Does biologic therapy impact the development of PsA among patients with psoriasis?

Abstract

ObjectiveTo examine the association of biologic therapy use for psoriasis with incident psoriatic arthritis (PsA) diagnosis.MethodsA retrospective cohort study was conducted in the OptumInsights Electronic Health Record Database between 2006 and 2017 among patients with psoriasis between the ages of 16 and 90 initiating a therapy for psoriasis (oral, biologic or phototherapy). The incidence of PsA was calculated within each therapy group. Multivariable Cox models were used to calculate the HR for biologic versus oral or phototherapy using biologics as a time-varying exposure and next in a propensity score-matched cohort.ResultsAmong 1 93 709 patients with psoriasis without PsA, 14 569 biologic and 20 321 cumulative oral therapy and phototherapy initiations were identified. Mean age was lower among biologic initiators compared with oral/phototherapy initiators (45.9 vs 49.8). The incidence of PsA regardless of therapy exposure was 9.75 per 1000 person-years compared with 77.26 among biologic users, 61.99 among oral therapy users, 26.11 among phototherapy users and 5.85 among those without a prescription for one of the target therapies. Using a multivariable adjustment approach with time-varying exposure, adjusted HR (95% CI) for biologic users was 4.48 (4.23 to 4.75) compared with oral or phototherapy users. After propensity score matching, the HR (95% CI) was 2.14 (2.00 to 2.28).ConclusionsIn this retrospective cohort study, biologic use was associated with the development of PsA among patients with psoriasis. This may be related to confounding by indication and protopathic bias. Prospective studies are needed to address this important question.

Psoriatic arthritis: prospects for the future

“…The authors demonstrated that biologic use was associated with the development of PsA among patients with psoriasis although acknowledged this may have been related to confounding by indication and protopathic bias. 63 It is therefore clear that further studies, in particular those that are prospective in nature, are required to further elucidate the relationship between risk and PsA development.…”

Reducing the Risk of Developing Psoriatic Arthritis in Patients with Psoriasis

“… 58 This may be related to confounding by indication and protopathic bias, ie, when a pharmaceutical agent is inadvertently prescribed for an early manifestation of a disease that has not yet been diagnostically detected. 58 Indeed, studying the influence of systemic treatment in the transition from psoriasis to PsA is undermined by several issues. Patients need to be followed up longitudinally for a long period because arthritis develops on average of several years after initial diagnosis of psoriasis.…”

“…Confounding by indication (ie, the reason for receiving a treatment, such as severe psoriasis, is also associated with the outcome of interest, such as PsA) and protopathic bias (ie, when a pharmaceutical agent is inadvertently prescribed for an early manifestation of a disease that has not yet been diagnostically detected) may distort the association between therapy and the development of the arthritis. 58 Assessing whether treating the skin disease with biologics may prevent development of arthritis, or instead treat early or mild forms of PsA that it is less clinically apparent is problematic. Predictive algorithms that use machine learning and related approaches may contribute to analyze relevant factors that settle disease from background events in the future.…”

“…57 Conversely, Meer et al in a retrospective cohort study of 193,709 patients with psoriasis without PsA found that, contrary to the study hypothesis, biologic use was associated with the development of PsA among patients with psoriasis. 58 This may be related to confounding by indication and protopathic bias, ie, when a pharmaceutical agent is inadvertently prescribed for an early manifestation of a disease that has not yet been diagnostically detected. 58 Indeed, studying the influence of systemic treatment in the transition from psoriasis to PsA is undermined by several issues.…”

Greetings from the editor 2022

“…In 2022 ARD will continue its path, striving to present breakthrough research activities across basic/translational and clinical/ outcomes sciences, already exemplified in this January issue, in which we learn about several studies on the potential prevention of the evolution of psoriatic arthritis in patients with psoriasis undergoing effective treatment, [28][29][30] accompanied by an editorial that summarises these findings and puts them into perspective. 31 But this edition harbours yet another publication, which for the first time appears simultaneously in all five EULAR and ACR journals, accompanied by a commentary from all five editors, making authors aware that all these journals will require adherence to ACR, EULAR and joint recommendations and criteria more strongly in future papers than done before.…”