Biologic Class May Influence Psoriatic Arthritis Risk in Patients With Plaque Psoriasis

A retrospective observational study published in Annals of the Rheumatic Diseases suggests that the risk of developing psoriatic arthritis (PsA) in patients with plaque psoriasis (PsO) may vary depending on the class of biologic therapy used. The findings highlight potential differences in PsA incidence among patients treated with tumor necrosis factor (TNF), interleukin-17 (IL-17), and interleukin-23 (IL-23) inhibitors. 

The study included 622 biologic-naïve patients with PsO, 62.4% of whom were male, with a mean age of 46.9 years. Patients were treated with TNF inhibitors (50.9%), IL-17 inhibitors (26.4%), or IL-23 inhibitors (22.7%) and followed for an average of 4.1 years per person, totaling 2510 person-years of follow-up. 

During the observation period, 60 patients (10%) developed PsA. The incidence was highest in the TNF inhibitor cohort (14.2%), followed by the IL-17 inhibitor cohort (5.5%) and IL-23 inhibitor cohort (4.3%). After adjusting for potential confounders using inverse probability of treatment weighting, the hazard ratio (HR) for PsA was 0.63 (95% CI: 0.38-1.05) for IL-17 inhibitors and 0.57 (95% CI: 0.34-0.96) for IL-23 inhibitors compared to TNF inhibitors. 

"The risk of developing PsA appeared slightly different in patients receiving diverse classes of biologics," the study authors noted. 

These findings suggest that IL-17 and IL-23 inhibitors may be associated with a lower risk of PsA onset compared to TNF inhibitors. Dermatologists should consider this potential difference when selecting biologic therapy for patients with PsO, particularly those at higher risk for PsA.

Reference
Gisondi P, Bellinato F, Galeone C, et al. Risk of developing psoriatic arthritis in patients with psoriasis initiating treatment with different classes of biologics. Ann Rheum Dis. Published online February 6, 2025. doi:10.1016/j.ard.2025.01.006