FC29 Risk of developing psoriatic arthritis in patients with psoriasis initiating treatment with different classes of biologics

Abstract It is debated whether this risk of psoriatic arthritis (PsA) is different according to the class of the biologic the patient with psoriasis (PsO) is receiving. To investigate the risk of PsA in patients receiving different classes of biologics. A retrospective observational study involving consecutive bio-naïve patients. The cumulative incidence rate of PsA using an event per person-years analysis was estimated in patients stratified according to the class of the biologic (TNF-a, IL-17 or IL-23 inhibitors). Cox proportional hazards models involving time-dependent explanatory variables were fitted to estimate the hazard risk (HR) of PsA. Six hundred and twenty-two patients, 388 (62.4%) males, mean age 46.9 years, were included. They have been treated with TNF-a (n = 317, 50.9%), IL-17 (n = 164, 26.4%) or IL-23 inhibitors (n = 141, 22.7%), and followed for 2820.2 person-year (a mean of 4.73 ± 2.12 years per person). Incidence rates of PsA were 2.60 [95% confidence interval (CI) 1.95–3.49], 1.58 (95% CI, 0.82–3.04) and 1.14 (95% CI, 0.51–2.54) cases per 100 patients/year in the TNF-a, IL-17 and IL-23 inhibitors groups, respectively. The variables associated with higher risk of incident PsA were baseline PASI score [adjusted hazard ratio, aHR 1.18 (95% CI 1.12–1.25) P < 0.001], family history of PsA [aHR 2.78 (95% CI 1.90–3.52), P = 0.005] and nail involvement [hazard ratio 1.85 (1.07–3.21) P = 0.029]. Treatment with IL-17 or IL-23 inhibitors was associated with a lower risk of PsA compared with TNF-a inhibitors [aHR 0.43 (95% CI 0.20–0.93) P = 0.031] and [aHR 0.58 (95% CI 0.24–0.75) P = 0.015], respectively. Treatment with IL-17 or IL-23 inhibitors is associated with lower risk of PsA.