A study from the UK showing that early intensive therapy was superior to standard step-up therapy for moderate-severe psoriatic arthritis (PsA) was highlighted as one of last year’s notable studies on PsA at the Rheumatology Winter Clinical Symposium (RWCS) 2026 in Maui, Hawaii.

The three-arm, randomized, open-label SPEED study, first presented at the European Alliance of Associations for Rheumatology (EULAR) 2025 Annual Meeting, compared standard step-up therapy with a combination of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and with early TNF inhibitor (TNFi) induction therapy for 6 months in 192 patients who had at least one poor prognostic factor.

The primary endpoint was mean PsA Disease Activity Score (PASDAS) at 24 weeks. Using analysis of variance testing, the investigators found statistically significant differences when comparing both the combination csDMARD group (methotrexate plus either sulfasalazine or leflunomide) and the early TNFi group (adalimumab plus methotrexate) to standard step-up care (starting with methotrexate).

There was no evidence of a significant difference in the primary endpoint between the combination csDMARD and early TNFi group, however.

For a secondary outcome of achievement of PASDAS “good response” at 24 weeks, there was again evidence of benefit for both intensive arms compared with standard step-up care. Only 8% of patients in the step-up group met this outcome compared with 31.2% and 45.3% of those receiving combination csDMARDs or early TNF inhibition, respectively.

Arthur Kavanaugh, MD, professor of medicine at the University of California, San Diego School of Medicine, who co-led the RWCS “year in review” session on PsA, said the differences are striking. “I think this really makes the case that you should use a TNF inhibitor early on, and if you can’t, you should use a combo csDMARD,” he said, “because in the step-up group, only 8% of people had a PASDAS good response. And this is out at 6 months.”

Also notable, said SPEED lead investigator Laura Coates, MBChB, PhD, of the University of Oxford in Oxford, England, were findings at week 48. Here, an extended benefit was seen only with early TNFi therapy, with this group showing evidence of a significant difference in both PASDAS based on a continuous scale and PASDAS based on the binary outcome of a good response at 48 weeks when compared with standard care.

“There was numerically a bit of a difference between the combination group and standard care, but at 48 weeks they’re starting to balance out a bit more,” Coates told Medscape Medical News. However, “there was a significant difference in favor of the TNFi, and that’s despite the fact that by week 48 they’ve been off the TNF inhibitor [for 6 months].”

The researchers also looked secondarily at the use of additional rescue medications at week 48 and found that biologics were used in 17% of the standard care group, 21% of the combination DMARD group, and 9% of the early TNFi group, Coates said in the interview.

“In terms of safety, there were slightly more common adverse events with the intensive therapy, as you’d expect — a few more liver test abnormalities with the combination DMARD group and a few more infections with early TNFi’s,” she said.

But responses to the Treatment Satisfaction Questionnaire for Medication (TSQM) at 24 weeks indicate that patients were more satisfied with intensive treatment, she told Medscape Medical News. (TNFi ranked at the top, followed by combination DMARDs.) The TSQM is helpful for understanding the trade-off between efficacy and side effects from the patient perspective.

The SPEED trial used a Trials Within Cohorts design. Patients were recruited from the UK-based MONITOR-PsA cohort — a cohort of patients who were recruited at diagnosis and were treatment-naive — if they had one or more poor prognostic factors (polyarthritis, C-reactive protein > 5 mg/dL, health assessment questionnaire score > 1, or radiographic erosions).

Coates and other researchers are currently combining data from SPEED and prior studies that compared treatments but did not select for poor prognosis. “We’re [creating] one dataset to try to look more at which patients benefit the most from early intensive treatment…to provide more detail on how best to select patients,” she said.

The SPEED trial was sponsored mainly by the National Institute for Health Research (NIHR) with some additional support from AbbVie. Coates is an NIHR research professor at the University of Oxford.

Coates disclosed having financial relationships with AbbVie, Amgen, Eli Lilly and Company, Janssen, Novartis, Pfizer, and other companies. Kavanaugh disclosed serving as a consultant to AbbVie, Amgen, BMS, Eli Lilly and Company, Janssen, Moonlake, Novartis, Pfizer, Takeda, and UCB.