A new study should help alleviate concerns about the cardiovascular safety profile of biologic therapies used for psoriasis. 

An article in the Journal of the European Academy of Dermatology and Venereology reported results of a comparison of the risk of major cardiovascular events, including acute coronary syndrome, unstable angina, myocardial infarction and stroke, in a large prospective cohort of patients with chronic plaque psoriasis. Participants with chronic plaque psoriasis were treated with adalimumab, etanercept or ustekinumab.

Psoriasis tablet. Source: Getty

Researchers from the University of Manchester examined the comparative risk of major CVEs using the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR). In the main analysis, the study team compared adults with chronic plaque psoriasis receiving ustekinumab with tumor necrosis-α inhibitors (TNFi: etanercept and adalimumab). Secondary analyses compared ustekinumab, etanercept, or methotrexate against adalimumab. 

Overall, the study included 5,468 biologic-naïve patients subsequently exposed to treatment. Of those, 951 were on ustekinumab; 1,313 on etanercept; and 3,204 adalimumab in the main analysis. The secondary analyses also included 2,189 patients receiving methotrexate. 

Median follow up times ranged from 1 to 3 years.

Results indicated that 7 patients treated with ustekinumab experience major CVEs compared with 29 in the TNFi group, 23 in the adalimumab group, 6 in the etanercept group and 9 in the methotrexate group.

In addition, the research identified no differences in the risk of major CVEs among biologic therapies (adjusted HR for ustekinumab vs TNFi: 0.96 [95%CI, 0.41 - 2.22]; ustekinumab vs adalimumab: 0.81 [0.30 - 2.17]; etanercept vs adalimumab: 0.81 [0.28 - 2.30]) and methotrexate against adalimumab (1.05 [0.34 - 3.28]).

“In this large prospective cohort study, we found no significant differences in the risk of major CVEs between three different biologic therapies and methotrexate,” study authors concluded. “Additional studies, with longer term follow-up, are needed to investigate the potential effects of biologic therapies on incidence of major CVEs.”

This summer, JAMA Cardiology published an article noting that psoriasis is associated with increased coronary plaque burden and cardiovascular events. U.S. National Institutes of Health-led authors pointed out that biologic therapy for psoriasis has been found to be favorably associated with luminal coronary plaque, although it has not been known whether these associations are attributable to direct anti-inflammatory effects on the coronary arteries.

Study authors concluded that biologic therapy for moderate to severe psoriasis was associated with reduced coronary inflammation assessed by perivascular fat attenuation index. This finding suggests that perivascular FAI might be used to track response to interventions for coronary artery disease.