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

OBJECTIVES: To evaluate whether the risk of progression from psoriasis to 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 TNF 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 analysed 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.