Biologics in psoriasis: can they prevent joint involvement?

Psoriatic arthritis (PsA) occurs at lower rates in patients with psoriasis receiving biologics than in patients receiving phototherapy. This was demonstrated with PsA incidence rates of 24.6 versus 50.0 per 1,000 person-years in a retrospective cohort study.

As the diagnosis of psoriasis often precedes the incidence of PsA, the potential of psoriasis treatments in delaying or preventing PsA was at the centre of the research by Ms Kathleen Miao (Keck School of Medicine of USC, CA, USA) and her colleagues [1,2]. Their retrospective cohort study strove to explore whether treatment with biologics would influence the incidence of PsA in patients with moderate-to-severe psoriasis compared with those receiving phototherapy [1]. The researchers analysed data from 4,695 patients with psoriasis from Optum’s de-identified Clinformatics® Data Mart Database between 2007 and 2021. All patients included in the study cohort received phototherapy as an index treatment for psoriasis; 461 later switched to biologics. The incidence of PsA after 10 years was defined as an outcome measure.

At diagnosis, the patients changing to biologics were younger (44.9 years) compared with the phototherapy patients (53.8 years). Over half of the cohort were women. PsA occurred at an incidence of 46.2 per 1,000 person-years in the entire group. Distinguished by treatment, this incidence changed to 50.0 per 1,000 person-years in the phototherapy arm and 24.6 per 1,000 person-years in the biologics arm (see Figure). With a difference of -25.48 cases of PsA per 1,000 person-years, this corresponded to a significantly lower incidence in the biologics group (P=0.0011). The hazard ratio of biologic versus phototherapy, identified by means of a Cox regression that adjusted for age, sex, and time on oral systemics, was 0.476 (P=0.005).

Figure: Intensive early therapy can reduce the cumulative incidence of psoriatic arthritis [1]



In their conclusion, the researchers suggest that biologics may reduce the incidence of PsA among psoriasis patients. To evaluate the protective extent of biologic treatment further, prospective and randomised-controlled trials are indicated.

1. Miao KL, et al. Do Biologics for Psoriasis Prevent the Development of Psoriatic Arthritis? A population-based study. P42744, AAD 2023 Annual Meeting, 17–21 March, New Orleans, USA.
2. Mease PJ, Armstrong AW. Drugs. 2014;74:423–41.

Posted on 15 May 2023