Reduced Risk of PsA in Patients with Psoriasis Associated with bDMARDs Therapy


Investigators believe drugs like etanercept and ustekinumab could reduce the risk of psoriatic arthritis in patients with moderate-to-severe chronic plaque psoriasis.

A recent investigation from Italy into the management of plaque psoriasis with biological disease-modifying antirheumatic drugs (bDMARDs) found that the treatment could possibly delay or reduce the risk of incident psoriatic arthritis in patients.

Chronic plaque psoriasis has been associated with nearly 20%-25% of adult cases of psoriatic arthritis, with psoriasis often preceding it by several years.

Prior to the current study, the treatment of psoriasis with bDMARDs as a preventive measure for the development of psoriatic arthritis had not been extensively investigated.

As such, Paolo Gisondi, MD, Department of Medicine, Section of Dermatology and Venereology at the University of Verona, Italy, and fellow investigators conducted a non-randomized intervention study to estimate the incidence of psoriatic arthritis in patients with moderate-to-severe chronic plaque psoriasis who received bDMARDs compared to those treated with narrow-band ultraviolet light B (UVB) phototherapy.

The Methods

Investigators enrolled psoratic patients into the study who had been consecutively attending the dermatology outpatient service of the University Hospital of Verona between January 1, 2012, and September 30, 2020.

Patients had either received bDMARDs or nb-UVB phototherapy for treatment of plaque psoriasis.

Investigators initially identified 982 potentially eligible patients, though a total of 464 psoriatic patients were enrolled. Most patients were treated for a mean of roughly 6 years with either bDMARDs or nb-UVB.

All patients were initially screened for psoriatic arthritis through the Early Arthritis for Psoriatic patients (EARP)- 10 questionnaire, which was routinely administered once every 6 months.

A total of 234 patients were treated with bDMARDs. Among these medications were infliximab (39 patients; 17%), etancerept (17; 7%), adalimumab 67; 29%), ustekinumab (50; 21%), and secukinumab (61; 26%). A total of 35 (15%) patients switched therapy.

Meanwhile, a total of 230 patients had undergone nb-UVB phototherapy.

The Findings

Over the follow-up, investigators observed a total of 51 (11% of total) patients developed incident psoriatic arthritis, including 19 (8%) and 32 (14%) in the bDMARDs and nb-UVB phototherapy groups (p=0.046), respectively.

Significantly higher proportions of peripheral arthritis (p= 0.003) and dactylitis (p<0.001) were observed in the phototherapy group.

In univariable regression analysis, treatment with bDMARDs was significantly associated with a lower risk of incident psoriatic arthritis (HR 0.53, 95%CI 0.30 to 0.94) compared with nb-UVB phototherapy.

Treatment with bDMARDs remained significantly associated with a lower risk of incident psoriatic arthritis after adjustments for age, sex, nail psoriasis and baseline PASI ≥10, as well as adjustments for presence of folds psoriasis, scalp psoriasis, family history of psoriasis and psoriasis duration >10 years.

Additionally, results from a PSM procedure found that treatment with bDMARDs did not show any significant association with the risk of incident PsA both in univariable regression analysis and even after adjustment for age and sex, compared to nb-UVB phototherapy.

The investigators concluded that the results of the study indicated that therapeutic intervention with bDMARDs could reduce the risk of incident psoriatic arthritis, though additional research was suggested.

“Future large prospective and intervention studies are needed to further validate these findings in independent samples,” the team wrote.

The study, "Biological disease-modifying antirheumatic drugs may mitigate the risk of psoriatic arthritis in patients with chronic plaque psoriasis," was published online in the Annals of Rheumatic Disease.

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