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Background: Biological treatments are very effective in the control of psoriasis but there are no conclusive data regarding the prevention of psoriatic arthritis (PsA). Objectives: To compare the incidence of PsA between patients receiving first- or second-line biological treatment for psoriasis. Methods: Retrospective study based on electronic history data included in Trinetx, a global network of electronic records of 199,875,420 patients. Patients with psoriasis without PsA who had started first-line biological treatment with TNF inhibitor (iTNF), iIL12-23, iIL17 and iIL23. The incidence of APs was compared in the different cohorts at 5 years (relative risk, RR) and throughout the follow-up in those 5 years (Hazard ratio, HR) using the 1st line iTNF population as a comparator. To perform the analysis, the cohorts were matched by propensity score matching and adjusted for different known risk factors for PsA (time since the onset of psoriasis, sex, nail psoriasis, obesity, alcohol or tobacco abuse, previous conventional treatments). Results: 1,101,000 were identified with psoriasis, without PsA (869,000), who started iTNF (23,610), iIL12-23 (5,820), iIL17 (5,270) and iIL23 (5,640). After adjusting for the different factors, we can compare a population of 5080 iIL12-23, 4280 iIL17 and 4850 iIL23 patients with respect to iTNF, of which 320, 390 and 200 developed PsA respectively. The risk of developing PsA in 1st line was 37% lower with iIL12-23 RR -4.5 (6.29-10.82) HR 0.631 (0.550-0.725) and 39% lower with iIL-23 RR -6.8 (4.12-10.92); HR 0.6804 (0.511, 0.714) at 5 years. In the 2nd line, the risk was 32% lower with iIL-12/23 RR -2.59 (6.46-9.05) HR 0.680 (0.550-0.841) and 31% lower with iIL23 at 3 years RR -3.37 (5.61-8.98) HR 0.690 (0.472-1.002) versus an anti-TNF in the 1st line. iIL-23, both in 1st HR 0.524 (0.437; 0.628) and 2nd line HR 0.529 (0.367; 0.761), present a 47% lower probability of developing PsA than antiIL-17 at 5 and 3 years Conclusion: Big data analysis offers an opportunity to obtain information on the efficiency of drugs in real life. This is the first study to analyze the incidence of PsA in matched, adjusted cohorts with a 5-year follow-up. According to these data, iIL12-23 and iIL23 reduce the incidence of PsA compared to iTNF and iIL17, both in naïve and bio-experienced patients. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: Beatriz Joven-Ibáñez Abbvie, Novartis, Lilly, Abbvie, Janssen, UCB, Amgen, UCB, Janssen, Abbvie, BMS, Janssen, Raquel Rivera Abbvie, Almirall, Amgen, Boehringer, BMS, Janssen, Lilly, Novartis, Leo Pharma, UCB, Abbvie, Amgen, Boehringer, BMS, DICE, Janssen, Lilly, Novartis, Pfizer, UCB, Gema Hernandez: None declared, Carmen García-Donoso: None declared, José Luis Pablos Álvarez: None declared.
Joven-Ibáñez et al. (Sat,) studied this question.