Article Text

other Versions

Download PDFPDF
Does biologic therapy impact the development of PsA among patients with psoriasis?
  1. Elana Meer1,
  2. Joseph F Merola2,3,
  3. Robert Fitzsimmons4,
  4. Thorvardur Jon Love5,
  5. Shiyu Wang4,
  6. Daniel Shin4,
  7. Yong Chen6,
  8. Sharon Xie6,
  9. Hyon Choi7,
  10. Yuqing Zhang7,
  11. Jose U Scher8,
  12. C T Ritchlin9,
  13. Joel M Gelfand4,6,
  14. Alexis Ogdie6,10
  1. 1University of Pennsylvania, Philadelphia, Pennsylvania, USA
  2. 2Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
  3. 3Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA
  4. 4Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  5. 5Faculty of Medicine, University of Iceland, Reykjavik, RVK, Iceland
  6. 6Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  7. 7Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
  8. 8Medicine/Rheumatology, New York University School of Medicine, New York, New York, USA
  9. 9Rheumatology, University of Rochester Medical Center, Rochester, New York, USA
  10. 10Division of Rheumatology and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Alexis Ogdie, Division of Rheumatology and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA 19104, USA; alexis.ogdie{at}


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
  • epidemiology
  • outcome assessment
  • health care
  • biological therapy

Data availability statement

Data may be obtained from a third party and are not publicly available.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data may be obtained from a third party and are not publicly available.

View Full Text


  • 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.

  • 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.

Linked Articles