Impact of Biologic Therapies on the Risk of Progression from Psoriasis to Psoriatic Arthritis: A Systematic Review and Meta-Analysis of Cohort Studies.
Wenhui Xie, Tong Chen, Yuan Chen et al.
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In 30 seconds
This systematic review and meta-analysis of cohort studies assessed whether biologic therapy is associated with incident psoriatic arthritis among adults with psoriasis and no prior psoriatic arthritis. Across 15 cohorts including 124,138 patients, biologic use was associated with lower risk than non-biologic therapy (pooled HR 0.54, 95% CI 0.43-0.68). IL-17 and IL-12/23 or IL-23 inhibitors were also associated with lower risk than tumor necrosis factor inhibitors. The authors suggest that early pathway suppression may delay clinical diagnosis, while noting that observational data limit causal inference.
Key findings
- Biologic use was associated with lower psoriatic arthritis risk than non-biologic therapy (pooled HR 0.54, 95% CI 0.43-0.68).
- Compared with tumor necrosis factor inhibitors, IL-17 inhibitors (HR 0.65, 95% CI 0.49-0.87) and IL-12/23 or IL-23 inhibitors (HR 0.46, 95% CI 0.36-0.60) were associated with lower risk.
- IL-23 inhibitors were associated with lower risk than IL-17 inhibitors (HR 0.67, 95% CI 0.58-0.77); IL-23 and IL-12/23 inhibitors did not differ (HR 0.88, 95% CI 0.69-1.13).
Why it matters
Incident psoriatic arthritis can lead to irreversible joint damage, so evidence about its risk in people with psoriasis is clinically important. These pooled cohort findings suggest biologic treatment, particularly some targeted pathways, may be associated with lower risk. They help frame questions about treatment timing and comparative therapies, but do not establish that biologics prevent arthritis.
What to keep in mind
The evidence comes from observational cohort studies, so residual confounding and other biases limit causal inference.