{
  "abstract": "Background Patients with psoriasis (PsO) are at increased risk of developing psoriatic arthritis (PsA). Emerging evidence suggests that biologic therapies may differentially influence the development of PsA; however, there are no data on the relative ability of second-line biological therapy to prevent PsA.Aim To evaluate the impact of biologic therapy on the risk of incident PsA in patients with PsO with a focus on second-line biologic therapy.Methods We identified 2819 patients who initiated biologic therapy for PsO between 2002 and 2022, including Tumor Necrosis Factor (TNF) inhibitors, interleukin (IL)-17 inhibitors, IL-23p19 inhibitors and IL-12/23 inhibitors. The primary outcome was incident PsA. Kaplan-Meier survival analysis and Cox proportional hazards models were used to evaluate arthritis-free survival and HRs for the development of PsA. Risk was assessed separately for first-line and second-line biologic therapy.Results Among 2819 patients with PsO initiating first-line biologic therapy, 400 (14.2%) developed PsA. In multivariable Cox regression, first-line anti-IL-23p19 agents were significantly associated with a lower risk of developing PsA compared with TNF inhibitors (HR 0.13; 95% CI 0.02 to 0.96; p=0.045). Among 1246 patients receiving second-line biologics, 125 (10.0%) developed PsA. Notably, in second-line therapy, only IL-17 inhibitors were independently associated with a statistically significant reduction in PsA risk versus TNF inhibitors (HR 0.37; 95% CI 0.16 to 0.85; p=0.019), with trends observed for anti-IL-12/23 (HR 0.14; 95% CI 0.02 to 1.05; p=0.056) and anti-IL-23p19 (HR 0.46; 95% CI 0.20 to 1.07; p=0.070).Conclusions This is the first study to evaluate second-line biological therapy in relation to PsA risk. IL-17 inhibitor therapy was significantly associated with a reduced risk of incident PsA compared with TNF inhibitors.",
  "authors": [
    {
      "affiliations": [
        "Department of Internal Medicine B & Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel",
        "Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel-Aviv, Israel",
        "Section of Musculoskeletal Disease, NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK",
        "Rheumatology Unit, Sheba Medical Center, Tel Aviv, Israel"
      ],
      "name": "Abdulla Watad"
    },
    {
      "affiliations": [
        "Department of Internal Medicine B & Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel",
        "Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel-Aviv, Israel"
      ],
      "name": "Yoav Elizur"
    },
    {
      "affiliations": [
        "Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel-Aviv, Israel",
        "Department of Internal Medicine C, Sheba Medical Center, Tel Aviv, Israel"
      ],
      "name": "Or Hen"
    },
    {
      "affiliations": [
        "Department of Internal Medicine B & Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel",
        "Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel-Aviv, Israel",
        "Section of Musculoskeletal Disease, NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK",
        "Rheumatology Unit, Sheba Medical Center, Tel Aviv, Israel"
      ],
      "name": "Paula David"
    },
    {
      "affiliations": [
        "Department of Internal Medicine B & Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel",
        "Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel-Aviv, Israel"
      ],
      "name": "Yonatan Shneor Patt"
    },
    {
      "affiliations": [
        "Department of Internal Medicine B & Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel",
        "Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel-Aviv, Israel"
      ],
      "name": "Omer Gendelman"
    },
    {
      "affiliations": [
        "Clalit Health Services, Tel Aviv, Israel"
      ],
      "name": "Amit Nachman"
    },
    {
      "affiliations": [
        "Division of Rheumatology, Azienda Sanitaria Universitaria del Friuli Centrale, Santa Maria della Misericordia Hospital, Udine, Italy"
      ],
      "name": "Alen Zabotti"
    },
    {
      "affiliations": [
        "Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel-Aviv, Israel",
        "Rheumatology Unit, Sheba Medical Center, Tel Aviv, Israel"
      ],
      "name": "Merav Lidar"
    },
    {
      "affiliations": [
        "Section of Musculoskeletal Disease, NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK"
      ],
      "name": "Dennis McGonagle"
    },
    {
      "affiliations": [
        "Department of Internal Medicine B & Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel",
        "Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel-Aviv, Israel"
      ],
      "name": "Howard Amital"
    }
  ],
  "title": "Impact of biologic class and treatment line on psoriatic arthritis risk in psoriasis: a population-based cohort study",
  "uid": "afcffdd7-ae49-526c-8bb4-e1263a040759"
}