Psoriasis Progression to Inflammatory Arthritis Reduced With Biologics

Treatment with interleukin (IL)-12/23 inhibitors or IL-23 inhibitors among patients with psoriasis is associated with a reduced risk for progression to incident inflammatory arthritis compared with tumor necrosis factor (TNF) inhibitors, according to study findings published in Lancet.

Researchers conducted a retrospective cohort study using electronic health records data collected from January 2014 through May 2022 of patients aged 18 years and older with 2 diagnostic codes for psoriasis given more than 30 days apart.

Participants had been newly prescribed a biologic medication upon or after receiving their first psoriasis diagnosis. They used weighted Cox proportional hazards regression with TNF inhibitor exposure as the reference to calculate time-dependent risk for inflammatory arthritis adjusted for clinical and demographic covariables.

The primary endpoint was time to incident inflammatory arthritis. This was defined by first occurrence of any diagnostic code for inflammatory arthritis (ie, psoriatic arthritis or other inflammatory arthritis) at least 2 weeks after the index date, which was defined by the first biologic prescription or after the date when a patient received their first psoriasis diagnosis code.

A total of 15,501 participants with psoriasis (mean age, 50.2±15.0 years; 54.2% women; 72.1% White; 7.4% Black; 10.2% Hispanic) were identified, of whom 6.3% developed inflammatory arthritis. Mean follow-up time was 2.4±2.0 years and the most common comorbidities were diabetes with complications (16.0%), obesity (15.3%), and chronic obstructive pulmonary disease (12.3%). The most common first biologics prescribed were TNF inhibitors (64.8%), IL-12/23 inhibitors (18.8%), IL-17 inhibitors (9.0%), and IL-23 inhibitors (7.4%). There were 3148 participants who switched biologic class; the most common second biologic class prescribed were IL-12/23 inhibitors (37.8%), and IL-17 inhibitors (26.0%).

Mean time to developing arthritis was 528±522 days. Analysis of time to incident arthritis showed patients prescribed a TNF inhibitor as their first biologic had the highest probability of developing arthritis compared with patients prescribed other biologics.

In multivariable regression analyses, the risk for developing inflammatory arthritis was significantly lower in participants prescribed IL-23 inhibitors (adjusted hazard ratio [aHR], 0.41; 95% CI, 0.17-0.95) or IL-12/23 inhibitors (aHR, 0.58; 95% CI, 0.43-0.76) compared with those prescribed TNF inhibitors.

A comparison of IL-17 inhibitors and TNF inhibitors showed no significant difference (aHR, 0.86; 95% CI, 0.54-1.38).

The results for the IL-23 inhibitors persisted in 3 of 6 sensitivity analyses when participants who developed arthritis within 3 to 6 months after first biologic prescription were excluded, or when a higher diagnostic threshold was used for incident arthritis. The results for IL-12/23 inhibitors persisted across all sensitivity analyses.

Limitations of the study include confounding by indication and channeling bias, and diagnosis misclassification in electronic health records.

Researchers conclude, “[T]reatment with IL-12/23 inhibitors or IL-23 inhibitors was associated with reduced risk of progression to inflammatory arthritis compared with TNF inhibitors.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.