New onset or transition of disease state of psoriatic arthritis during treatment with ustekinumab: A single‐center retrospective study

Abstract

Ustekinumab (UST) is a treatment option for psoriatic arthritis (PsA), but recent observations indicate that some psoriatic patients may experience new onset of PsA or worsening of pre-existent PsA. We retrospectively analyzed all cases of psoriasis vulgaris (PsV) and PsA treated with UST in our facility between 2011 and 2015. PsA developed in eight out of 179 PsV patients, mostly later than 8 months after initiation of UST. It was generally not severe, and none had received tumor necrosis factor (TNF)-α inhibitors previously, indicating that the possibility of unmasking pre-existing subclinical arthritis is minimal. The eruptions were well controlled at the time of the onset of arthritis in most cases. Interestingly, those who developed arthritis showed a significantly lower body mass index. Regarding pre-existing PsA, nine PsA patients received UST, and at least partial improvement of PsA could be achieved in two out of three bio-naive and three out of six bio-switched patients from TNF-α inhibitors. PsA was largely more refractory to UST than the eruptions. Altogether, our present study is in agreement with the notion that UST may be less efficient than TNF-α inhibitors for PsA. While UST cannot fully prevent new development of PsA, it is unlikely that UST increases the risk of new onset of PsA as a paradoxical adverse reaction.

New-Onset Psoriatic Arthritis under Biologics in Psoriasis Patients: An Increasing Challenge?

“…Reviewing the literature, characteristics that may strongly predict the development of PsA were not found, since there are very variable data. For example, the female prevalence reported by Van Muijen et al [23] is supported also by our results but not by Napolitano et al The correlation with body mass index suggested by Asahina et al [24] and the correlation with PASI showed by Napolitano et al [22] were not confirmed in the other studies.…”

“…Indeed, different studies [22][23][24]34] and real-life experiences [35][36][37][38][39][40][41][42] showed the possibility of PsA onset in patients treated with biologics for psoriasis in 4.5-9.4% of cases [22,24]. The present study aims to evaluate the incidence of new-onset PsA in patients with plaque psoriasis on anti-TNFα (adalimumab, certolizumab, etanercept, infliximab), anti-IL12/23 (ustekinumab), anti-IL23 (risankizumab, tildrakizumab, guselkumab) or anti-IL17 (brodalumab, ixekizumab, secukinumab) therapy attending our Dermatology Unit and undergoing at least 1-year follow-up.…”

“…To our knowledge, studies [22][23][24] investigating PsA onset during psoriasis treatment with biologics are very limited (three existing studies).…”

“…A retrospective analysis involving patients treated with ustekinumab for psoriasis [24] reported that eight out of 179 patients (4.5%) developed a new-onset of PsA during the treatment. This study showed a male/female ratio of 3/1 with a mean PASI of 12.9 ± 5.1.…”

“…Indeed, they are all approved for PsA with brodalumab, risankizumab, and tildrakizumab awaiting FDA approval. However, several studies reported the possibility of new-onset of PsA during biologic therapies in psoriatic patients with two studies highlighting the concept of paradoxical PsA [22][23][24].…”