are central to optimizing outcomes. In this recent literature, biologics targeting TNF, IL-17, and IL-23 have reshaped our understanding of the treatment landscape. Novel oral cytokine-signaling inhibitors, such as TYK2 and IL-23 receptor antagonists, represent promising future options but require long-term safety and head-to-head data in PsA. Comorbidities, patient preference, and safety considerations remain essential in tailoring therapy.</p><p><strong>Conclusions: </strong>PsA management is shifting from reactive to proactive care. Aligning clinical practice toward early detection of skin and joint disease, rapid access to appropriate biologics, and disciplined treat-to-target approaches offer the best prospect for durable remission and improved quality of life. The next challenge lies in defining early PsA, predicting progression from psoriasis, and integrating new therapeutic classes into evidence-based treatment algorithms.</p>","PeriodicalId":21267,"journal":{"name":"Rheumatology and Therapy","volume":" ","pages":"27-43"},"PeriodicalIF":2.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12816465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145846773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of Biological Sex on Participant Characteristics, Guselkumab Efficacy and Radiographic Progression in Active Psoriatic Arthritis: Post Hoc Analysis of Three Randomized Trials.","authors":"Dafna D Gladman, Lihi Eder, Carlo Selmi, Philip J Mease, Alexis Ogdie, Karissa Lozenski, Elizabeth Adamson, Mohamed Sharaf, Emmanouil Rampakakis, Laura Pina Vegas, Laura C Coates","doi":"10.1007/s40744-025-00812-3","DOIUrl":"10.1007/s40744-025-00812-3","url":null,"abstract":"<p><strong>Introduction: </strong>Psoriatic arthritis (PsA) is a heterogeneous disease, and clinical manifestations can differ between sexes. Sex-disaggregated baseline characteristics, guselkumab efficacy, and radiographic progression were assessed in a pooled cohort of randomized controlled trial (RCT) participants with active PsA.</p><p><strong>Methods: </strong>Post hoc analyses of DISCOVER-1 (N = 381), DISCOVER-2 (N = 739), and COSMOS (N = 285) assessed sex-related baseline characteristics differences. Week (W) 24 clinical response rates with guselkumab 100 mg at W0/W4/every 8W (Q8W) were compared between sexes using multivariate logistic regression. In DISCOVER-2, multivariate repeated-measures mixed models evaluated associations between sex and radiographic progression with guselkumab Q4W + Q8W through W100, and between early (W8) response in joint disease activity with guselkumab Q4W + Q8W and radiographic progression, stratifying by sex.</p><p><strong>Results: </strong>Females were older; had higher body mass index; longer PsA duration; less severe psoriasis; more prevalent enthesitis; and reported more fatigue, pain, and functional impairment. Analyses adjusting for sex-specific differences in baseline characteristics showed no significant sex impact on guselkumab clinical response. Through W100, males exhibited significantly greater radiographic progression than females in unadjusted and adjusted models. Early clinical improvement in joint disease activity with guselkumab afforded significantly less radiographic progression through W100 in males (p = 0.0288) and numerically less in females.</p><p><strong>Conclusions: </strong>Despite being associated with significant differences in characteristics at baseline, sex had no independent effect on guselkumab clinical efficacy in this RCT cohort. The known independent association between male sex and radiographic progression was confirmed; males exhibited a stronger relationship between early improvement in joint disease activity and lower long-term rates of radiographic progression.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier NCT03162796, NCT03158285, NCT03796858.</p>","PeriodicalId":21267,"journal":{"name":"Rheumatology and Therapy","volume":" ","pages":"213-229"},"PeriodicalIF":2.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12816435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145757464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does HLA-B27 Status Influence Ixekizumab Efficacy in Axial Spondyloarthritis? Results From the COAST-V, COAST-W, and COAST-X Trials.","authors":"John D Reveille, Martin Rudwaleit, Proton Rahman, Jose A Maldonado-Cocco, Marina Magrey, Rebecca Bolce, Khai Jing Ng, Theresa Hunter Gibble, Jeffrey Lisse, So Young Park, Andris Kronbergs, Victoria Navarro-Compán","doi":"10.1007/s40744-025-00810-5","DOIUrl":"10.1007/s40744-025-00810-5","url":null,"abstract":"<p><strong>Introduction: </strong>The human leukocyte antigen (HLA)-B27 is associated with axial spondyloarthritis (axSpA) and is a predictor of response to tumor necrosis factor inhibitors. However, limited data are available on HLA-B27 and interleukin-17 inhibitors. We evaluated the influence of HLA-B27 status on ixekizumab response through 52 weeks in patients with axSpA.