TOPLINE

In a real‑world cohort of patients with treatment-refractory psoriatic arthritis (PsA), combining two advanced targeted therapies was feasible and was associated with improvements in joint and skin measures and patient‑reported outcomes. Adverse events were infrequent and mostly mild.

METHODOLOGY

• Researchers performed a nested analysis within a prospective PsA cohort at two Toronto centers and identified 39 adults who received two concurrent biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) for at least 60 consecutive days. They aimed to describe patterns, effectiveness, and safety of intentional dual b/tsDMARD therapy. 
• Dual therapy was defined as the concurrent use of two agents from these classes: TNF inhibitors, interleukin (IL)-17 inhibitors, IL-12/23 inhibitors, IL-23 inhibitors, JAK inhibitors, tyrosine kinase 2 (TYK2) inhibitors, or phosphodiesterase 4 inhibitors (apremilast). 
• A total of 24 patients (median age at initiation, 51 years; 45.8% women) who received a biologic plus a JAK or TYK2 inhibitor were included for the effectiveness analysis. Furthermore, 15 patients who received a biologic plus apremilast were included for the safety analysis. 
• Researchers assessed disease activity measures, including a tender joint count in 68 joints (TJC), a swollen joint count in 66 joints, Disease Activity Index for Psoriatic Arthritis (DAPSA), Psoriasis Area and Severity Index (PASI), body surface area, and patient visual analog scale. 
• Patients were assessed every 3-6 months, with effectiveness examined at 3-6 and 6-12 months. Safety was evaluated through all-cause adverse events across all regimens. 

TAKEAWAY

• The median duration of dual therapy was 418 days. Of all regimens, 77% remained ongoing at the last follow‑up, and 23% were discontinued because of adverse events or lack of efficacy.
• Among patients who received bDMARDs with a JAK or TYK2 inhibitor, the median TJC decreased from 2.0 to 1.0, the median DAPSA decreased from 19.0 to 12.8, and the median PASI decreased from 2.0 to 0.0 from baseline to 6-12 months of follow-up. 
• Patients had a median treatment history of five prior b/tsDMARDs before starting dual therapy. 
• Over 42.5 patient‐years of combined biologic and JAK/TYK2 inhibitor exposure, six adverse events were recorded, the majority of which were mild, with no serious events. Across apremilast regimens, three adverse events were recorded, including one death in a patient with preexisting cardiomyopathy.

IN PRACTICE

“Dual b/tsDMARD therapy demonstrated clinically meaningful improvement with no new safety concerns, supporting its cautious, individualized use when sequential monotherapy fails,” the authors wrote.

SOURCE

The study was led by André Lucas Ribeiro, MD, Hospital Moinhos de Vento, Porto Alegre, Brazil. It was published online on August 10, 2026, in ACR Open Rheumatology.

LIMITATIONS

The study had a modest sample size. The combination regimens were heterogeneous.
Follow-up duration varied across patients, which may have prevented definitive conclusions about long-term outcomes or rare adverse events.

DISCLOSURES

Several authors reported having financial ties — including receiving grants, consulting fees, honoraria, or serving in advisory board roles — with pharmaceutical companies.

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