Biologic DMARD class influences progression from psoriasis to PsA: A real-world cohort study

Why clinicians should know about it

• Picked for Rheumatology (paper of the day, 15 August 2026): Real‑world cohort: bDMARD class and psoriasis‑to‑PsA progression

Abstract

OBJECTIVES: To evaluate whether the risk of progression from psoriasis to psoriatic arthritis (PsA) is affected by the class of bDMARD used for treatment of psoriasis, in a real-world cohort with a large follow-up. METHODS: We conducted a retrospective study in two university dermatology-rheumatology centers. Consecutive adults with psoriasis receiving bDMARDs for ≥6 months between 2008 and 2025 were included. Patients were followed until PsA diagnosis, last visit, or study end. The primary outcome was incidence of PsA. RESULTS: Among 393 patients, 86 (22%) developed PsA during follow-up. In the single-class bDMARD exposure analysis (n = 257), PsA occurred more frequently in patients treated with tumour necrosis factor inhibitors (TNFi) than in those receiving IL-17, IL-23, or IL-12/23 inhibitors. After adjustments, all non-TNFi bDMARDs were associated with significantly lower odds (OR range 0.16-0.25) and hazards (HR range 0.17-0.30) of PsA compared with TNFi. Similar findings were observed when patients were grouped according to the bDMARD class used for the longest duration. In patients analyzed by first bDMARD received (n = 137), PsA prevalence and adjusted hazards did not differ between bDMARD classes. CONCLUSION: In this long-term real-life cohort of patients with psoriasis, treatment with non-TNFi bDMARDs-particularly IL-17 and IL-23 inhibitors-was associated with lower risk of incident PsA compared with TNFi. These findings support PsA interception and warrant prospective studies to determine whether biologic class selection can modify disease progression.

Abstract as published, via PubMed.