Biologic therapies and psoriatic arthritis risk in psoriasis: A systematic review and meta-analysis.

In 30 seconds

This systematic review and meta-analysis assessed whether biologic therapies are associated with lower incidence of psoriatic arthritis (PsA) among people with psoriasis. Across 18 studies comparing biologic and non-biologic therapies, the primary analysis found no significant overall difference: pooled RR 0.71 (95% CI: 0.34, 1.51) and HR 0.71 (95% CI: 0.44, 1.17). Results varied by data source and biologic class, with some subgroup analyses suggesting lower observed risk. The authors characterize these findings as hypothesis-generating and call for confirmation in prospective studies and randomized trials.

Key findings

• Across the primary analysis, biologics were not associated with a significant reduction in PsA incidence versus non-biologic therapies (RR: 0.71, 95% CI: 0.34, 1.51; HR: 0.71, 95% CI: 0.44, 1.17).
• Clinical cohort studies showed lower observed risk with biologics (RR: 0.31, 95% CI: 0.11, 0.87), whereas registry studies did not (RR: 1.03, 95% CI: 0.44, 2.40).
• In analyses of dichotomous outcomes, IL-17i, IL-23i or IL-12/-23i were associated with lower PsA risk than TNFi.
• Sensitivity analyses excluding one influential study identified a lower observed PsA risk among patients receiving biologics.

Why it matters

Preventing progression from psoriasis to PsA would be clinically important, but the pooled evidence does not establish an overall preventive association for biologics. Differences across data sources and drug classes suggest that estimates may depend on study design or treatment pathway. Distinguishing a true preventive effect from observational associations is necessary before prevention can inform treatment decisions.

What to keep in mind

The evidence comes from studies with differing data sources and outcome measures; subgroup findings varied, and the authors state that prospective studies and randomized trials are needed to confirm them.