Studies Draw Mixed Conclusions on Role of Biologics for Psoriatic Arthritis

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While some studies suggest biologic therapy is associated with preventing psoriatic arthritis (PsA), other studies clash, stating pharmacological intervention either delays the onset or assists the development of arthritis.¹

In an editorial study, led by Marta Loredo, of the rheumatology division at Central University Hospital of Asturias in Oviedo, Spain, the investigators compared studies examining the associations between PsA and biologic therapy. Studies had 3 outcomes: Either the treatment improved psoriatic arthritis, delayed the onset of the disease, or helped develop arthritis.

Current Data on Biologics in PsA

One study found conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), synthetic-targeted (st) DMARDs, and biologics, such as TNF-alpha, IL-17, IL-12/23, and IL23 inhibitors can reduce the presence of psoriatic arthritis.

Another study compared biological therapies and phototherapies for patients with psoriatic arthritis. The investigators found an annual incidence rate of 1.20 cases (95% CI, 0.77 – 1.89) for biological therapies and a rate of 2.17 (95% CI, 1.53 – 3.06) per 100 patient-years for phototherapy. Overall, biological therapies were associated with a reduced incidence of PsA (adjusted Hazard Ratio [aHR], 0.27; 95% [CI], 0.11 – 0.66).²

Similarly, another study with 1719 patients with psoriasis found, for patients treated with biologics, the risk of developing PsA was significantly lower than the patients treated with topicals. Though, it was not significantly lower compared to patients treated with cDMARD (incidence rate ratio 0.35; 0.035 – 1.96; P = .1007).³

A different study found the onset of PsA after undergoing psoriasis treatment was lower in patients treated with systemic therapies—12% for biologics and 9.6% for csDMARDs)—than patients treated with topicals or untreated cases (37.4%; P < .001).⁴

Moreover, a case-control study compared 663 patients who had undergone biologic treatment for psoriasis without arthritis with 663 patients with psoriasis who did not receive the biologic treatment. The investigators discovered the patients without biologic treatment had a significantly higher risk of developing PsA (aHR 1.39, 95% CI, 1.03 – 1.87) within the 10-year follow.⁵

Despite the evidence produced within the aforementioned studies, not all studies included in the review supported use of biologics therapy, particularly in patients with psoriasis.

One retrospective study with 190,000 psoriasis patients found biologic treatment was associated with the development of PsA among psoriasis patients.6 Loredo and colleagues pointed out the results of the study could be related to biases, but other studies had also explained the “paradoxical appearance” or “de novo” onset of PsA in patients with psoriasis once receiving biological therapy.

Loredo and colleagues concluded their report by highlighting another study that showed a positive association between biologics and psoriatic arthritis. After being exposed to IL12/23i and IL23i, patients had a significantly lower risk of developing arthritis than patients exposed to TNFi. The investigators found no difference in developing PsA when exposed to IL7i and TNFi.⁷

“Until well-designed prospective studies or ad hoc quality clinical trials are developed, it cannot be firmly concluded that early systemic therapy prevents or delays the onset of PsA in patients with psoriasis,” the investigators wrote. “In any case, close monitoring of those patients with psoriasis and a high risk of transition to PsA is essential in order to establish, as early as possible, all those measures aimed at reducing or halting the progression of the disease.”¹

References

1. ^{Marta Loredo, Ignacio Braña & Rubén Queiro. Does pharmacological intervention prevent or delay the onset of psoriatic arthritis among psoriasis patients? Taylor & Francis Online. 2023. DOI: 10.1080/14712598.2023.2273269}
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