TOPLINE:

Both adalimumab and ixekizumab demonstrated comparable effectiveness in improving disease activity and achieving remission-related outcomes over 12 months in patients with psoriatic arthritis (PsA). Patients treated with ixekizumab showed a greater skin improvement at 3 months than those treated with adalimumab.

METHODOLOGY:

• Researchers conducted an observational longitudinal cohort study across seven Italian tertiary rheumatology centres from October 2019 to December 2023 to compare the effectiveness of adalimumab vs ixekizumab over 12 months and to identify predictors of remission in patients with PsA.
• They included 437 adult patients with PsA, all of whom initiated therapy according to clinical indication — 186 patients initiated adalimumab and 251 initiated ixekizumab — and had follow‑up data available for up to 12 months.
• Patients in the adalimumab group were more frequently bio-naive, had fewer prior biologic disease-modifying antirheumatic drug lines, and exhibited higher axial involvement and lower rates of peripheral arthritis than those in the ixekizumab group. Nail psoriasis was also more common in the adalimumab group.
• Data on clinical and laboratory parameters and patient-reported outcomes were collected at baseline and at 3, 6, and 12 months.
• The primary outcome was the comparison of disease activity between the two groups, assessed as changes in Disease Activity in Psoriatic Arthritis (DAPSA) and Psoriasis Area and Severity Index (PASI) scores at 3, 6, and 12 months; secondary outcomes were clinical remission predictors (the achievement of a DAPSA score ≤ 4 or minimal disease activity [MDA]), treatment discontinuation rates, and adverse events.

TAKEAWAY:

• DAPSA scores decreased from baseline to 3 months, with additional reductions observed from 3 to 6 months and from 6 to 12 months (P < .05 for all), with no significant differences in trajectories found between adalimumab and ixekizumab groups.
• Ixekizumab-treated patients demonstrated a 0.82-point greater improvement in mean PASI scores from baseline to 3 months than adalimumab-treated patients (P = .004), although they showed higher mean PASI scores over time (P = .010).
• Clinical factors linked to disease remission, assessed using DAPSA scores or MDA, showed no differences related to the two treatments. The likelihood of remission was higher among men vs women and those with moderate-to-high PASI scores at baseline vs those without active skin disease; the likelihood was lower among patients with nail psoriasis and those who received more prior biologic treatments.
• During 12-month follow-up, 32.0% of patients discontinued treatment (30.6% in the adalimumab group and 33.1% in the ixekizumab group), mainly due to ineffectiveness. Overall, 52 adverse events were reported among 43 patients, which were mostly mild or moderate; "infections and infestations" were the most common adverse events.

IN PRACTICE:

"The AIRE study extends evidence from RCTs [randomised controlled trials] to everyday rheumatological clinical practice, offering insights into the optimal management of PsA in real-life care," the authors wrote.

SOURCE:

This study was led by Valentino Paci, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona; Alen Zabotti, Azienda Sanitaria Universitaria Friuli Centrale, Udine; and Alessandro Fontanarosa, Centre of Epidemiology, Biostatistics and Medical Informatics, Marche Polytechnic University, Ancona, all in Italy. It was published online on March 24, 2026, in RMD Open.

LIMITATIONS:

The observational design may have introduced the risk for information bias, and there may be residual confounding. Data on enthesitis, dactylitis, axial, and nail domains were limited. Concomitant topical therapies may have attenuated differences in skin outcomes.

DISCLOSURES:

The authors did not declare any specific funding for the study. Some authors disclosed receiving research support and speaking and/or consulting fees from multiple pharmaceutical companies, including AbbVie, Eli Lilly and Company, Johnson & Johnson, and others.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.