Evaluating the Efficacy of Biologic With and Without Methotrexate

Join Danielle Gatti Palumbo, PharmD, a clinical pharmacist, RhAPP faculty member, and RhAPP Board member, as she breaks down a network meta-analysis evaluating the efficacy of biologics with and without methotrexate (MTX) in the treatment of psoriatic arthritis (PsA). This insightful journal club discussion highlights key findings on whether MTX is necessary as background therapy when initiating biologics.

Methotrexate, while commonly used in PsA treatment, is not FDA-approved for PsA in the U.S., yet it is often required by insurance companies before biologic therapy. Clinical guidelines, including EULAR, ACR, and GRAPPA, recommend MTX for peripheral arthritis, but this is largely based on observational data rather than robust randomized controlled trials (RCTs).

The meta-analysis, published in Rheumatic & Musculoskeletal Diseases (RMD), examined randomized double-blind controlled trials and compared biologic monotherapy versus combination therapy with MTX using ACR 20, 50, and 70 responses. The study found no statistically significant difference between biologics alone or in combination with MTX, suggesting that MTX does not enhance biologic efficacy in PsA.

These findings reinforce the argument that biologic monotherapy may be a better first-line option for PsA and should be considered when advocating for insurance approvals.

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