</p><p><strong>Methods: </strong>Data were analyzed from three randomized placebo-controlled trials: COAST-V (NCT02696785), COAST-W (NCT02696798), and COAST-X (NCT02757352). Patients fulfilled the Assessment of SpondyloArthritis international Society (ASAS) criteria for radiographic (r)-axSpA or non-radiographic (nr)-axSpA. Patients were randomized to receive 80 mg ixekizumab every 2 weeks, 80 mg ixekizumab every 4 weeks, or placebo. This post hoc analysis assessed the intent-to-treat population. The magnitude of benefit was calculated as the value for ixekizumab minus placebo.</p><p><strong>Results: </strong>Among ixekizumab-treated patients with r-axSpA at week 16, ASAS ≥ 40% improvement (ASAS40) was achieved by 39.6% (n = 118/298) of HLA-B27-positive and 29.3% (n = 12/41) of HLA-B27-negative patients. The magnitude of benefit (ixekizumab-placebo) was 23.5% for HLA-B27-positive and 15.2% for HLA-B27-negative patients. At week 52, 44% of HLA-B27-positive and 31.7% of HLA-B27-negative patients achieved ASAS40. Similar trends were seen for Axial Spondyloarthritis Disease Activity Score low disease activity (ASDAS LDA; < 2.1) and Bath Ankylosing Spondylitis Disease Activity Index ≥ 50% improvement (BASDAI50). In ixekizumab-treated patients with nr-axSpA at week 16, ASAS40 response was achieved by 41.7% (n = 55/132) of HLA-B27-positive and 28.0% (n = 14/50) of HLA-B27-negative patients. The magnitude of benefit was 19.2% for HLA-B27-positive and 16.0% for HLA-B27-negative patients. At week 52, 52.3% of HLA-B27-positive and 32.0% of HLA-B27-negative patients achieved ASAS40. Similar trends were seen among patients with nr-axSpA for ASDAS LDA and BASDAI50.</p><p><strong>Conclusions: </strong>In patients with r-axSpA and nr-axSpA, ixekizumab improved response through 52 weeks for both HLA-B27-positive and HLA-B27-negative patients. However, the magnitude of benefit for ixekizumab versus placebo was numerically greater for HLA-B27-positive patients.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifiers, NCT02696785, NCT02696798, and NCT02757352.</p>","PeriodicalId":21267,"journal":{"name":"Rheumatology and Therapy","volume":" ","pages":"279-291"},"PeriodicalIF":2.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12816414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145794905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacokinetics and Safety of Ustekinumab in Patients with Juvenile Psoriatic Arthritis: Results of the Real-World Ustekinumab Pediatric Opportunistic Pharmacokinetics Study (U-POPS).","authors":"Edwin Lam, Katherine Berezny, Corey J Bishop, Kathleen G Lomax, Sophia G Liva, Hermine I Brunner, Amy S Paller, Lucia Z Diaz, Lara Wine Lee, Cory Rubin, Ruy Carrasco, Lisa Imundo, Azadeh Majlessi, Valerie Smith, Renping Zhang, Jocelyn H Leu","doi":"10.1007/s40744-025-00820-3","DOIUrl":"10.1007/s40744-025-00820-3","url":null,"abstract":"<p><strong>Introduction: </strong>The \"Ustekinumab Pediatric Opportunistic Pharmacokinetics Study\" (U-POPS) was conducted to evaluate the pharmacokinetics (PK) and safety of ustekinumab, an interleukin-12/23p40 antagonist, in patients with juvenile psoriatic arthritis (jPsA) who were already receiving ustekinumab via an opportunistic study design. U-POPS was based on the clinical hypothesis that PK should be similar in jPsA and pediatric psoriasis (PsO) populations to further strengthen the extrapolation paradigm between the two populations.</p><p><strong>Methods: </strong>This real-world, open-label study enrolled participants 5 to < 18 years old with jPsA or 6 to < 18 years with PsO (internal control) who were on ustekinumab for ≥ 16 weeks and received ≥ 3 doses to ensure steady-state concentrations. Ustekinumab was prescribed by the treating physician and supplied outside of the study; PK samples were collected at intervals during a maximum of 16 weeks. The primary endpoint was the observed serum ustekinumab concentrations, which were compared to model-predicted values from prior PsO PK data.</p><p><strong>Results: </strong>The study included 11 patients with jPsA (mean age, 15.1 years) and 20 with pediatric PsO (mean age, 12.6 years), yielding 100 PK samples. The median ustekinumab dose was 45 mg every 12 weeks. Observed serum ustekinumab concentration-time profiles aligned well with model-predicted concentration-time profiles from pediatric PsO patients. Treatment-emergent adverse events (TEAEs) occurred in 25.8% of patients (jPsA, n = 1; PsO, n = 7) and were consistent with those observed in other ustekinumab studies, with no serious TEAEs reported.