A large international study found that patients with psoriasis receiving biologic therapies may have had a lower risk of developing cardiovascular disease compared with those receiving oral anti-psoriatic medications.
Investigators included data from over 25,000 patients with psoriasis across multiple health care systems worldwide, using records spanning 2014-2025.
In the analysis, the investigators reviewed records from the TriNetX Global Collaborative Network, containing data on more than 156 million individuals from 142 health care organizations in 18 countries. They identified 12,732 patients prescribed biologic therapies and matched them to 12,732 patients receiving oral anti-psoriatic treatments. Patients qualified if they had at least two psoriasis diagnoses 30 days apart and no prior history of cardiovascular disease.
During a 5-year follow-up, the cumulative incidence of cardiovascular disease was 10.68% in the biologics group vs 16.17% in the oral therapy group, representing a 38% relative risk reduction.
Biologic therapies targeted tumor necrosis factor (TNF)-alpha, interleukin (IL)-17, IL-23, and IL-12/23. Oral anti-psoriatic therapies included methotrexate, cyclosporin, acitretin, and apremilast.
Patients on biologics showed lower risk across a range of cardiovascular conditions, including cerebrovascular diseases (stroke and transient ischemic attacks), arrhythmias (atrial fibrillation and ventricular arrhythmias), inflammatory heart diseases (myocarditis and pericarditis), ischemic heart diseases (myocardial infarction and angina), heart failure, nonischemic cardiomyopathy, thrombotic disorders (pulmonary embolism and deep vein thrombosis), peripheral arterial occlusive disease, and major adverse cardiac events.
Hazard ratios (HR) consistently favored biologic therapy. For any cardiovascular disease, the HR was 0.621, indicating a 37.9% risk reduction. The HR was 0.579 for ischemic heart disease and 0.616 for cerebrovascular disease.
The reduced cardiovascular risk remained consistent across subgroups, including variations in age; sex; geographic region; and comorbidities such as psoriatic arthritis, hypertension, diabetes, hyperlipidemia, and obesity. Among patients over 45 years, the HR was 0.699. Among those with diabetes, it was 0.716.
Analysis by biologic class showed differing levels of cardiovascular risk reduction. TNF-alpha inhibitors were associated with an 11.4% lower risk. IL-17 inhibitors showed a 27.6% lower risk, whereas IL-23 inhibitors were linked to a 26.1% lower risk. No statistically significant reduction was observed for IL-12/23 inhibitors.
Multiple sensitivity analyses supported these findings. Adjustments accounted for prior use of oral medications, treatment adherence, and concurrent cardiovascular drug use. Across all models, biologic therapies remained associated with reduced cardiovascular risk.
Although the study demonstrated an association between biologic therapies and lower cardiovascular risk in psoriasis patients, the investigators noted that its observational design does not allow for conclusions about causality.
The authors have declared that no competing interests exist.
Source: PLOS Medicine
