TNF, IL-17 and IL-23 inhibitors performed similarly in real-world PsA

Design

Prospective multicentre cohort analysed as target trial emulation

Population

990 patients with PsA starting TNF, IL-17 or IL-23 inhibitors

Primary outcome

Change in DAPSA over 6 months; drug retention

Effect

No significant between-class difference in DAPSA trajectories or retention

This Italian multicentre study enrolled 990 consecutive patients with moderate-to-high PsA activity starting a biologic between 2022 and 2025, and analysed them in a target trial emulation with propensity weighting. 342 started a TNF inhibitor, 313 an IL-17 inhibitor and 335 an IL-23-pathway inhibitor.

Disease activity (DAPSA) fell in all three groups over six months, with no significant difference between classes. Among those still on treatment at six months, long-term retention did not differ. Shorter disease duration was associated with better response in exploratory analyses.

Emulated trials balance measured factors only, and the study was not designed to compare safety.

For most patients, choice of biologic class in PsA can follow comorbidity, skin and gut involvement, and patient preference, rather than an expected difference in joint response.

• Six-month disease activity fell similarly with TNF, IL-17 and IL-23 inhibitors.
• Drug retention after six months did not differ between classes.
• Shorter disease duration was linked to better response.
• Choose the class by comorbidity, skin, gut and eye involvement, and preference.
• Treat early where possible; duration of disease mattered more than class.

Why it matters

It supports choosing PsA biologics by the whole patient rather than by an assumed hierarchy of joint efficacy.

Don't overread it

This emulated trial is observational and cannot exclude unmeasured differences between groups.

The statistics, in plain English

No significant difference does not prove the classes are identical, but in nearly 1,000 patients a large difference would probably have shown.

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