</p><p><strong>Conclusions: </strong>The opportunistic U-POPS study confirmed the existing population PK model for ustekinumab and suggests that ustekinumab exposure and time course are similar between jPsA and pediatric PsO populations, with no new safety concerns.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier, NCT05252533 (registration date: 02-16-2022); EudraCT Number, 2021-005085-18.</p>","PeriodicalId":21267,"journal":{"name":"Rheumatology and Therapy","volume":" ","pages":"265-278"},"PeriodicalIF":2.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12816458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145834750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"On-Label Treatment Persistence Through 24 Months Among Patients with Active Psoriatic Arthritis Initiating Guselkumab or Subcutaneous Tumor Necrosis Factor Inhibitors.","authors":"Philip J Mease, Jessica A Walsh, Timothy P Fitzgerald, Soumya D Chakravarty, Elizabeth Adamson, Bruno Emond, Carmine Rossi, Samuel Schwartzbein, Kana Yokoji, Yuxi Wang, Patrick Lefebvre, Dominic Pilon, Shikha Singla, Joseph F Merola","doi":"10.1007/s40744-025-00804-3","DOIUrl":"10.1007/s40744-025-00804-3","url":null,"abstract":"<p><strong>Introduction: </strong>There is limited prior literature comparing long-term treatment persistence between guselkumab and subcutaneous (SC) tumor necrosis factor inhibitors (TNFi) in biologic-naïve and biologic-experienced patients with active psoriatic arthritis (PsA). This study compared on-label persistence through 24 months between patients with active PsA newly initiating guselkumab or SC TNFi.</p><p><strong>Methods: </strong>IQVIA PharMetrics^® Plus database was used to identify adults with active PsA initiating guselkumab or an SC TNFi (adalimumab or biosimilar, certolizumab pegol, etanercept or biosimilar, SC golimumab) between 07/14/2020 and 12/31/2022 (index date: first treatment claim for one of these medications). Patients were further stratified as biologic-naïve (no pre-index biologic disease-modifying antirheumatic drug [bDMARD] claim) or biologic-experienced (≥ 1 pre-index bDMARD claim). The guselkumab and SC TNFi cohorts were balanced using overlap propensity score weighting. Treatment persistence with on-label therapy (absence of dose modification or therapy exposure gap of twice the duration between consecutive administrations, i.e., 112 days for guselkumab or 56 days for SC TNFi) was estimated using weighted Kaplan-Meier analysis through 24 months. On-label persistence rates were compared between cohorts using weighted Cox proportional hazards models.</p><p><strong>Results: </strong>In the guselkumab cohort (N = 804), 361 (44.9%) were biologic-naïve and 443 (55.1%) were biologic-experienced; in the SC TNFi cohort (N = 2490), 2171 (87.2%) were biologic-naïve and 319 (12.8%) were biologic-experienced. At 24 months post index, on-label persistence rates were 45.5% (guselkumab) versus 28.5% (SC TNFi; P < 0.001). Patients initiating guselkumab were 2.24 times more likely to be persistent with on-label therapy through 24 months than patients initiating an SC TNFi (hazard ratio [95% confidence interval] 2.24 [1.90, 2.64]; P < 0.001). Results were consistent among biologic-naïve (2.36 [1.88, 2.98]; P < 0.001) and biologic-experienced patients (1.86 [1.46, 2.37]; P < 0.001).</p><p><strong>Conclusion: </strong>Patients with active PsA initiating guselkumab were significantly (approximately two times) more likely to remain persistent with on-label therapy through 24 months versus SC TNFi, overall and among biologic-naïve and biologic-experienced subgroups.</p>","PeriodicalId":21267,"journal":{"name":"Rheumatology and Therapy","volume":" ","pages":"115-134"},"PeriodicalIF":2.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12816468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145524261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment Patterns and Clinical Outcomes for Patients Living with Active Giant Cell Arteritis in Canada.","authors":"Jean-Paul Makhzoum, Miriam Avadisian, Dalinda Liazoghli","doi":"10.1007/s40744-025-00817-y","DOIUrl":"10.1007/s40744-025-00817-y","url":null,"abstract":"<p><strong>Introduction: </strong>Giant cell arteritis (GCA) is a chronic inflammatory vasculitis in large and medium-sized arteries. Glucocorticoids (GCs) remain the cornerstone of treatment but carry significant long-term adverse effects. Tocilizumab (TCZ), an interleukin (IL)-6 receptor inhibitor, has become a GC-sparing agent, yet optimal treatment duration remains uncertain.</p><p><strong>Methods: </strong>This retrospective cohort study evaluated treatment patterns, clinical outcomes, and GC burden in patients (N = 121) with GCA treated at a specialized clinic in Montreal, Canada, between January 2017 and February 2025. Patients were stratified by initial treatment: GC only, GC + TCZ, and GC + other immunosuppressants (OIS). The primary endpoint was sustained remission at 12 months, defined by symptom resolution and normalization of inflammatory markers maintained for ≥ 6 months.