Biologics ± tirzepatide in patients with PsA and obesity/overweight

Results from a propensity score-matched study, evaluating tirzepatide + biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs; n = 31) vs b/tsDMARDs alone (n = 62) in patients with psoriatic arthritis (PsA) and obesity or overweight with ≥1 weight-related comorbidity, were published in RMD Open by Venerito et al. Outcomes at 6 months included minimal disease activity (MDA; ≥5/7 criteria), Disease Activity Index for Psoriatic Arthritis (DAPSA) low disease activity (LDA) ≤14, PsA Impact of Disease-12 (PsAID-12), Patient Acceptable Symptom State (PASS) ≤4, Health Assessment Questionnaire (HAQ) ≤0.5, Psoriasis Area and Severity Index (PASI) ≤1, Visual Analog Scale (VAS) pain, and C-reactive protein (CRP). 

Key data: At 6 months, the tirzepatide + b/tsDMARD group had greater reductions in body mass index (BMI; −2.9 kg/m² vs +0.4 kg/m²; p < 0.001) and CRP (4.2 mg/L vs 7.7 mg/L; p < 0.001); higher rates of PsAID-12 PASS (48% vs 21%; p = 0.009), HAQ ≤0.5 (42% vs 18%; p = 0.022), and PASI ≤1 (74% vs 52%; p = 0.045); and lower rates of VAS pain (33.1 vs 46.4; p = 0.028) compared with the b/tsDMARDs-alone group. While physician-assessed targets, including MDA (26% vs 16%; p = 0.279) and DAPSA LDA (84% vs 82%; p > 0.99), did not differ between groups, adjusting the 6-month value for the baseline showed reductions in DAPSA with tirzepatide + b/tsDMARD vs b/tsDMARD alone (−1.78; p = 0.016). Gastrointestinal (GI) adverse events (AEs), including nausea (35%) and diarrhea (19%), were common but manageable in patients receiving tirzepatide. 

Key learning: Tirzepatide + b/tsDMARDs was associated with significant improvements in weight management, patient-reported outcomes (PROs), skin disease control, and baseline-adjusted joint disease activity, as well as reductions in CRP compared with b/tsDMARDs alone. Treating obesity and PsA concomitantly may represent a potential paradigm shift in the management of patients with PsA and obesity/overweight; however, further evaluation in larger randomized studies is needed.