Progression from oligoarticular to polyarticular psoriatic arthritis and apremilast as a disease modifier: Novel insights from FOREMOST
Year: 2026
Type: article
Abstract: OBJECTIVES: Data regarding progression from oligoarticular to polyarticular psoriatic arthritis (PsA) are sparse. Using FOREMOST, we identify progression predictors and evaluate apremilast's treatment effect in early PsA. METHODS: FOREMOST (NCT03747939) randomized N = 308 patients with early (mean duration, 9.9 months) PsA and limited joint involvement (>1 to ≤4 swollen and >1 to ≤4 tender joints; not confirmed by imaging) to apremilast or placebo for 24 weeks, followed by open-label apremilast through week 48. Multivariable logistic regression modelled predictors of progression from oligoarticular (≤4 active [swollen and/or tender] joints) to polyarticular (>4 active joints) PsA at week 16 and the effect of apremilast. Disease progression, disease activity, clinical signs/symptoms and tolerability were summarized through week 48 for N = 291 patients receiving ≥1 apremilast dose (from randomization or switched from placebo). RESULTS: Most (268/308 [87.0%]) patients had oligoarticular PsA at baseline; 25.1% (59/235) progressed to polyarticular PsA by week 16 (data as observed). Apremilast reduced odds of progression vs placebo by 58% (odds ratio [OR; 95% CI]: 0.42 [0.22, 0.77]). In placebo-treated patients, being female, being csDMARD-naïve, and having dactylitis significantly increased odds of progression (OR: 3.35 [1.20, 9.34], 3.42 [1.18, 9.93], and 9.26 [1.32, 65.09], respectively). Apremilast treatment for up to 48 weeks maintained low rates of disease progression and improvements in disease activity/clinical signs and symptoms, with no new safety signals. CONCLUSION: Initiating apremilast treatment during the early, oligoarticular phase of PsA reduced disease activity and delayed progression to polyarticular disease, with benefits maintained with up to 48 weeks of treatment. TRIAL REGISTRATION: ClinicalTrials.gov; NCT03747939.
Source: Lara D. Veeken
Institutions: University of Oxford, University of Toronto, Toronto Western Hospital, Krembil Research Institute, Schroeder Arthritis Institute, The University of Texas Southwestern Medical Center, University Hospital Schleswig-Holstein, University of California, Los Angeles, Rheumazentrum Ruhrgebiet, Ruhr University Bochum, University of Bath, Kyorin University, Amgen (United States), University of Washington, Swedish Medical Center, Inserm, Sorbonne Université, Assistance Publique – Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Institut Pierre Louis d‘Épidémiologie et de Santé Publique
Language: English
Subfield: Rheumatology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,597
OpenAlex ID: W7166804790