Biologic Psoriasis Treatments May Have Lower Cardiovascular Disease Risk than Oral

A recent retrospective cohort study indicated that patients with psoriasis who had been prescribed biologics displayed a lower cardiovascular disease (CVD) risk compared to those prescribed oral therapies.1

Psoriasis is a well-known contributor to CVD risk. Previous studies have indicated that diagnosed patients who were not prescribed disease modifying anti-rheumatic drugs had a substantially higher risk of CVD.2

“This study aimed to assess the association between biologics and CVD risk in patients with [psoriasis] compared to oral anti-psoriatic drugs,” wrote Teng-Li Lin, MD, department of dermatology, Dalin Tzu Chi Hospital, and colleagues. “We hypothesized that biologic treatments would be associated with a lower risk of CVDs in patients with [psoriasis] compared to those on oral therapy.”1

Investigators collected data from the Global Collaborative Network within the TriNetX database, specifically analyzing records from 2014-2025. Patients ≥18 years with two separate psoriasis diagnoses at least 30 days apart from one another were eligible.1

Exclusion criteria included individuals without psoriatic conditions (such as rheumatoid arthritis, ankylosing spondylitis, juvenile idiopathic arthritis, inflammatory bowel diseases, and so on) and patients with CVDs before index date after exclusions. 12,732 were selected as members of the biologics cohort and 12,732 for the oral cohort.1

The biologics cohort was comprised of patients who had received either anti-tumor necrosis factor (TNF)-α (infliximab, adalimumab, etanercept, golimumab, and certolizumab), anti-interleukin (IL)-12/23 (ustekinumab), anti-IL-17 (secukinumab, ixekizumab, and brodalimumab), or anti-IL-23 (guselkumab, risankizumab, and tildrakizumab) for a minimum of 3 times following diagnosis. The oral cohort had received either methotrexate, cyclosporin, acitretin, and apremilast, for at least 3 times post diagnosis, but never biologic treatments.1

The study’s primary outcome was first incident of any CVDs within the TriNetX network, which was defined as the composite of a variety of cardiovascular complications, including cerebrovascular disease, arrhythmias, inflammatory heart diseases, ischemic heart diseases, heart failure, non-ischemic cardiomyopathy, thrombotic disorders, peripheral arterial occlusive disease, and cardiac arrest or cardiogenic shock.1

Lin and colleagues found that 950 patients in the biologics cohort and 1281 in the oral cohort developed CVDs over the course of observation (P <.001). The former saw a significantly lower 5-year CVD incidence (10.68%; 95% CI, 10.03%-11.36%, P <.001) compared to the latter (16.17%; 95% CI, 15.34%-17.05%, P <.001). The biologics cohort also saw fewer occurrences of nearly every CVD category, with 12 out of 14 showing fewer events.1

After Cox regression, investigators pointed out that the biologics cohort had substantially attenuated risks of CVDs (hazard ratio [HR], .621; 95% CI, .571-.676), arrhythmias (HR, .632; 95% CI, .565-.706), inflammatory heart diseases (HR, .566; 95% CI, .360-.891), ischemic heart diseases (HR, .579; 95% CI, .465-.721), heart failure (HR, .637; 95% CI, .521-.780), non-ischemic cardiomyopathy (HR, .654; 95% CI, .466-.918), thrombotic disorders (HR, .570; 95% CI, .444-.733), peripheral arterial occlusive diseases (HR, .501; 95% CI, .383-.656), and major adverse cardiac events (HR, .697; 95% CI, .614-.792).1

The team also indicated that receiving only anti-TNF-α (HR, .886; 95% CI, .807-.973), anti-IL-17 (HR, .724; 95% CI, .599-.875), or anti-IL-23 (HR, .739; 95% CI, .598-.914) was associated with reduced risks of any CVDs. No significant association was noticed for only anti-IL-12/23 (HR, .915; 95% CI, .742-1.128). These reductions remained consistent across all subgroups.1

Despite these results, investigators caution that, as the study conducted was only observational, no direct causality could be established. Additionally, the study’s format only allows for investigation of the results of using biologic treatments in general; specific details like dosage levels or duration could not be obtained during this study.

“[The] findings should be interpreted cautiously, as the primary results reflect the overall association of any biologics ever used with subsequent cardiovascular risk, and the study does not compare the relative association of different biologic classes with this risk,” Lin and colleagues wrote. “Further research is needed to evaluate the impact of dosage, duration, and treatment sequencing across biologic therapies.”1

References

1. Lin T-L, Fan Y-H, Fan K-S, Juan C-K, Chen Y-J, Wu C-Y. Cardiovascular disease risk in patients with psoriasis receiving biologics targeting TNF-α, IL-12/23, IL-17, and Il-23: A population-based retrospective cohort study. PLOS Medicine. 2025;22(4). doi:10.1371/journal.pmed.1004591

2. Ogdie A, Yu Y, Haynes K, et al. Risk of major cardiovascular events in patients with psoriatic arthritis, psoriasis and rheumatoid arthritis: a population-based cohort study. Ann Rheum Dis. 2015;74(2):326-332. doi:10.1136/annrheumdis-2014-205675