PSORIATIC arthritis risk may vary depending on biologic therapy selection and treatment sequencing, with new real-world evidence suggesting IL-17 inhibitors were associated with lower rates of disease development after switching biologic treatment in psoriasis.
Rising Interest in Biologic Sequencing
Patients with psoriasis are at increased risk of developing psoriatic arthritis, yet whether biologic therapies influence this progression remains unclear. Previous studies suggested first-line IL-23p19 inhibitors may reduce psoriatic arthritis risk, but evidence regarding second-line biologic treatment strategies has been lacking. Researchers therefore examined whether biologic class and sequencing affect incident psoriatic arthritis development.
Tracking Psoriatic Arthritis Development
This population-based cohort study identified 2,819 patients initiating biologic therapy for psoriasis between 2002 and 2022. Treatments included Tumour Necrosis Factor inhibitors, IL-17 inhibitors, IL-23p19 inhibitors, and IL-12/23 inhibitors. Investigators separately analysed first-line and second-line biologic therapy. The primary outcome was incident psoriatic arthritis. Kaplan-Meier survival analyses and multivariable Cox proportional hazards models assessed arthritis-free survival and hazard ratios for disease development. Among the total cohort, 1,246 patients later received second-line biologic therapy.
IL-17 Inhibitors Reduced Psoriatic Arthritis Risk
Among 2,819 patients initiating first-line biologic therapy, 400 individuals (14.2%) developed psoriatic arthritis. Multivariable Cox regression showed first-line IL-23p19 inhibitors were associated with significantly lower psoriatic arthritis risk compared with Tumour Necrosis Factor inhibitors, with hazard ratio 0.13 (95% CI 0.02 to 0.96; p=0.045). Among 1,246 patients receiving second-line biologics, 125 individuals (10.0%) developed psoriatic arthritis. In second-line analyses, IL-17 inhibitors were the only class independently associated with significantly reduced psoriatic arthritis risk versus Tumour Necrosis Factor inhibitors, with hazard ratio 0.37 (95% CI 0.16 to 0.85; p=0.019). Trends toward reduced risk were also observed for IL-12/23 inhibitors (hazard ratio 0.14; 95% CI 0.02 to 1.05; p=0.056) and IL-23p19 inhibitors (hazard ratio 0.46; 95% CI 0.20 to 1.07; p=0.070).
Implications for Biologic Sequencing Strategies
The findings suggest biologic class and sequencing may influence future psoriatic arthritis development in psoriasis patients. Researchers highlighted IL-17 inhibitors as a potentially preferable second-line strategy following Tumour Necrosis Factor inhibitor failure. Further prospective studies are needed to validate these findings and guide prevention-focused biologic sequencing recommendations.
Reference
Watad A et al. Impact of biologic class and treatment line on psoriatic arthritis risk in psoriasis: a population-based cohort study. RMD Open. 2026;12:e006687.
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