IL12/23 and 23 inhibitors best at preventing PsA

Psoriatic arthritis

By Selina Wellbelove

2 Jul 2024

An analysis of big data has revealed that use of IL12/23 and IL23 inhibitors in psoriasis patients was linked with a greater reduction in subsequent development of psoriatic arthritis (PsA) than treatment with TNFi or IL17i.

The retrospective study, presented at EULAR’s 2024 annual congress in Vienna, analysed the electronic records of more than one million people with psoriasis to compare the incidence of new-onset PsA between patients receiving a first or second-line biologic for the condition.

Incidence of PsA was assessed over a five-year period, using a population that received first-line TNFi as a comparator, with cohorts matched and findings adjusted to take into account various risk factors such as sex, nail psoriasis, obesity and alcohol or tobacco use.

Of 1,101,000 identified with psoriasis (869,000 without PsA), 23,610 started treatment with TNFi; 5,820 with an IL12/23 inhibitor; 5,270 with an IL17i and 5,640 with an IL23i.

After adjusting for different factors, the team compared a population of 5,080 people taking IL12/23i, 4,280 taking IL17i and 4,850 taking IL23i against the TNFi group.

This showed that the risk of developing PsA during first-line treatment was 37% lower with an IL12/23i compared to a TNFi (relative risk [RR] -4.5; HR 0.63) at five years, and 39% lower with IL23i (RR -6.8; HR 0.68).

For patients on second-line treatment, the risk was 32% lower with IL12/23i (RR -2.59; HR 0.68) and 31% lower with IL23i at three years (RR -3.37; HR 0.69) versus a first-line anti-TNF, the authors noted.

In both the first and second line setting IL23i was linked with a 47% lower probability of developing PsA than IL17i at three and five years, the results showed.

“This is the first study to analyse the incidence of PsA in matched, adjusted cohorts with a 5-year follow-up. According to these data, IL12/23i and IL23i reduce the incidence of PsA compared to TNFi and IL17i, both in naïve and bio-experienced patients,” the authors concluded.

View the study abstract here

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