</p><p><strong>Results: </strong>Overall, two-thirds of patients (83, 68.6%) (95% confidence interval [CI] 60.3-76.9%) achieved sustained remission, with similar rates in GC only (35, 72.9%) and GC + TCZ (44, 69.8%) groups, but lower in the GC + OIS group (4, 40.0%). Most patients remained on GCs after 1 year, highlighting the difficulty of achieving steroid-free remission. Relapses occurred in nearly half of patients (58, 47.9%), with a median time to first relapse of 283.5 days (95% CI 206-326). Methotrexate showed limited GC-sparing efficacy, with several patients relapsing (6, 60%). TCZ-treated patients had the lowest cumulative GC exposure (mean 3431 mg (standard deviation [SD] = 1049) vs. 4690 mg (SD 969) in GC only), though a quarter of patients (16, 25.4%) relapsed after TCZ discontinuation.</p><p><strong>Conclusion: </strong>The current 1-year TCZ treatment limit in Canada may be inadequate for long-term disease control. Adverse events were generally low, though hypertension, hyperglycemia, and infections were common. Two bowel perforations occurred in the TCZ group. These findings underscore the need for individualized, long-term treatment in GCA to minimize steroid exposure and maintain disease control. Future research should explore optimal therapy durations and support policy changes to expand access to steroid-sparing agents to improve long-term GCA outcomes.</p>","PeriodicalId":21267,"journal":{"name":"Rheumatology and Therapy","volume":" ","pages":"243-263"},"PeriodicalIF":2.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12816455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145828194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-per-Responder Analysis of Bimekizumab (IL-17A/F Inhibitor) Against IL-Inhibitors for Psoriatic Arthritis in Spain, Based on Matching-Adjusted Indirect Comparisons.","authors":"Jorge Mestre-Ferrandiz, Victoria Navarro-Compán, Yoana Ivanova-Markova, Almudena González-Domínguez, Stefano Maratia","doi":"10.1007/s40744-025-00807-0","DOIUrl":"10.1007/s40744-025-00807-0","url":null,"abstract":"<p><strong>Introduction: </strong>Bimekizumab is a monoclonal IgG1 antibody that selectively inhibits interleukin (IL)-17F and IL-17A and was approved to treat patients with active psoriatic arthritis (PsA) in the European Union in 2023. This study compares the cost per responder (CPR) of bimekizumab against IL-17A (secukinumab), IL-12/23 (ustekinumab) and IL-23 (guselkumab and risankizumab) targeted therapies to treat patients with PsA in Spain.</p><p><strong>Methods: </strong>The CPR was calculated by dividing the average annual drug cost per patient by the response rates for minimal disease activity (MDA) and American College of Rheumatology (ACR) 50 and ACR70 at week 52 in patients who were biological disease-modifying antirheumatic drug (bDMARD) naïve or who had experienced inadequate response or intolerance to tumour necrosis factor inhibitors (TNFi-IR). Response rates from four published matching-adjusted indirect comparisons (MAIC) were used. Spanish list prices and Royal Decree Law 8/2010 discounts were considered.</p><p><strong>Results: </strong>In bDMARD-naïve patients, bimekizumab had a lower CPR for MDA and ACR70 versus all comparators except for secukinumab 150 mg, where the CPR for bimekizumab was higher for all three efficacy measures. The incremental CPR ranged between 17.2% (95% confidence interval [CI] - 26.1%, 50.6%) for ACR70 and 92.7% (95% CI 60.0%, 119.4%) for ACR50. The incremental CPR for ACR50 for bimekizumab compared to secukinumab 300 mg was also slightly higher (2.3% [95% CI - 12.5%, 14.3%]). In patients with TNFi-IR, bimekizumab was more cost-efficient than all comparators for the three response rate measures at week 52.</p><p><strong>Conclusion: </strong>CPR analyses based on MAIC response rates at week 52 suggest that bimekizumab is more cost-efficient than IL-12/23 and IL-23 therapies, including ustekinumab, guselkumab and risankizumab, for treating PsA in Spain across both bDMARD-naïve patients and patients with TNFi-IR for all outcomes (MDA, ACR50/70). Compared to IL-17A (secukinumab), bimekizumab is consistently cost-efficient in patients with TNFi-IR for all outcomes and is cost-efficient in bDMARD-naïve patients versus those taking 300 mg regarding MDA and ACR70.</p>","PeriodicalId":21267,"journal":{"name":"Rheumatology and Therapy","volume":" ","pages":"83-94"},"PeriodicalIF":2.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12816415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145452815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}