Biologic DMARD class influences progression from psoriasis to PsA: a real-world cohort study.

OBJECTIVES

To evaluate whether the risk of progression from psoriasis to PsA is affected by the class of bDMARD used for treatment of psoriasis, in a real-world cohort with a large follow-up.

METHODS

We conducted a retrospective study in two university dermatology-rheumatology centers. Consecutive adults with psoriasis receiving bDMARDs for ≥6 months between 2008 and 2025 were included. Patients were followed until PsA diagnosis, last visit, or study end. The primary outcome was incidence of PsA.

RESULTS

Among 393 patients, 86 (22%) developed PsA during follow-up. In the single-class bDMARD exposure analysis (n = 257), PsA occurred more frequently in patients treated with TNF inhibitors (TNFi) than in those receiving IL-17, IL-23, or IL-12/23 inhibitors. After adjustments, all non-TNFi bDMARDs were associated with significantly lower odds (OR range 0.16-0.25) and hazards (HR range 0.17-0.30) of PsA compared with TNFi. Similar findings were observed when patients were grouped according to the bDMARD class used for the longest duration. In patients analysed by first bDMARD received (n = 137), PsA prevalence and adjusted hazards did not differ between bDMARD classes.

CONCLUSION

In this long-term real-life cohort of patients with psoriasis, treatment with non-TNFi bDMARDs-particularly IL-17 and IL-23 inhibitors-was associated with lower risk of incident PsA compared with TNFi. These findings support PsA interception and warrant prospective studies to determine whether biologic class selection can modify disease progression.