IL-23 blockers may lower the risk of developing inflammatory and psoriatic arthritis

According to an analysis including 7,144 biologic-naïve patients with psoriasis, those receiving IL-23 inhibitors are less likely to develop inflammatory or psoriatic arthritis (PsA) than patients receiving IL-17 or TNF inhibitors. Despite the known limitations of observational data, this is the second cohort study to reveal a lower risk of developing arthritis in patients receiving IL-23 inhibitors warranting further research.

Approximately a quarter of patients with psoriasis will develop inflammatory or PsA. A recent retrospective cohort study using a claims database reported that patients receiving IL-12/23 or IL-23 inhibitors were significantly less likely to develop PsA relative to other classes of biologics [1]. “This will be a talk about a likely new frontier of treating patients with psoriasis getting at the question: Does treatment for psoriasis potentially forestall the development of PsA in patients that don´t have psoriatic arthritis?” explained Prof. Bruce Strober (Yale University School of Medicine, CT, USA) [2]. The objective of the study was to assess whether the risk of inflammatory arthritis or PsA gets delayed according to the type of biologic therapy patients are receiving. The participants in this analysis were enrolled in the Optum Clinformatics Data Mart (CDM) database between January 2014 and December 2022 with 2 ICD-9/ICD-10 diagnosis codes for psoriasis.

Biologic-naïve participants were assigned to 4 cohorts based on the biologics they received first (i.e. IL-23, IL-17, IL12/23, or TNF inhibitors). Participants were followed for up to 3 years, until inflammatory arthritis developed (identified by ICD-9/ICD-10 codes), until participants switched or discontinued their biologics, or were lost to follow-up, whichever occurred first.

The analysis included 7,345 biologic-naïve participants: 2,712 were treated with an IL-23 blocker, 1,078 with an IL-12/23 blocker, 811 with an IL-17 blocker, and 2,744 were in the TNF cohort. Participants receiving an IL-23 blocker for psoriasis had numerically lower incidence rates of inflammatory arthritis and PsA.

When compared with participants receiving IL-23 inhibitors, participants receiving IL-17 (HR 1.44; P=0.0295) or TNF inhibitors (HR 1.9; P<0.0001) were significantly more likely to develop inflammatory arthritis. For the development of PsA, a significant difference was only seen compared with TNF inhibitors (HR 2.05; P<0.001).

However, Prof. Strober emphasised that bias is a potential limitation of this study as healthcare professionals may have preferentially prescribed IL-23 blockers to participants with early markers of PsA. Therefore, the current results should be backed by additional studies regarding the impact of biologics on the future risk of arthritis.

1. 
   
   1. Singla S, et al. Lancet Rheumatol. 2023;5(4):E170–171.
   2. Strober B. Risk of developing inflammatory arthritis in psoriasis patients initiating treatment with biologics: A population-based analysis. FC08.8, EADV Congress 2023, 11–14 October, Berlin, Germany.

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Posted on 28 November, 202322 February, 2024