Cardiovascular Risks Associated with Biologic Therapies to Treat Psoriasis

A new study evaluated the risk of major cardiovascular events—including acute coronary syndrome, unstable angina, myocardial infarction, and stroke—among chronic plaque psoriasis patients treated with three different biologic therapies.

This prospective cohort study, the findings of which appeared in the Journal of the European Academy of Dermatology and Venereology, compared cardiovascular outcomes among patients treated with adalimumab, etanercept, or ustekinumab. Data were gathered from the British Association of Dermatologists Biologics and Immunomodulators Register. The primary analysis was a comparison between chronic plaque psoriasis patients treated with ustekinumab versus tumor necrosis-a inhibitors (TNFi: etanercept and adalimumab); the secondary analyses assessed ustekinumab, etanercept, or methotrexate versus adalimumab.

The primary analysis included 5,468 previously biologic-naïve patients: 951 were exposed to ustekinumab, 1,313 to etanercept, and 3,204 to adalimumab. The secondary analysis included an additional 2,189 methotrexate patients. The median (p25 to p750) follow-up times were 2.01 (1.16 to 3.21) years for ustekinumab, 1.93 (1.05 to 3.34) years for TNFi, 1.94 (1.09 to 3.32) years for adalimumab, 1.92 (0.93 to 3.45) years for etanercept, and 1.43 (0.84 to 2.53) years for methotrexate. Major cardiovascular events occurred in seven ustekinumab patients, 29 TNFi patients, 23 adalimumab patients, six etanercept patients, and nine methotrexate patients. The risk of major cardiovascular events did not differ regardless of biologic therapy (adjusted HRs for ustekinumab versus TNFi, 0.96, 0.41 to 2.22; ustekinumab versus adalimumab, 0.81 [0.30 to 2.17]; etanercept versus adalimumab, 0.81 [0.28 to 2.30]; and methotrexate versus adalimumab 1.05 [0.34 to 3.28]; 95% CI for all).

“In this large prospective cohort study, we found no significant differences in the risk of major [cardiovascular events] between three different biologic therapies and methotrexate,” the researchers wrote. “Additional studies, with longer term follow‐up, are needed to investigate the potential effects of biologic therapies on incidence of major [cardiovascular events].”