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Psoriatic arthritis

No benefit from adding MTX to ustekinumab

Nature Reviews Rheumatology volume 19, page 129 (2023)Cite this article

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The results of the investigator-initiated phase IIIb MUST trial suggest that there is no added benefit from continuing or initiating methotrexate (MTX) in patients with psoriatic arthritis (PsA) being treated with the IL-12–IL-23 inhibitor ustekinumab. The study included 173 patients with active PsA from 22 centres in Germany, stratified according to current MTX use (n = 84) or no previous MTX treatment for PsA (n = 89), who were randomly assigned in a 1:1 ratio to receive open-label ustekinumab plus masked MTX or placebo. At week 24, mean 28-joint disease activity score based on erythrocyte sedimentation rate was 2.9 in the ustekinumab monotherapy group and 3.1 for patients treated with ustekinumab plus MTX (between-group difference 0.29; 95% confidence interval 0.13–0.71), indicating non-inferiority of the monotherapy compared with the combination therapy. No additional effect of MTX was seen on the other outcomes evaluated, including joint counts, psoriasis, dactylitis, enthesitis, patient-reported outcomes, treatment retention and immunogenicity.

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Original article

  • Koehm, M. et al. Methotrexate plus ustekinumab versus ustekinumab monotherapy in patients with active psoriatic arthritis (MUST): a randomised, multicentre, placebo-controlled, phase 3b, non-inferiority trial. Lancet Rheumatol. 5, e14–e23 (2023)

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  1. Nature Reviews Rheumatology http://www.nature.com/nrrheum/

    Sarah Onuora

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  1. Sarah Onuora
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Correspondence to Sarah Onuora.

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Onuora, S. No benefit from adding MTX to ustekinumab. Nat Rev Rheumatol 19, 129 (2023). https://doi.org/10.1038/s41584-023-00912-w

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  • DOI: https://doi.org/10.1038/s41584-023-00912-w

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