RESEARCH SNAPSHOT
Risk of psoriatic arthritis reduced in psoriasis patients receiving biologics
Psoriasis is defined as a complex , chronic and multifactoral inflammatory condition that involves hyperproliferation of the keratinocytes in the epidermis . 1 The disease affects around 2.5 % of the population and while skin manifestations are the most prevalent clinical symptoms , around a third of patients will develop psoriatic arthritis ( PsA ) approximately 10 years after their psoriasis diagnosis . 2
Patients with moderate-to-severe psoriasis are normally treated with biologics , of which there are many different agents that target various interleukins implicated in the pathophysiology of the disease . Although biologics such as adalimumab and infliximab are also approved for the management of PsA and help to slow disease progression , what remains uncertain is whether the treatment of psoriasis with biologics could either prevent or delay the later development of PsA .
This was the reason behind a study by a team from the Division of Dermatology , Rabin Medical Center ,
Tikwa , Israel . The team undertook a retrospective cohort study using electronic health records of patients treated for psoriasis with a biologic agent but who had not developed any signs of PsA . 3 Biologics included were adalimumab , etanercept , infliximab , ustekinumab , secukinumab , ixekizumab and guselkumab , although patients were excluded if they had received any biologics for other conditions in the past . The team used a matched cohort of patients with psoriasis but who had not received a biologic but had used at least two systemic agents or systemics in combination with phototherapy . The primary outcome was PsA incidence during 10 years of follow-up and this information was extracted from the patient ’ s electronic health records .
Findings The study included 687 patients with a mean age of 35.7 years ( 35.3 % female ) and who were treated with a biologic agent and matched with a control cohort who had not received biologics . After 10 years of followup , the risk of developing PsA was significantly higher among the control cohort ( hazard ratio , HR = 1.39 , 95 % CI 1.03 – 1.87 ). Furthermore , this risk was also significantly higher for women ( HR = 1.80 , 95 % CI 1.34 – 2.42 ).
Commenting on their findings , the authors believed that this was the first study to demonstrate an effect of biologics on risk of developing PsA and noted how , given that PsA places a huge burden upon patients , it was important to explore preventative strategies . While calling for further studies to explore this relationship , the authors concluded that their results support the early initiation of biologics in those patients with significant risk factors for PsA .
References 1 Psoriasis . Medscape . https :// emedicine . medscape . com / article / 1943419-overview 2 Ritchlin CT et al . Psoriatic Arthritis . N Engl J Med 2017 ; 376:2095 – 6 . 3 Rosenthal YS et al . Psoriatic arthritis incidence among patients receiving biologic medications for psoriasis : A nested case control study . Arthritis Rheumatol 2021 . https :// doi . org / 10.1002 / art . 41946 .
30 | Issue 99 | 2021 | hospitalpharmacyeurope . com