Why carry out the study?

The therapeutic arsenal for psoriatic arthritis (PsA) is gradually being expanded, notably by better identification of potential therapeutic targets, but studies of the optimal use of these targeted treatments are needed.

The objective of this work was to guide the choice of targeted therapy to use as first-line treatment in a patient with PsA in whom methotrexate (MTX) has failed.

We propose a six-point argument for a post-MTX treatment strategy in patients with PsA based on current evidence.

What was learned from the study?

In case of initiation of an anti-tumor necrosis factor alpha (anti-TNFα) agent, maintaining treatment with MTX seems preferable, even in the absence of evidence of the superior efficacy of the combination, to avoid immunization and reduced therapeutic maintenance.

In case of initiation of anti-IL-17, anti-IL-12/23, anti-IL-23 agents, or JAK inhibitors, again in the absence of evidence of the superior efficacy of the combination, discontinuing MTX therapy may be possible, at least in two steps, after verifying the efficacy of the targeted therapy initiated on the joints and skin.