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Biological disease-modifying antirheumatic drugs may mitigate the risk of psoriatic arthritis in patients with chronic plaque psoriasis
  1. Paolo Gisondi1,
  2. Francesco Bellinato1,
  3. Giovanni Targher2,
  4. Luca Idolazzi3,
  5. Giampiero Girolomoni1
  1. 1Department of Medicine, Section of Dermatology and Venereology, Università degli Studi di Verona, Verona, Italy
  2. 2Section of Endocrinology, Diabetes and Metabolism, Università degli Studi di Verona, Verona, Italy
  3. 3Section of Rheumatology, Università degli Studi di Verona, Verona, Italy
  1. Correspondence to Professor Paolo Gisondi, Department of Medicine, Section of Dermatology and Venereology, Università degli Studi di Verona, Verona, Italy; paolo.gisondi{at}univr.it

Abstract

Objective To estimate the incidence of psoriatic arthritis (PsA) in patients with psoriasis who had received a continuous treatment with biological disease-modifying antirheumatic drugs (bDMARDs) compared with phototherapy.

Methods A retrospective non-randomised study involving patients with moderate-to-severe plaque psoriasis, who were prescribed at least 5 years of bDMARDs or at least three narrow-band ultraviolet light B (nb-UVB) phototherapy courses, and did not have a diagnosis of PsA at enrolment. Development of PsA in each patient was assessed by a rheumatologist according to the Classification for Psoriatic Arthritis criteria. The annual and cumulative incidence rate of PsA was estimated by using an event per person-years analysis. Cox proportional hazards models were undertaken to assess the hazard risk (HR) of PsA after adjustment for confounders.

Results A total of 464 psoriatic patients (bDMARDs, n=234 and nb-UVB, n=230) were followed between January 2012 and September 2020 (corresponding to 1584 and 1478 person year of follow-up for the two groups, respectively). The annual incidence rate of PsA was 1.20 cases (95% CI 0.77 to 1.89) versus 2.17 cases (95% CI 1.53 to 3.06) per 100 patients/year in the bDMARDs versus phototherapy group, respectively (HR 0.29, 0.12–0.70; p=0.006). The variables independently associated with higher risk of PsA were older age (adjusted HR 1.04, 1.02–1.07), nail psoriasis (adjusted HR 3.15, 1.63–6.06) and psoriasis duration >10 years (adjusted HR 2.02, 1.09–3.76); notably, bDMARDs treatment was associated with a lower risk of incident PsA (adjusted HR 0.27, 0.11–0.66).

Conclusions bDMARDs treatment may delay or reduce the risk of incident PsA in patients with moderate-to-severe chronic plaque psoriasis.

  • arthritis
  • psoriatic
  • biological therapy
  • tumor necrosis factor inhibitors
  • arthritis

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. These are deidentified participant dataAll the data are available at paolo.gisondi@univr.it. There is no embrago for the data.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. These are deidentified participant dataAll the data are available at paolo.gisondi@univr.it. There is no embrago for the data.

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Footnotes

  • Handling editor Josef S Smolen

  • Contributors FB performed all statistical analyses, contributed to writing the manuscript and visited the patients of the study population. PG designed the study, contributed to writing the manuscript and visited the patients of the study population. GT contributed to perform statistical analyses, and writing the manuscript. LI visited the patients of the study population and revised the manuscript. GG visited the patients of the study population and revised the final version of the manuscript.

  • Funding This work was supported by the European Union’s Horizon 2020 Research andInnovation Program (Grant agreement n. 848028).

  • Competing interests PG has been a consultant and/or speaker for Abbvie, Almirall, Amgen, Janssen, Leo-pharma, Eli Lilly, Novartis, Pierre Fabre, Sandoz, Sanofi, and UCB. LI served as consultant and/or speaker for AbbVie, Amgen, Biogen, Merck Sharp & Dohme, Eli-Lilly, Novartis, Celgene, Sandoz. GG served as consultant and/or speaker for AbbVie, Abiogen, Almirall, Amgen, Biogen, Boehringer-Ingelheim, Bristol-Meyers Squibb, Celltrion, Eli-Lilly, Genzyme, Leo Pharma, Novartis, OM Pharma, Pfizer, Regeneron, Samsung Sanofi and UCB.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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