Current and Emerging Therapies in Psoriatic Arthritis

At the Masterclasses in Dermatology APP Institute, Dr Joseph Merola offered an expert update on psoriatic arthritis (PsA) therapy. His session, “Psoriatic Arthritis Treatment Update,” made clear that PsA care is moving beyond broad treatment toward precision strategies informed by disease domain.

“Treatment decisions in PsA should be based on the domains of disease,” Dr Merola explained. “This includes peripheral joints, axial disease, skin, nails, enthesitis, and dactylitis—each of which may respond differently to therapy.”

He walked through the current landscape of therapies, spanning tumor necrosis factor inhibitors, IL-17A/F blockers, IL-23 inhibitors, Janus kinase inhibitors, and phosphodiesterase 4 blockers. The real excitement, however, centered around novel agents and head-to-head trials shifting the therapeutic ceiling.

Among the highlights:

• Bimekizumab, a dual IL-17A/F inhibitor, showed superior American College of Rheumatology (ACR) response criteria-50 and Psoriasis Area and Severity Index (PASI)-90 responses vs risankizumab in head-to-head studies, marking the first phase 3b study in PsA to use ACR50 at week 16 as the primary endpoint.
• Sonelokimab, a nanobody targeting IL-17A/F, achieved ACR50 in ~60% and PASI90 in >70% of patients by week 24 in the ARGO trial, with over half reaching minimal disease activity.
• Deucravacitinib, a TYK2 inhibitor, demonstrated strong efficacy in the POETYK PsA-2 study, achieving notable improvements in enthesitis resolution and skin clearance by week 16.

Dr Merola also spotlighted the SPEED trial, which found that initiating early biologic therapy in high-risk PsA patients, rather than using the traditional “step-up” model, led to faster and more sustained disease control. “Starting with more intensive therapy, especially early biologics, in PsA patients who have poor prognostic features achieves faster and better disease control,” he emphasized.

The session ended with a look into the future. Trials such as PAMPA (pairing IL-17A antagonists with glucagon-like peptide-1s and ICONIC-PsA (targeting IL-23R with icotrokinra) are testing innovative combinations and oral agents that may reshape first-line options in years to come.

Reference

Merola J. Psoriatic arthritis treatment update. Presented at: Masterclasses in Dermatology APP Institute; October 11–12, 2025; Dallas, TX.