Biologic use in psoriasis may lower risk for developing psoriatic arthritis
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Patients with psoriasis who received biologic drugs demonstrated a lower risk — that was statistically and clinically significant — for developing psoriatic arthritis, according to data published in Arthritis & Rheumatology.
“Several biologic agents have been shown to be superior to DMARDs in treating PsA symptoms and have also shown effectiveness in slowing articular damage,” Yael Shalev Rosenthal, MPH, of Tel Aviv University, in Israel, and colleagues wrote. “However, they are not used as a first line therapy in moderate to severe psoriasis, much due to their high cost. The influence of biological treatment for psoriasis on the incidence and timing of PsA onset is unknown.”
“Since biologic agents were shown to slow PsA disease progression, it is reasonable to assume that their use in [patients] diagnosed with psoriasis with no evidence of PsA at the time of treatment initiation will prevent or delay onset PsA,” they added. “The fact that up to 30% of patients suffering from psoriasis will eventually develop PsA in a meantime of 10 years provides a unique opportunity for early intervention. This is especially relevant in patients with increased risk for developing PsA.”
To examine the impact of biological therapy for psoriasis on PsA incidence, Rosenthal and colleagues conducted a retrospective cohort study of electronic medical records obtained from Maccabi Healthcare Services. According to the researchers, Maccabi is the second largest health coverage organization in Israel, with more than 2 million insured members.
For their study, the researchers included patients who had received biological therapy for psoriasis — either adalimumab (Humira, AbbVie), etanercept (Enbrel, Amgen), infliximab (Remicade; Janssen, Johnson & Johnson), ustekinumab (Stelara, Janssen), secukinumab (Cosentyx, Novartis), ixekizumab (Taltz, Eli Lilly & Co.) or guselkumab (Tremfya, Janssen) — but had not been diagnosed with PsA at the time, or prior to, treatment initiation. Investigators then matched these patients based on age at diagnosis, sex, time until treatment initiation, maximum BMI and smoking status.
Rosenthal and colleagues identified 687 patients who had received biological drugs and 2,278 who had not. However, the two groups were different in most characteristics, so the researchers implemented propensity score matching. Ultimately, they included a total of 1,326 cases — 663 patients who received biological drugs and 663 who had not. The researchers compared the groups using log rank test and a multivariable Cox regression.
According to the researchers, the Kaplan-Meier curve for the propensity-score matched groups demonstrated an increased risk for PsA in the control group, compared with those who received biological treatment, that was statistically significant. The results of the multivariable Cox regression similarly demonstrated a significantly higher PsA risk among the control group, compared with the biological group (adjusted HR = 1.39; 95% CI, 1.03-1.87).
“Further studies are needed to understand in depth the relationship between biologic medications and PsA onset,” Rosenthal and colleagues wrote. “However, the results of the present study show a statistically and clinically significant lower risk for developing PsA among patients receiving biologic medications for psoriasis treatment. These results may support initiation of treatment with biologic medications at an earlier stage in patients who present with significant risk factors for PsA.”
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