Biological Agents More Effective Than Methotrexate in PsA Prevention

Biological agents were found more effective than methotrexate in preventing psoriatic arthritis (PsA) in patients with psoriasis, according to one study.¹

Woman with psoriasis | Andrey Popov - stock.adobe.com

These findings suggest that a personalized approach should be implemented to better optimize treatments and manage a patient’s care journey.

This retrospective cohort study is published in Rheumatology and Therapy.¹

“Our findings hold the potential to reshape the paradigms governing the management of psoriasis and PsA, potentially paving the way for innovative therapeutic approaches,” the researchers wrote.

While strategies for preventing PsA range from lifestyle modifications to pharmacological interventions, there is conflicting evidence on the role of biologics in the prevention of PsA. Therefore, the researchers aimed to investigate the use of biologic agents, methotrexate, phototherapy, and topical therapy for PsA prevention in patients with psoriasis.

A total of 58,671 patients from the Israeli Meuhedet Health Services Organization database were evaluated for incident PsA across different treatment regimens. All patients included in the study had an initial diagnosis of psoriasis between January 1, 2000, and December 31, 2020.

The researchers compared incident PsA with different treatment regimens by designating patients to either group 1, topical therapy; group 2, phototherapy; group 3, conventional disease-modifying antirheumatic drugs (cDMARDs; methotrexate); group 4, biologic DMARDs which was also stratified according to biologic class.

Methotrexate is a type of drug called an antimetabolite. It is known to decrease activity in the immune system, slow the growth of skin cells, as well as slow the growth of cancer cells.²

Other patient demographic variables included age, gender, ethnicity, and BMI. Additionally, the presence of other comorbidities such as diabetes, ischemic heart disease (IHD), stroke, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), and cancer was obtained.

Patients treated with a biologic agent had a lower incidence of PsA compared with patients in the methotrexate group (HR, 0.46; 95% CI, 0.35-0.62). Additionally, incidence rates per 100 person-years varied across biologic treatment groups, with the anti-interleukin-12/23 (anti-IL-12/23) or anti-IL-23p19 group at 4.57, the anti-IL-17 group at 4.35, and the tumor necrosis factor (TNF) inhibitor group at 2.55. However, no differences were identified between the biological agents in regards to preventing PsA.

Furthermore, patients who received phototherapy had a higher PsA development rate than patients who received topical therapy (HR, 1.85; 95% CI, 1.65-2.07).

In a multivariate logistic regression analysis of predictors for the incidence of PsA in patients with psoriasis treated with biologic agents, the researchers found that being exposed to at least 2 biological agents was associated with a significantly higher risk of PsA (OR, 6.09; 95% CI, 3.49-10.64; P < .001), as was prior methotrexate therapy (OR, 1.88; 95% CI, 1.07-3.27; P = .026).

However, the researchers acknowledged some limitations to the study, including its retrospective and observational design and its failure to consider other outcomes such as joint damage, functional impairment, and quality of life.

Despite these limitations, the researchers believe the study found evidence that biological agents are more effective than methotrexate in preventing PsA in patients with psoriasis.

“The optimal management strategy for preventing PsA in patients with psoriasis should be based on a personalized approach that takes into account the patient’s individual characteristics, preferences, and underlying pathogenesis of the disease,” the researchers wrote.

References

1. Watad A, Zabotti A, Patt YS, et al. From psoriasis to psoriatic arthritis: Decoding the impact of treatment modalities on the prevention of psoriatic arthritis. Rheumatol Ther. Published online June 7, 2024. doi:10.1007/s40744-024-00680-3

2. What is methotrexate, and how can it help me? Cleveland Clinic. Accessed June 10, 2024. https://my.clevelandclinic.org/health/drugs/20143-methotrexate