Introduction: An important consideration in the treatment of patients with psoriatic arthritis (PsA) is whether the addition of methotrexate (MTX) to biologics has greater efficacy than biologic monotherapy with respect to efficacy outcomes in these patients., Objectives: To conduct a network meta-analysis (NMA) comparing biologics by treatment class with and without MTX for treatment of adults with active PsA., Methods: A systematic literature review (SLR) identified randomised, double-blinded, controlled trials, and a Bayesian NMA compared biologics with and without MTX by treatment class (tumour necrosis factor inhibitors (TNFi), interleukin-23 inhibitors (IL-23i) and IL-17i). Efficacy outcomes included American College of Rheumatology 20%, 50% and 70% (ACR20, ACR50 and ACR70) improvement response., Results: The SLR initially identified 31 studies, of which 17 met feasibility criteria for the NMA by containing the 'without MTX' subgroup. For ACR20 efficacy (the most robust assessment examined), all active treatments were significantly better than placebo. No statistically significant differences were demonstrated between biologic monotherapy (for all classes examined) and biologics in combination with MTX for ACR20/50. IL-17i were comparable to IL-23i, and IL-17i were significantly better than TNFi for ACR20. Although limited by fewer trials, TNFi, IL-23i and IL-17i were not statistically different for ACR50/70., Conclusions: Concomitant use of MTX and biologics did not improve ACR efficacy outcomes versus biologic monotherapy. MTX does not appear to be necessary as a background therapy when biologics are used for the achievement of ACR20/50 responses in patients with PsA., Competing Interests: Competing interests: PJM has received research grants, consulting fees and/or speaker fees from AbbVie, Aclaris, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Lilly, Galapagos, Gilead, GlaxoSmithKline, Inmagene, Janssen, Novartis, Pfizer, SUN Pharma and UCB Pharma. SReddy has received consulting fees or served on advisory boards for UCB, Novartis, Fresenius Kabi, Amgen, AbbVie, Janssen and Pfizer; has served as a treasurer for the Psoriasis and Psoriatic Arthritic Clinics Multicenter Advancement Network; and has served on the medical board for the National Psoriasis Foundation. DEF has received grant and/or research support from Emerald, Kadmon, PICORI, Pfizer, Prometheus, Talaris and Mitsubishi and has served as a consultant to AbbVie, Novartis and Pfizer. SRoss, JRL, PR, KG, CS and AV are employees and shareholders of Eli Lilly and Company. AV has received consulting fees from AbbVie, Amgen, BMS, Eli Lilly and Company, Genentech, Janssen, Merck, Novartis, Pfizer and UCB., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)