Ustekinumab Reduces Uveitis Risk in Patients with Psoriasis

Credit: Victor Freitas/Unsplash

Ustekinumab, an interleukin (IL)-23 inhibitor, achieved a reduced risk of uveitis among individuals with moderate to severe psoriasis, compared with treatment with tumor necrosis factor-α inhibitors (TNFi), according to new research.¹

Investigators attributed the lower uveitis incidence to the unique mechanism of action of ustekinumab, noting that Th-1/Th-18 cells play roles in the development of both the eye disorder and psoriasis, with IL-23 one of the essential cytokines in this inflammatory pathway.

“As inhibition of IL-23 prevents the maintenance of IL-17 and the inflammatory pathway of psoriasis, ustekinumab may be more effective than TNFi in preventing uveitis,” wrote the investigative team, led by Ju Hee Han, MD, department of dermatology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea.

Recent evidence has pointed to an elevated incidence of uveitis among patients with psoriasis.² Given this reported increase, jointly released guidelines from the American Academy of Dermatology (AAD) and the National Psoriasis Foundation (NPF) recommend that dermatologists actively screen for uveitis.³

Although previous studies have investigated the incidence rate of uveitis among patients with psoriasis, there were limited data on the incidence rate compared with each medication used in treatment.² As a result, Han and colleagues compared the risk of uveitis after treatment with ustekinumab and TNFi for this study.¹

From the Korean Health Insurance Review and Assessment Service database, patients with moderate to severe psoriasis who had a psoriasis area and severity index score >10, even after conventional treatment between January 2016 and September 2019, were recruited for evaluation.

Ultimately, this review identified 2467 patients treated with ustekinumab and 1746 treated with TNFi in the database. Uveitis risk between the two treatment cohorts was assessed using a Cox regression hazard model, adjusted for age, sex, diabetes, hypertension, dyslipidemia, malignancy, and psoriatic arthritis.

Upon analysis, the uveitis incidence rate was 10.16 per 1,000 person-years in the TNFi cohort and 2.34 per 1,000 person-years in the ustekinumab cohort. Ustekinumab achieved a significantly reduced risk of uveitis compared with the TNFi group (hazard ratio [HR], 0.22; 95% CI, 0.113–0.414).

These findings were confirmed after multivariable Cox proportional hazards regression analysis, with a lower uveitis risk in the ustekinumab cohort (HR, 0.22; 95% CI, 0.117–0.424), compared with TNFi treatment. Ustekinumab-treated patients also experienced a significantly lower cumulative incidence rate of uveitis (log-rank test, P <.001).

Considering these data, Han and colleagues indicated ustekinumab may be a better offering than TNFi, particularly for patients with moderate to severe psoriasis and risk factors for uveitis. They noted these findings provided valuable insight into the benefit of ustekinumab for psoriasis, as only a few treatments have demonstrated effectiveness for related comorbidities.

“Further research is needed to investigate the mechanisms by which ustekinumab demonstrates lower risk of uveitis and to determine whether other biological agents that inhibit the IL-23/17 axis have a preventive effect on uveitis,” investigators wrote.

References

1. _{Bang CH, Oh HJ, Kim YH, et al. Ustekinumab Demonstrates Lower Uveitis Risk in Moderate to Severe Psoriasis Patients Compared with Tumor Necrosis Factor-α Inhibitors. Acta Derm Venereol. 2024;104:adv34206. Published 2024 Sep 9. doi:10.2340/actadv.v104.34206}
2. _{Kim BR, Choi SW, Choi CW, Lee KH, Kim MJ, Woo SJ, et al. Risk of uveitis in patients with psoriasis in Korea: a nationwide population-based cohort study. J Eur Acad Dermatol Venereol 2023; 37: 1336–1343. doi.10.1111/jdv.19060.}
3. _{Elmets CA, Leonardi CL, Davis DMR, Gelfand JM, Lichten J, Mehta NN, et al. Joint AAD–NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities. J Am Acad Dermatol 2019; 80: 1073–1113.}