Biologic therapy was associated with a lower risk of several ocular surface diseases in patients with psoriasis compared with nonbiologic systemic therapy, according to a retrospective cohort study published in Eye.
Researchers used the TriNetX Global Collaborative Network, which includes records from more than 165 million patients worldwide, to compare 30,911 patients who initiated biologic therapy with 35,832 who received nonbiologic systemic treatment. The analysis assessed 68 ocular outcomes over follow-up periods ranging from 6 months to 10 years, with 1:1 propensity score matching performed separately for each follow-up interval.
The strongest associations favored biologic therapy for dry eye disease, keratitis, and conjunctivitis. Lower-risk associations were evident by 6 months and remained observable through 10 years. Biologic therapy was also associated with lower risk for other external eye diseases, including blepharitis, as well as more variable reductions in glaucoma and age-related cataract.
By contrast, the study did not find a consistent reduction in retinal or vitreous disease overall, with many estimates approaching no difference over time. However, regional analyses—particularly in the US network—did show lower risk for some outcomes, including age-related macular degeneration.
Sensitivity analyses across US and Europe/Middle East networks generally supported the primary findings. Additional analyses suggested that outcomes may differ by biologic class for some conditions, including conjunctivitis and iridocyclitis.
The findings should be interpreted cautiously because the study was observational and cannot establish causation. The researchers also noted potential misclassification from ICD-10 coding, possible residual confounding related to psoriasis severity and treatment adherence, and heterogeneity within broad diagnostic categories such as keratitis. Matching was performed separately for each follow-up interval, which may introduce selection and survival bias.
“Biologic therapy in psoriasis was associated with a lower risk of ocular surface disease and may inform interdisciplinary management and consideration of ocular outcomes in treatment decisions,” wrote Shoham Kubovsky, of Hadassah Medical Center, Jerusalem, Israel, and colleagues.
Disclosures: Yuval Ramot reported speaker honoraria, consultancy fees, or travel support from multiple pharmaceutical companies, including Pfizer, AbbVie, Novartis, Janssen, Johnson & Johnson, Sanofi, Bristol Myers Squibb, Takeda, and Lilly. The other researchers reported no competing interests.
Source: Eye
