This protocol covers the structured next step for patients with psoriatic arthritis and co-existing inflammatory bowel disease (IBD), when an initial biologic or targeted therapy has not delivered adequate improvement or remission.
The patient has psoriatic arthritis with concurrent inflammatory bowel disease. The IBD comorbidity is a key factor in determining which therapies are appropriate: certain agent classes carry a heightened risk of IBD flares and are excluded in this setting, narrowing the eligible treatment options compared to standard psoriatic arthritis management.
The previous treatment line used one of the following agents (name only): anti-TNF monoclonal antibody, IL-12/23 inhibitor, IL-23 inhibitor, or JAK inhibitor. IL-17 inhibitors were not used at this line due to the heightened risk of IBD flares they carry.
Escalation to this protocol is indicated when that first-line therapy did not achieve improvement at 3 months, or did not reach remission or low disease activity at 6 months.
The approach involves switching to a different biologic DMARD or JAK inhibitor, with IBD-specific restrictions that determine which classes remain eligible. The full selection criteria, sequencing logic, and eligibility rules are available in the complete protocol.
Improvement at 3 months; remission or low disease activity at 6 months, guided by regular disease activity assessment and therapy adjustment as needed.
DOI: 10.1136/ard-2024-225531
With IBD to an anti-TNF monoclonal antibody or an IL-23 inhibitor or IL-12/23 inhibitor or a JAKi.
IL-17is (both A and A/F) are not recommended in case of active IBD, given indications of a heightened risk of flares.
In patients with an inadequate response or intolerance to a bDMARD or a JAKi, switching to another bDMARD or JAKi should be considered, including one switch within a class.
Treatment should be aimed at reaching the target of remission or, alternatively, low disease activity, by regular disease activity assessment and appropriate adjustment of therapy.
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