Cho Yongtai, Park Suneun, Jung Kyungyeon, Lee Jeong-Eun, Woo Jieun, Kim Ju Hwan, Shin Ju-Young
School of Pharmacy, Sungkyunkwan University, 2066, Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do, 16419, South Korea.
Department of Clinical and Social Pharmacy, Sungkyunkwan University, Suwon, South Korea.
BioDrugs. 2025 Jan;39(1):143-152. doi: 10.1007/s40259-024-00689-8. Epub 2024 Nov 17.
Evidence comparing the impact of various biologics for psoriasis on the progression to psoriatic arthritis (PsA) is limited. We therefore assessed the risk of PsA associated with interleukin (IL)-23 inhibitor, IL-17 inhibitor, or IL-12/23 inhibitor use compared with tumor necrosis factor (TNF) inhibitor use among patients with psoriasis.
This population-based cohort study used the nationwide claims database from South Korea (2007-2023). New users of IL or TNF inhibitors with psoriasis who did not have PsA or other inflammatory arthritis were categorized into each class of the IL inhibitors for comparison with TNF inhibitor users. The outcome measured was the development of incident PsA. We calculated multinomial overlap weights to balance predefined covariates. Hazard ratio (HR) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards models.
We identified 9499 patients with psoriasis (mean age 45.1 years; 33.6% female), of whom 3913 (41.2%), 2126 (22.4%), 2773 (28.8%), and 727 (7.7%) were exposed to IL-23 inhibitor, IL-17 inhibitor, IL-12/23 inhibitor, and TNF inhibitor, respectively. PsA developed in 281 (3.0%) patients during 23,275 person-years. The weighted HR for any IL inhibitors was 0.40 (95% CI 0.25-0.62), with specific HRs of 0.22 (95% CI 0.13-0.37), 0.47 (95% CI 0.28-0.80), and 0.46 (95% CI 0.29-0.74) for IL-23 inhibitor, IL-17 inhibitor, and IL-12/23 inhibitor, respectively. IL-23 inhibitors exhibited the greatest rate difference of - 2.61 (95% CI - 3.67 to - 1.55) cases of PsA per 100 person-years.
The use of IL inhibitors, particularly IL-23 inhibitors, compared with TNF inhibitors, was associated with a lower risk of developing PsA.
比较各种治疗银屑病的生物制剂对银屑病关节炎（PsA）进展影响的证据有限。因此，我们评估了银屑病患者使用白细胞介素（IL）-23抑制剂、IL-17抑制剂或IL-12/23抑制剂相较于使用肿瘤坏死因子（TNF）抑制剂发生PsA的风险。
这项基于人群的队列研究使用了韩国全国性索赔数据库（2007 - 2023年）。没有PsA或其他炎症性关节炎的银屑病IL或TNF抑制剂新使用者被分类到每种IL抑制剂类别中，与TNF抑制剂使用者进行比较。测量的结局是新发PsA的发生情况。我们计算了多项重叠权重以平衡预定义的协变量。使用Cox比例风险模型计算风险比（HR）和95%置信区间（CI）。
我们确定了9499例银屑病患者（平均年龄45.1岁；33.6%为女性），其中3913例（41.2%）、2126例（22.4%）、2773例（28.8%）和727例（7.7%）分别接受了IL-23抑制剂、IL-17抑制剂、IL-12/23抑制剂和TNF抑制剂治疗。在23275人年期间，281例（3.0%）患者发生了PsA。任何IL抑制剂的加权HR为0.40（95%CI 0.25 - 0.62），IL-23抑制剂、IL-17抑制剂和IL-12/23抑制剂的具体HR分别为0.22（95%CI 0.13 - 0.37）、0.47（95%CI 0.28 - 0.80）和0.46（95%CI 0.29 - 0.74）。IL-23抑制剂每100人年的PsA发生率差异最大，为 - 2.61（95%CI - 3.67至 - 1.55）例。
与TNF抑制剂相比，使用IL抑制剂，尤其是IL-23抑制剂，发生PsA的风险较低。
