Objective To examine the association of biologic therapy use for psoriasis with incident psoriatic arthritis (PsA) diagnosis.
Methods A 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.
Results Among 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).
Conclusions In 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
- outcome assessment
- health care
- biological therapy
Data availability statement
Data may be obtained from a third party and are not publicly available.
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Handling editor Josef S Smolen
EM and JFM contributed equally.
Contributors Study concept and planning: JFM, TJL, HC, JUS, CTR, JMG, AO. Analysis: RF, DS, YC, SX, AO. Interpretation: all. Wrote first draft: EM. Revised draft and edited: all.
Funding AO and RF received funding from National Psoriasis Foundation.
Competing interests No commercial entities provided support for the work in the submitted manuscript. Dr. Gelfand served as a consultant for Abcentra, Abbvie, BMS, Boehringer Ingelheim, Cara (DSMB), GSK, Lilly (DMC), Janssen Biologics, Novartis Corp, UCB (DSMB and Mindera Dx, receiving honoraria; and receives research grants (to the Trustees of the University of Pennsylvania) from Abbvie, Boehringer Ingelheim, Janssen, Novartis Corp, Celgene, Ortho Dermatologics, and Pfizer Inc; Dr Gelfand is a Deputy Editor for the Journal of Investigative Dermatology receiving honoraria from the Society for Investigative Dermatology, is Chief Medical Editor for Healio Psoriatic Disease (receiving honoraria) and is a member of the Board of Directors for the International Psoriasis Council, receiving no honoraria. Thorvardur Love has received reimbursement from Celgene for speaking about guidelines for the treatment of psoriatic arthritis. Alexis Ogdie has served as a consultant for Abbvie, Amgen, BMS, Celgene, Corrona, Global Health Living Foundation, Janssen, Lilly, Novartis, Pfizer, and Takeda and has received grants to the University of Pennsylvania from Pfizer and Novartis and to Forward from Amgen. Her husband has received royalties from Novartis. The remaining authors have no COI to report.
Provenance and peer review Not commissioned; externally peer reviewed.
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