TOPLINE

Among patients with psoriasis treated with a single class of biologic disease-modifying antirheumatic drug (bDMARD), treatment with interleukin (IL)-17, IL-23, or IL-12/23 inhibitors was associated with a significantly lower risk of developing psoriatic arthritis (PsA) than treatment with TNF inhibitors.

METHODOLOGY

• Researchers conducted a retrospective observational cohort study at two university dermatology-rheumatology centres in Greece to evaluate whether the class of bDMARD affected the risk for progression from psoriasis to PsA.
• They included 393 adults with psoriasis (mean age, 52 years; 54% men) who received treatment with bDMARDs for at least 6 months between January 2008 and June 2025. The median follow-up duration was 12 years.
• bDMARDs were grouped as TNF inhibitors, IL-17 inhibitors, IL-12/23 inhibitors, and IL-23 inhibitors.
• Analyses included patients treated with a single bDMARD category, longest duration bDMARD exposure, first bDMARD among switchers, and a calendar-period sensitivity analysis restricted to patients initiating treatment from 2017 to 2025.
• The primary outcome was incident PsA.

TAKEAWAY

• Overall, 22% of patients developed PsA during follow-up. Among patients who received a single bDMARD, PsA was more common in those who received TNF inhibitors vs other three classes (P < .05 for all).
• Compared with TNF inhibitors, IL-17, IL-12/23, and IL-23 inhibitors were associated with a 70%, 76%, and 83% lower risk for PsA, respectively (P < .001 for all). No significant differences were found among the IL-targeting inhibitor classes themselves.
• Among patients grouped by the longest bDMARD exposure, all three IL-targeting inhibitor classes were associated with lower odds of PsA than TNF inhibitors (P < .05 for all).
• Among patients receiving their first bDMARD, the prevalence of PsA and adjusted risk did not differ significantly among bDMARD classes. However, in the 2017-2025 sensitivity analysis, IL-17 and IL-23 inhibitors were associated with significantly lower odds and adjusted risk for PsA than TNF inhibitors (P < .05 for both).

IN PRACTICE

"In our real-world study, we found that both IL-23i [IL-23 inhibitors] and IL-17i [IL-17 inhibitors] offer protection from the development of PsA, in patients with psoriasis," the authors wrote. "[The] findings should be interpreted cautiously and considered hypothesis-generating, warranting prospective validation," they concluded.

SOURCE

The study was led by Nikolaos Kougkas, PhD, Hippokration University Hospital, Thessaloniki, Greece. It was published online on August 12, 2026, in Rheumatology.

LIMITATIONS

The retrospective design and inconsistently timed bDMARD data prevented the researchers from tracking changes in biologic use over time. Longitudinal measures of psoriasis severity were not consistently available. Requiring at least 6 months of biologic exposure may have introduced selection bias.

DISCLOSURES

The study did not receive any specific funding. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.