Trends in Psoriatic Arthritis Management From 1993 to 2019: Rise of Biologics and Decline of Oral Small Molecules

Brad R Woodie; Sarayu Balachandar; Alan B Fleischer Jr

doi:10.1177/24755303251342501

Trends in Psoriatic Arthritis Management From 1993 to 2019: Rise of Biologics and Decline of Oral Small Molecules

J Psoriasis Psoriatic Arthritis. 2025 May 10:24755303251342501. doi: 10.1177/24755303251342501. Online ahead of print.

Authors

Brad R Woodie¹, Sarayu Balachandar¹, Alan B Fleischer Jr²

Affiliations

¹ College of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
² Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.

Abstract

Background: Traditional oral small molecule disease-modifying antirheumatic drugs (OSMs) have historically been the cornerstone of psoriatic arthritis (PsA) management. However, biologics have gained prominence due to their superior efficacy in patients with an inadequate response to OSMs.

Objective: To analyze trends in the use of OSMs, biologics, and combination therapy for PsA management from 1993 to 2019.

Methods: We utilized the National Ambulatory Medical Care Survey to examine PsA treatment patterns. Medications were classified as OSMs, biologics, or combination therapy (both an OSM and a biologic). Weighted Rao-Scott χ² tests and one-way ANOVA assessed differences in treatment patterns over time and by patient demographics.

Results: Among an estimated 3.7 million visits for PsA (112 unweighted visits) where systemic therapy was prescribed, biologic use significantly increased (P = .006) over time, OSM use declined (P < .001), and combination therapy initially increased but later decreased (P < .001). There were no significant differences in treatment patterns by age, sex, race, ethnicity, or insurance status (all P > .2).

Conclusions: Biologics have increasingly replaced traditional OSMs as the primary treatment for PsA. The decline in combination therapy after 2013 likely reflects the improved efficacy of newer biologics, reducing the need for adjunctive OSM use. Limitations include the lack of disease severity data and the absence of visits for newer therapies, such as Janus kinase inhibitors.

Keywords: combination drug therapy; disease modifying antirheumatic drugs; drug utilization; immunosuppressive agents; national ambulatory medical care survey; prescription patterns.