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Journal Article Comparative Study Ppublish 13 citations

PubMed: 39875705 DOI: 10.1007/s40259-025-00705-5

Interleukin-23 versus Interleukin-17 Inhibitors in Preventing Incidental Psoriatic Arthritis in Patients with Psoriasis: A Real-World Comparison From the TriNetX US Collaborative Network.

BioDrugs 39(2):297-306

Authors: Sebastian Yu, An-Ping Huo, Yu-Hsun Wang, James Cheng-Chung Wei

Affiliations

  • Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
  • Department of Dermatology, Kaohsiung Medical University Gangshan Hospital, Kaohsiung, Taiwan.
  • Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
  • Master of Public Health Program, College of Public Health, National Taiwan University, Taipei, Taiwan.
  • Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
  • Department of Allergy, Immunology and Rheumatology, South District, Chung Shan Medical University Hospital, No. 110, Sec. 1, Jianguo N. Rd, Taichung City, 40201, Taiwan.
  • School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
  • Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan.
  • Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
  • Department of Allergy, Immunology and Rheumatology, South District, Chung Shan Medical University Hospital, No. 110, Sec. 1, Jianguo N. Rd, Taichung City, 40201, Taiwan.
  • Department of Nursing, Chung Shan Medical University, Taichung, Taiwan.
  • Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.
  • Office of Research and Development, Asia University, Taichung, Taiwan.
  • Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.

Abstract

BACKGROUND

Psoriatic arthritis (PsA) is a common comorbidity in patients with psoriasis (PsO) that leads to significant disease burden. Biologic therapies targeting the interleukin (IL)-23/IL-17 axis have been widely used for PsO, but their comparative effectiveness in preventing PsA remains unclear.

OBJECTIVE

The study objective was to compare the occurrence of developing incidental PsA among PsO patients treated with interleukin-23 inhibitors (IL23is) or interleukin-17 inhibitors (IL17is).

METHODS

A retrospective cohort study was conducted using real-world data from the TriNetX US Collaborative Network, including 53 healthcare organizations. Adult PsO patients treated with IL23is or IL17is between January 2019 and June 2022 were identified. Cox regression analysis was used to assess the risk of PsA incidence, with hazard ratios (HRs) and 95% confidence intervals (CIs) reported. Subgroup analyses were performed based on age, sex, and ethnicity. Sensitivity analyses included comparisons with tumor necrosis factor (TNF) inhibitors (TNFis) to ensure robustness.

RESULTS

A total of 4,580 PsO patients were included in the study, with 2,273 receiving IL23is and 2,307 receiving IL17is. Treatment with IL23is was associated with a significantly lower incidence of PsA compared to IL17is (HR = 0.60, 95% CI 0.44-0.82, P = 0.001). This reduction in risk was particularly notable in the 41- to 65-year age group (HR = 0.42, 95% CI 0.27-0.64, P < 0.001) and among females (HR = 0.57, 95% CI 0.38-0.86, P = 0.007). Subgroup analyses based on ethnicity revealed varying outcomes, with White patients showing a significant risk reduction (HR = 0.55, 95% CI 0.38-0.79, P = 0.001) but no significant risk reduction was observed in Black or African American patients (HR = 1.37, 95% CI 0.37-5.13, P = 0.637). Sensitivity analyses comparing IL23is and TNFis confirmed the robustness of the findings.

CONCLUSION

IL23is are associated with a lower risk of PsA incidence compared to IL17is in PsO patients, particularly in specific age, sex, and ethnic groups. These findings suggest that IL23is may be more suitable for PsO patients at high risk of PsA and could inform potential updates to treatment guidelines. Further research should focus on refining therapeutic strategies by incorporating patient-specific factors such as comorbidities, ethnicity, and genetic predispositions, which could optimize biologic selection and enhance PsA prevention efforts in clinical practice.

MeSH

Interleukin-23, Arthritis, Psoriatic, Comorbidity, Incidence, Arthritis, Sex, Therapeutics, Psoriasis, Interleukin-17