Impact of Biologics on Comorbidities in Patients with Psoriasis or Psoriatic Arthritis

Background/Objectives: Psoriasis and psoriatic arthritis are associated with various comorbidities, particularly cardiovascular conditions. Although biologics are increasingly used to manage moderate-to-severe disease, their effect on comorbidity risk remains unclear. This study aimed to assess the association between biologics and the risk of comorbid diseases compared to conventional systemic immunosuppressants. Methods: A retrospective cohort study was conducted using the Korean National Health Insurance Service database from 2002 to 2021. Patients with a principal diagnosis of psoriasis or psoriatic arthritis were included. Overall, 8173 biologics users (TNF-α, IL-12/23, IL-23, or IL-17 inhibitors) were compared to 41,598 patients treated exclusively with cyclosporine A or methotrexate. Adjusted hazard ratios (aHRs) for incident comorbid diseases were calculated using Cox proportional hazard models, with follow-up through 31 December 2021. Results: Biologics use was associated with a decreased risk of rheumatoid arthritis (aHR, 0.37; 95% CI, 0.17-0.79), mood disorders (aHR, 0.72; 95% CI, 0.53-0.97), and solid tumors (aHR, 0.63; 95% CI, 0.47-0.84). Subgroup analyses revealed that IL-23 inhibitors were linked to reduced risk of solid tumors (aHR, 0.31; 95% CI, 0.12-0.83), whereas IL-17 inhibitors were associated with increased risk of chronic obstructive pulmonary disease (aHR, 2.96; 95% CI, 1.08-8.14). No significant differences were found for major cardiovascular events. Conclusions: Biologics appear relatively safe with respect to cardiovascular disease and may reduce the risk of certain comorbidities such as mood disorders and solid tumors in patients with psoriasis or psoriatic arthritis. Clinicians should consider comorbidity profiles when selecting biologic agents for individual patients.