Biologics could help prevent psoriasis progressing to PsA

New research utilising a global network of medical data, presented at the 2024 EULAR Congress, suggest it could be possible to prevent those with psoriasis developing psoriatic arthritis (PsA) through targeted use of certain biologics.

The estimated prevalence of PsA in people with psoriasis ranges widely between 6 and 42 per cent, but in most cases, skin symptoms precede PsA, thus making skin psoriasis a model for pre PsA. Assuming that there are shared pathways in the pathogenesis, it is possible that stringent treatment of moderate-to-severe psoriasis could reduce progression to clinically overt PsA.

This retrospective study used big data from a global network of electronic records of over one million people with psoriasis to compare the incidence of new-onset PsA between those receiving a first- or second-line biologics for psoriasis. This included tumour necrosis factor inhibitors (TNFi) and biologics directed against interleukins (IL-12i, 23i, 17i, and 12/23i).

The incidence of PsA was compared in the different cohorts at five years, and throughout the follow-up, using the first-line TNFi population as a comparator.

The results showed that the risk of developing PsA during first-line treatment was 37 per cent lower with an IL-12/23i, and 39 per cent lower with IL-23i compared to TNFi at five years. For those on second-line treatment, the risk was 32 per cent lower with IL-12/23i and 31 per cent lower with IL-23i at three years than with a first-line TNFi.

In both first- and second-line treatment, IL-23i presented a 47 per cent lower probability of developing PsA compared to IL-17i at three and five years.

These kinds of analyses based on ‘Big Data’ offer an opportunity to obtain information on the efficiency of drugs in real life. This large study is relevant because it explores the incidence of PsA in matched, adjusted cohorts with a five-year follow-up.

According to these data, IL-12/23i and IL-23i reduce the incidence of PsA compared to TNFi and IL-17i, both in naïve and bio experienced patients.

As more knowledge becomes available, the concept of intercepting PsA before it becomes clinically apparent becomes a possibility, the study concludes.Reference: Joven-Ibáñez B, et al. Evaluation of the risk of psoriatic arthritis in patients with psoriasis undergoing biological treatment. Global population