TREMFYA – Use in Combination with JAK Inhibitors for the Treatment of Psoriatic Arthritis with or without Psoriasis in Adult Patients

SUMMARY  

• The company cannot recommend any practices, procedures or usage that deviate from the approved labeling.
• Two case reports described the use of combination TREMFYA and a Janus kinase (JAK) inhibitor, tofacitinib, for the treatment of psoriatic arthritis (PsA) in adult patients.^1,2 
• Cases of adult patients with concomitant psoriasis (PsO) and PsA who received combination TREMFYA and a JAK inhibitor, upadacitinib, are summarized below.^3,4 

CLINICAL DATA

Case Series or Case Reports

Combination with Tofacitinib

Gervaise et al (2026)¹ reported a case of a 51-year-old woman with PsA meeting ClASsification criteria for Psoriatic ARthritis (CASPAR) who was treated with a combination of TREMFYA and tofacitinib.

• The patient also had concomitant Crohn's disease (CD) and her cutaneous and gastrointestinal symptoms were considered mildly responsive to treatment. The patient’s large-joint arthritis and dactylitis were uncontrolled.
• Despite receiving 4 tumor necrosis factor inhibitors (TNFis) and methotrexate (MTX), the patient's joint symptoms continued.
• She was treated with tofacitinib 5 mg twice daily plus MTX 20 mg weekly for 11 months without improvement, prompting a switch to TREMFYA 100 mg monthly.
• Concurrently, she was treated with intra-articular triamcinolone injections (40 mg) in both knees and a 3-day course of intravenous (IV) methylprednisolone (250 mg/day).
• After the fourth TREMFYA dose, the patient independently restarted tofacitinib, leading to improvement in joint symptoms within days.
• The combination has been maintained for 3 years, enabling discontinuation of MTX and nonsteroidal anti-inflammatory drugs (NSAIDs).

Shurey et al (2022)² reported a case of a 36-year-old woman with PsA treated with a combination of TREMFYA and tofacitinib.

• The patient had persistent involvement of synovitis, dactylitis, enthesitis, and PsO since disease onset.
• The patient was previously treated with MTX, etanercept, infliximab, adalimumab, and ixekizumab. Then in July 2019, the patient was switched to TREMFYA from ixekizumab.
• After switching to TREMFYA, she still experienced:
  • PsO with a Psoriasis Area and Severity Index (PASI) score of 9.6
  • Peripheral arthritis with:
    • Swollen joint count (SJC) of 9
    • Tender joint count (TJC) of 11
    • Bilateral Achillies enthesitis
    • Dactylitis of 3 toes
    • C-reactive protein (CRP) of 16.6
• In November 2019, tofacitinib was added to her current treatment regimen.
• The patient subsequently achieved:
  • SJC of 0
  • TJC of 1
  • No enthesitis and dactylitis
  • Mild PsO with body surface area (BSA)<1%
  • CRP of 1.6
  • Minimal disease activity (MDA)
• After 17 months, there were no complications reported.

Combination with Upadacitinib

Antolini et al (2025)³ reported a case of a 61-year-old man with PsO and PsA who was treated with a combination of TREMFYA and upadacitinib.

• The patient had psoriatic disease involving skin, peripheral joints, and entheses since the age of 30.
• He had previous treatment failure with various conventional, biologic, and targeted synthetic disease modifying antirheumatic drugs.
  • TREMFYA and tofacitinib were among these treatments.
• TREMFYA was initiated in May 2022, achieving complete remission of skin lesions (reduction in PASI from 38 to 5.2), however there wasn't effectiveness for the patient's PsA with a Disease Activity Index for Psoriatic Arthritis (DAPSA) of 38.
• In September 2022, TREMFYA was discontinued and upadacitinib was started.
• After 3 months of treatment, the patient achieved a reduction in DAPSA from 38 to 5.4 but had multiple erythematosus and scaling PsO plaques on the trunk and legs with a PASI score of 21.
• Additionally, dactylitis developed in the first digit of the right foot.
• TREMFYA was re-initiated and combined with upadacitinib 15 mg/day.
• After 12 weeks of treatment, the patient achieved:
  • Improvement in cutaneous lesions with residual hyperpigmentation
  • Reduction in DAPSA to 1.07
  • Complete resolution of dactylitis
• No adverse events (AEs) were reported within the 12-month follow-up.

Hren et al (2024)⁴ evaluated the use of JAK inhibitors combined with biologics, among a larger case series, for the treatment of recalcitrant PsO and PsA. Of the cases, 2 patients were treated with a combination of TREMFYA and upadacitinib.

• Data were collected retrospectively from a clinic which included 2 patients receiving TREMFYA and upadacitinib combination therapy for concomitant PsO and PsA.
• For the treatment of PsA, the goal was to achieve MDA, classified as 5 of the 7 following criteria:
  • SJC ≤1
  • TJC ≤1
  • PASI ≤1
  • Patient reported pain ≤15 on a 0-100 mm visual analog scale (VAS)
  • Health Assessment Questionnaire-Disability Index (HAQ-DI) ≤0.5
  • Tender entheseal points ≤1
  • Patient global assessment of disease activity ≤20 on a 0-100 mm VAS
• Remission of PsO was defined as a BSA involvement of <1%.
• Details on the selected baseline characteristics and results of 2 patients receiving combination upadacitinib and TREMFYA with concomitant PsO and PsA are shown in Table: Selected Baseline Characteristics and Outcomes of Patients with Concomitant PsO and PsA Treated with the Combination of TREMFYA and Upadacitinib

Literature Search

A literature search of MEDLINE^®, EMBASE^®, BIOSIS Previews^®, and DERWENT^® (and/or other resources, including internal/external databases) was conducted on 21 August 2026.