Targeting Cardiometabolic Burden in PsA, With Philip Mease, MD

Growing attention has turned toward the role of obesity, metabolic dysfunction, and cardiovascular risk in shaping psoriatic arthritis (PsA) outcomes. Rheumatologists increasingly recognize that excess adiposity not only elevates systemic inflammation but also reduces the likelihood of achieving key treatment Recent clinical interest has expanded to include GLP-1 receptor agonists and dual GLP-1/GIP agonists, further expanding the investigative frontiers for the in-demand drugs.

Emerging evidence suggests that GLP-1–based therapies may influence immune cell activity, reduce adipose-derived cytokines, and mitigate obesity-driven inflammatory load. Several studies presented at the American College of Rheumatology (ACR) Convergence 2025, held October 24–29 in Chicago, Illinois, explore GLP-1s in a variety of rheumatological diseases and others examine more closely cardiometabolic outcomes

Philip Mease, MD, Clinical Professor at the University of Washington and Director of Rheumatology Research at the Swedish Medical Center in Seattle, presented a new analysis of apremilast, which seemed to exert beneficial cardiometabolic effects. In the phase 4 FOREMOST trial, patients with early oligoarticular PsA randomized to APR experienced greater reductions in BMI (–1.77% vs 0.21%) and weight (–1.71% vs 0.25%) at Week 16 compared with placebo. These improvements were maintained through 48 weeks, with over 50% of treated patients achieving ≥1% weight loss and approximately 20% achieving ≥5% reductions. Patients also demonstrated a shift toward lower-risk BMI and HbA1c categories over 48 weeks, with the largest improvements occurring in those who began the study with obesity or diabetes.1

Another abstract reported that PsA patients receiving GLP-1 receptor agonists exhibited lower risk of major adverse cardiac events and reduced mortality compared with PsA patients not using GLP-1 RAs, indicating potential cardioprotective and anti-inflammatory advantages. These findings support the concept that GLP-1 RAs may serve as a meaningful adjunct for PsA patients who have cardiometabolic comorbidities such as obesity or type 2 diabetes, although additional mechanistic and long-term studies are needed.2

"One other area that rheumatologists are becoming increasingly sensitive about is the comorbidities of obesity and cardiovascular issues. This is being highlighted by studies which are showing us that if a patient is obese, their disease activity is greater and they are less likely to achieve targets like remission [and] low disease activity if they are obese," Mease said.

Mease's disclosures include AbbVie, ACELYRIN, Amgen, Bristol Myers Squibb, Century Therapeutics, Cullinan Biotech, Eli Lilly, Genascence, GRAPPA, Immagene, Johnson & Johnson, MoonLake Immunotherapeutics, Novartis, OMERACT, Pfizer, SPARTAN, Takeda, and UCB Pharma.

References

1. Mease P, Cantero AG, Soung J, et al. Effects of Apremilast on Body Mass Index, Weight, and HbA1c as Cardiometabolic Outcomes in Patients With Early Oligoarticular Psoriatic Arthritis in the FOREMOST Study. Presented at: ACR Convergence 2025; October 24-29; Chicago, Illinois. Abstract #0581

2. Tsibadze N, Tskhakaia I, Tan I. Mortality and Major Adverse Cardiac Events (MACE) with GLP-1 Receptor Agonists in Psoriatic Arthritis. Presented at: ACR Convergence 2025; October 24-29; Chicago, Illinois. Abstract #0849