Watad Abdulla, Zabotti Alen, Patt Yonatan Shneor, Gendelman Omer, Dotan Arad, Ben-Shabat Niv, Fisher Lior, McGonagle Dennis, Amital Howard
Department of Internal Medicine B & Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel.
Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Rheumatol Ther. 2024 Aug;11(4):963-976. doi: 10.1007/s40744-024-00680-3. Epub 2024 Jun 7.
Biologic therapies are licensed for both psoriasis (PsO) and psoriatic arthritis (PsA) with some electronic medical record data suggest that IL (Interleukin)-23 blockers might be more protective in PsA prevention than TNF blockers; however, the findings have been inconsistent. Higher Psoriasis Area and Severity Index (PASI) scores have also been linked to an increased PsA risk. To clarify these unresolved issues we investigated biologic agents, methotrexate, phototherapy, and topical therapy for PsA prevention in patients with psoriasis.
This retrospective cohort study analyzed data from 58,671 patients with psoriasis from the Israeli Meuhedet Health Services Organization database was evaluated for incident PsA. Patients were categorized on the basis of treatment: group 1, topical therapy; group 2, phototherapy; group 3, conventional disease-modifying antirheumatic drugs (cDMARDs; methotrexate); group 4, biologic DMARDs which was also stratified according to biologic class.
The PsA incidence rate was lower in the biologic agents' group versus the methotrexate group (HR 0.46 [95% CI 0.35-0.62]). The incidence rates per 100 person-years varied across biologic treatment groups, with the anti‑IL‑12/23 or anti‑IL‑23p19 group at 4.57, the anti-IL-17 group at 4.35, and the TNF inhibitor group at 2.55. No differences were found between various biological agents in terms of preventing PsA. The phototherapy group exhibited a higher PsA development rate than the topical therapy group (HR 1.85 [95% CI 1.65-2.07]).
Biological agents are more effective than methotrexate in reducing incident PsA in patients with psoriasis. This lower rate of PsA on topical therapy compared to phototherapy supports the importance of psoriasis severity as a risk factor.
生物疗法已获批准用于治疗银屑病（PsO）和银屑病关节炎（PsA），一些电子病历数据表明，白细胞介素（IL）-23阻滞剂在预防PsA方面可能比肿瘤坏死因子（TNF）阻滞剂更具保护作用；然而，研究结果并不一致。较高的银屑病面积和严重程度指数（PASI）评分也与PsA风险增加有关。为了澄清这些未解决的问题，我们研究了生物制剂、甲氨蝶呤、光疗和局部治疗对银屑病患者预防PsA的作用。
这项回顾性队列研究分析了来自以色列Meuhedet健康服务组织数据库的58671例银屑病患者的数据，评估新发PsA情况。患者根据治疗方法进行分类：第1组，局部治疗；第2组，光疗；第3组，传统改善病情抗风湿药物（cDMARDs；甲氨蝶呤）；第4组，生物DMARDs，也根据生物制剂类别进行分层。
生物制剂组的PsA发病率低于甲氨蝶呤组（风险比[HR]0.46[95%置信区间（CI）0.35 - 0.62]）。每100人年的发病率在不同生物治疗组中有所不同，抗IL - 12/23或抗IL - 23p19组为4.57，抗IL - 17组为4.35，TNF抑制剂组为2.55。在预防PsA方面，各种生物制剂之间未发现差异。光疗组的PsA发生率高于局部治疗组（HR 1.85[95%CI 1.65 - 2.07]）。
生物制剂在降低银屑病患者新发PsA方面比甲氨蝶呤更有效。与光疗相比，局部治疗的PsA发生率较低，这支持了银屑病严重程度作为风险因素的重要性。
