Cardiovascular safety of systemic psoriasis treatments: A prospective cohort study in the BIOBADADERM registry

Abstract

Background: Psoriasis is a chronic inflammatory disease with multiple comorbidities, including an increased risk of major adverse cardiovascular events (MACE). There is limited and contradictory evidence comparing the impact of systemic treatments for psoriasis on MACE.

Objectives: To evaluate the incidence of MACE associated with each systemic treatment used for patients with psoriasis and compare these rates to those observed with methotrexate (MTX).

Methods: We conducted a prospective cohort study using data from the BIOBADADERM registry. Propensity score matching was used to adjust for baseline differences between treatment groups. We calculated the incidence rate (IR) of MACE for each systemic treatment class, including biologics (anti-TNF, IL-12/23, IL-17 and IL-23 inhibitors), conventional systemic therapies (MTX, cyclosporine, dimethyl fumarate and acitretin) and apremilast (APR). The IR for each group was compared to those observed in patients treated with MTX using Poisson regression models adjusted for potential confounders, with 95% confidence intervals (95% CI). The primary outcome was the adjusted incidence rate ratios (IRR) for MACE between patients receiving MTX and those receiving another systemic treatment.

Results: We analysed data from 5622 patients, 11,368 treatment cycles and 21,762 person-years (PYs). APR (IRR = 0.17; 95% CI, 0.04-0.70) and IL-17 (IRR = 0.43; 95% CI, 0.20-0.91) were associated with a significant reduction in the risk of MACE compared to MTX. Cyclosporine was associated with an increased risk of MACE (IRR = 3.59; 95% CI, 1.17-10.99) compared to MTX. The remaining systemic psoriasis treatments were not significantly associated with an increased or decreased risk of MACE.

Conclusions: This real-world evidence study indicates a potential association between APR and IL-17 with a lower incidence of MACE, while CYC showed a higher incidence compared to MTX. These findings underscore the importance of considering cardiovascular outcomes when selecting systemic therapies for patients with psoriasis.