Biologic Therapy Not Linked to Overall Reduction in Psoriatic Arthritis Risk
Biologic therapy was not associated with a significantly reduced overall risk of incident psoriatic arthritis (PsA) among patients with psoriasis, although subgroup findings suggested potential differences by data source and biologic class, according to a systematic review and meta-analysis.
The analysis included 18 studies evaluating conventional synthetic disease-modifying antirheumatic drugs, biologic disease-modifying antirheumatic drugs (bDMARDs), phototherapy, topical therapy, and no therapy. Investigators assessed PsA incidence among patients with psoriasis and calculated pooled relative risk (RR) and hazard ratio (HR) estimates using random effects models.
In the primary analysis, bDMARDs did not significantly reduce PsA risk compared with non-biologic therapies. The pooled RR was 0.71 (95% CI, 0.34-1.51), and the pooled HR was 0.71 (95% CI, 0.44-1.17).
Subgroup analyses, however, identified differences based on study type. A lower risk of incident PsA with bDMARDs was observed in clinical cohort studies (RR, 0.31; 95% CI, 0.11-0.87), but not in registry-based studies (RR, 1.03; 95% CI, 0.44-2.40). Sensitivity analyses excluding 1 influential study also found a lower observed risk of PsA among patients treated with bDMARDs.
Treatment class may also influence risk. Among studies reporting dichotomous outcomes, IL-17 inhibitors, IL-23 inhibitors, and IL-12/23 inhibitors were associated with lower PsA risk compared with tumor necrosis factor (TNF) inhibitors. IL-17 inhibitors also showed a numerically lower risk than IL-12/23 inhibitors. In studies reporting continuous outcomes, IL-23 inhibitor exposure was associated with lower PsA risk compared with IL-17 inhibitors or TNF inhibitors.
Although the authors concluded that “biologic [therapy] was not associated with a reduced overall risk of PsA in psoriasis,” subgroup analyses suggested “potential risk modification.”
Reference
Yang L, Gao X, Wang Z, Wu D. Biologic therapies and psoriatic arthritis risk in psoriasis: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol. Published online June 2, 2026. doi:10.1111/jdv.70540
