IL-23 Inhibitors Associated With Lowest Psoriatic Arthritis Incidence: Study

IL-23 Inhibitors Associated With Lowest Psoriatic Arthritis Incidence in Comparative Study

Patients with psoriasis treated with interleukin (IL)-23 inhibitors had a lower observed incidence of psoriatic arthritis (PsA) than those receiving Janus kinase (JAK) inhibitors or IL-17 inhibitors, according to a retrospective analysis published online October 20, 2026, in the Journal of Drugs in Dermatology.

Researchers from SUNY Downstate Health Sciences University conducted two retrospective, propensity score-matched cohort studies using a large federated research network. The analyses compared adults with psoriasis initiating JAK inhibitors against separate cohorts initiating IL-17 or IL-23 inhibitors. Patients with preexisting PsA were excluded.

Psoriatic Arthritis Risk Differed Across Treatment Classes

Investigators matched cohorts 1:1 for demographic characteristics, comorbidities, psoriasis subtype, baseline musculoskeletal symptoms, prior medication exposure, and healthcare utilization. The primary endpoint was incident PsA occurring between 1 day and 5 years after treatment initiation.

PsA incidence was 15.1% among IL-23 inhibitor recipients compared with 19.0% among JAK inhibitor recipients (risk ratio [RR], 1.25; 95% CI, 1.15 to 1.37; hazard ratio [HR], 1.32; 95% CI, 1.20 to 1.46; P < 0.0001).

IL-17 inhibitor recipients had a higher incidence of PsA than JAK inhibitor recipients (27.1% vs 16.8%; RR, 0.62; 95% CI, 0.58 to 0.67; HR, 0.66; 95% CI, 0.61 to 0.72; P < 0.0001). The authors noted the retrospective design limited causal interpretation.

"IL-23 inhibitors were associated with the lowest observed incidence of PsA," the authors concluded. "Although causal inference is limited, these findings may help inform therapeutic decision-making in psoriasis."

Source

Adler R, et al. Journal of Drugs Dermatology. 2026;25(11):9963. Published online October 20, 2026. Doi: