Arthur Kavanaugh,<\/b> <\/b>MD<\/b>. Image: Rob Volansky | Healio<\/i>
Rheumatologists have multiple pathways to achieve that goal using old and new therapeutic paradigms, according to Kavanaugh. <\/p>\n
\u201cWe are looking for precision medicine,\u201d he said. \u201cWe have made a little bit of progress, but we still can\u2019t say, \u2018Based on your disease progress, we should go with this.\u2019\u201d<\/p>\n
There may be the perception that the newer agents and mechanisms of action like interleukin (IL)-17, IL-23 or IL-12\/23 inhibitors are better or more effective than decades-old standards like TNF inhibitors, according to Kavanaugh. <\/p>\n
\u201cBut nothing has actually beaten [TNF inhibitors] in terms of efficacy,\u201d he said.<\/p>\n
However, he added that IL-17 and IL-23 inhibitors may be better for the skin. <\/p>\n
\u201cIn dermatology, from head-to-head data, they have had agents that have done better than TNF inhibitors,\u201d Kavanaugh said. \u201cIL-23 inhibitors have really taken off in psoriasis subsets. The algorithms are starting to diverge between rheumatology and our dermatology colleagues.\u201d<\/p>\n
A similar pattern has emerged for IL-17 inhibitors. <\/p>\n
\u201cThis is an incredibly important new topic,\u201d Kavanaugh said. \u201cThey work better in the skin. Our dermatology colleagues go to them more than the TNF inhibitors. For joints, they do not do as well as TNF inhibitors.\u201d<\/p>\n
Kavanaugh counseled attendees to consider data from the BE-BOLD study, which compared the IL-17 inhibitor bimekizumab (Bimzelx, UCB) with the IL-23 inhibitor risankizumab (Skyrizi, AbbVie), when assessing individual patients with PsA. <\/p>\n
\u201cBimekizumab did better than risankizumab in joint response,\u201d he said. \u201cWe love head-to-head studies. Otherwise, we are left with indirect comparisons that are never quite as strong or robust.\u201d<\/p>\n
Another consideration pertains to the medication delivery. Kavanaugh discussed findings from the ICONIC LEAD study, which assessed the oral IL-23 targeted agent icotrokinra (Icotyde, Johnson & Johnson). The drug showed significant skin clearance in psoriasis, according to the data. <\/p>\n
\u201cIt is orally available,\u201d Kavanaugh said. \u201cThis will raise a lot of considerations in terms of compliance. It is going to be something that is popular.\u201d<\/p>\n
Oral biologics could have a significant impact on the market, according to Kavanaugh. <\/p>\n
\u201cIt will address cost and access issues,\u201d he said. \u201cIt is exciting to me that there are biologics in pill form.\u201d<\/p>\n
Another exciting development, according to Kavanaugh, is a return to combination therapy in PsA, particularly following \u201cnegative data\u201d from the early days of biologic therapy that essentially derailed this approach. <\/p>\n
\u201cCombination therapy is a hot topic that has come back,\u201d he said, noting landmark data demonstrating the effectiveness of combination therapy with ixekizumab (Taltz, Eli Lilly) alongside the GLP-1 receptor agonist tirzepatide (Zepbound, Eli Lilly) in PsA.<\/p>\n
Meanwhile, in the VEGA study, researchers combined IL-23 and TNF inhibition with some success. Importantly, no new safety signals were reported for this combination. <\/p>\n
\u201cIt turns out combination therapy is a good idea, you just have to have the right combination,\u201d Kavanaugh said. \u201cThis is paving the way to think about other combinations.\u201d<\/p>\n
However, rheumatologists should not expect a raft of combinations to hit the market overnight, according to Kavanaugh. <\/p>\n
\u201cIt is a slow road,\u201d he said. \u201cStill the biggest unmet need is which therapy or therapeutic approach is best for which patient.\u201d<\/p>\n
Despite this gap, Kavanaugh said he is encouraged by ongoing research in the field. <\/p>\n
\u201cThis is a very exciting time,\u201d he said. \u201cWe have come a long way in not that many years. I am very excited for the future.\u201d<\/p>\n
For more information:<\/h2>\n Arthur Kavanaugh, MD,<\/b> can be reached at akavanaugh@health.ucsd.edu. <\/p>\n\n
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Published by:<\/span>\n
Sources\/Disclosures<\/h3>\n Source: <\/h2>\n Kavanaugh A. Achieving precision medicine in PsA: Novel treatment strategies. Presented at The Congress of Clinical Rheumatology East; April 30-May 3, 2026; Destin, Florida (hybrid meeting).<\/p>\n
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