Objective:

To examine the risk of developing inflammatory arthritis in patients with psoriasis initiating biologic treatments.

Approach:

• Study Design: Retrospective analysis using the Optum Clinformatics Data Mart database, involving 7,345 patients with psoriasis who initiated biologic treatment from January 2014 to March 2023.
• Treatment Groups: Patients were divided into four treatment groups: IL-23 inhibitors, IL-17 inhibitors, IL-12/23 inhibitors, and TNF inhibitors.
• Inclusion/Exclusion Criteria: Included patients aged 18 or older with ≥ 2 ICD-9/ICD-10 diagnosis codes for psoriasis; excluded those with prior biologic/methotrexate treatment or preexisting inflammatory arthritis.
• Follow-Up: Patients were followed for up to 3 years or until the development of inflammatory arthritis, treatment switch/discontinuation, or loss of follow-up.
• Statistical Analysis: Used a Cox proportional hazards model adjusting for baseline characteristics and relevant comorbidities.

Key Findings:

• Patients treated with IL-23 inhibitors had a lower risk of developing inflammatory arthritis compared to other biologic therapies.
• Incidence rates of inflammatory arthritis per 100 person-years were: IL-23 inhibitors: 4.99, IL-17 inhibitors: 7.29, IL-12/23 inhibitors: 6.06, TNF inhibitors: 9.39.
• Adjusted hazard ratios for developing inflammatory arthritis compared to IL-23 inhibitors were: IL-17 inhibitors: 1.44, TNF inhibitors: 1.90.
• Similar trends were observed for the risk of developing psoriatic arthritis.

Interpretation:

Limitations:

• Potential for protopathic bias as clinicians may preferentially prescribe IL-17 or TNF inhibitors to patients with joint pain.
• Retrospective nature of the study may limit causative conclusions.

Conclusion:

Sources:

• Journal of the American Academy of Dermatology