Comparative risk of psoriatic arthritis in psoriasis patients on immunomodulators

Summary: Abstract Body: Psoriatic arthritis (PsA) is a progressive arthritis that is difficult to prevent and treat. DMARDs are associated with a decreased risk of developing PsA in patients with psoriasis (PsO), but it is unknown if immunomodulators can decrease the risk of developing PsA. We aim to assess the comparative risk of PsA in PsO patients on immunomodulators approved for PsA. We identified patients with PsO using the TriNetX Research Network between January 1, 2012, and January 1, 2023. The greedy nearest neighbor matching algorithm was used to 1:1 propensity score match PsO patients by demographics and psoriatic arthritis risk factors to a comparator cohort. Index events were identified as a PsO diagnosis and use of only one immunomodulatory agent. We excluded patients who had an outcome of interest before the index event. Cox Proportional-Hazards Models with 95% confidence intervals were assessed to evaluate the three-year risk of PsA. PsO patients had a significantly increased three-year risk of PsA when treated with Adalimumab compared to Ixekizumab, Risankizumab, Guselkumab, Ustekinumab, and Upadacitinib. Infliximab had an increased risk compared to Ixekizumab, Risankizumab, Guselkumab, Abatacept, and Upadacitinib. Ixekizumab had an increased risk compared to Risankizumab and Ustekinumab, and a decreased risk compared to Certolizumab pegol. Secukinumab had an increased risk compared to Risankizumab, Guselkumab, Ustekinumab, Abatacept, Tofacitinib, and Upadacitinib. Golimumab had an increased risk compared to Risankizumab, Abatacept, and Upadacitinib. Certolizumab pegol had an increased risk compared to Risankizumab, Guselkumab, Ustekinumab, Abatacept, and Tofacitinib. Risankizumab had a decreased risk compared to Etanercept and Guselkumab. Etanercept had an increased risk compared to Guselkumab and Ustekinumab. Overall, Risankizumab, Guselkumab, Ustekinumab, and Abatacept have the greatest decreased risk of PsA compared to other immunomodulators. Madelyn Schmidt¹, Travis Dowdle², George Golovko², Ayezel Munoz² 1. The University of Texas Medical Branch John Sealy School of Medicine, Galveston, TX, United States. 2. The University of Texas Medical Branch at Galveston, Galveston, TX, United States. Clinical Research: Epidemiology and Observational Research