Differential effect of biologics for psoriasis on the risk of developing arthritis

A study including 7,144 patients revealed that therapy with IL-23 blockers was associated with lower risk of inflammatory or psoriasis arthritis.

Participants on IL-17 or TNF inhibitors: significantly more likely to develop inflammatory arthritis

“Approximately a quarter of psoriasis patients will develop inflammatory or PsA,” explained Prof. Bruce Strober (Yale University School of Medicine, CT, USA)1. But does the risk of inflammatory arthritis or PsA get delayed by the type of biologic therapy patients are treated with? This was the objective of the study by Prof. Strober and his colleagues. The patients included in this analysis were enrolled in the Optum® Clinformatics® Data Mart (CDM) database between January 2014 and December 2022 with 2 ICD-9/ICD-10 diagnosis codes for psoriasis.

Biologic-naïve participants were assigned to 4 cohorts based on the biologics they received first (i.e. IL-23, IL-17, IL12/23-blocker, or TNF inhibitors). All participants were followed for up to 3 years, until inflammatory arthritis developed (identified by ICD-9/ICD-10 codes), until participants switched or discontinued their biologics, or were lost to follow-up, whichever occurred first.

A total of 7,345 biologic-naïve participants could be included in the analysis: 2,712 were treated with an IL-23 blocker, 1,078 with an IL-12/23 blocker, 811 with an IL-17 blocker, and 2,744 were in the TNF cohort. Participants receiving IL-23 for psoriasis had numerically lower incidence rates of inflammatory arthritis and PsA.

When compared with participants receiving IL-23 inhibitors, participants receiving IL-17 (HR 1.44; P=0.0295) or TNF inhibitors (HR 1.9; P<0.0001) were significantly more likely to develop inflammatory arthritis. For the development of PsA, a significant difference was only seen compared with TNF inhibitors (HR 2.05; P<0.001). 

However, Prof. Strober emphasised that bias is a potential limitation of this study as healthcare professionals may have preferentially prescribed IL-23 blockers to participants with early markers of PsA. Therefore, the current results should be backed by additional studies regarding the impact of biologics on the future risk of arthritis.

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  1. Strober B. Risk of developing inflammatory arthritis in psoriasis patients initiating treatment with biologics: A population-based analysis. ID FC08.8, EADV Congress 2023, 11–14 October, Berlin, Germany.