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

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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 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 can 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. 2025:S0003-4967(25)00051-2. doi:10.1016/j.ard.2025.01.006

Study Highlights Patient-Driven Risk Tolerance in Severe Alopecia Areata

A new analysis published in The Journal of Dermatology highlights the importance of patient preferences in optimizing treatment strategies for severe alopecia areata (AA). Researchers evaluated the benefit-risk profiles of 2 doses of ritlecitinib— an oral Janus kinase 3/Tec kinase inhibitor approved for severe AA—by integrating patient-derived risk tolerance with clinical efficacy and safety data.

The study employed a discrete-choice experiment involving 201 adults with physician-confirmed AA and ≥ 50% scalp hair loss. Participants assessed benefit attributes, including achieving ≥ 80% scalp hair coverage and moderate-to-normal eyebrow and eyelash regrowth, alongside risks for serious infection, cancer, and blood clots over 3 years. These data informed the maximum acceptable risk patients would tolerate to achieve increased benefits from the higher dose (50 mg) over the lower dose (30 mg). Key findings revealed that patients were willing to accept an absolute increase in 3-year risks of 3.88 percentage points (95% CI: 2.86–4.90) for serious infection, 1.63 percentage points (95% CI: 1.08–2.18) for cancer, and 5.30 percentage points (95% CI: 3.60–7.00) for blood clots to achieve higher probabilities of significant hair regrowth. These risk tolerances align with differences in efficacy between the doses observed in the ALLEGRO-2b/3 clinical trial, supporting the potential for higher dosing in patients prioritizing increased treatment benefits.

“Patients with severe alopecia areata clearly value the prospect of achieving substantial hair regrowth,” the study authors noted. “These findings suggest that many are willing to accept moderate increases in potential treatment-related risks to maximize efficacy.”

Reference

Hauber B, Whichello C, Mauer J, et al. Using patient preference to inform ritlecitinib dose selection for alopecia areata treatment. J Dermatol. Published online January 15, 2025. doi:10.1111/1346-8138.17628