Wheelersburg

Researchers are evaluating treatments for patients with psoriatic arthritis PsA who have not responded well to tumor necrosis factor inhibitors TNFi. The trial aims to find out if switching to guselkumab, a selective interleukin 23 inhibitor IL23i, is more effective than switching to a second TNFi, golimumab. This is the first study to compare these treatment switches in PsA patients and will focus on those who have an inadequate response to TNFi in a real-world clinical setting. Participants will be randomly assigned to one of three treatment groups guselkumab 100mg every 4 weeks, guselkumab 100mg every 8 weeks, or golimumab 50mg every 4 weeks. Both medications are given as subcutaneous injections. The study is open-label, meaning both patients and researchers know which treatment is given. The trial will continue for 12 months to assess treatment effectiveness. Throughout the study, participants will be monitored for disease activity using measures like cDAPSA low disease activity and Investigator Global Assessment of Psoriasis. Additional assessments include minimal disease activity, quality of life questionnaires, fatigue, and resolution of symptoms such as dactylitis and enthesitis. Safety and treatment response will be evaluated regularly, with the main outcomes measured at 6 and 12 months.

Researchers are comparing treatments for people with active rheumatoid arthritis RA who have not responded well to tumor necrosis factor inhibitor TNFi biologics. This study evaluates switching to either a non-TNFi biologic drug including rituximab, abatacept, tocilizumab, or sarilumab or a targeted synthetic DMARD tsDMARD such as tofacitinib, baricitinib, or upadacitinib. The study aims to provide important real-world data on patient-reported outcomes PROs to help guide treatment decisions, as current guidelines are based on limited evidence and often influenced by insurance or physician preference. Participants will be randomized to one of two groups switching to a targeted synthetic DMARD or switching to a non-TNFi biologic drug. Both treatment options are widely used in clinical practice, but have not been directly compared in a pragmatic trial focusing on PROs. The study will allow patients to continue stable doses of conventional synthetic DMARDs like methotrexate if used for at least three months. The trial will assess changes over 12 months, focusing on functional limitation and quality of life. During the trial, participants will be monitored regularly to assess their function and symptoms using patient-reported tools such as the Health Assessment Questionnaire HAQ. Researchers will collect information on treatment effectiveness, side effects, and safety in a real-world population, including those with other health conditions. The study is designed to reflect routine clinical care and will last for at least 12 months, with follow-up to evaluate changes from baseline in physical function and other outcomes important to patients.