Ustekinumab, Other Biologics for PsA and PsO Have Similar Cardiovascular Safety

New research has found no difference in cardiovascular (CV) safety profiles of ustekinumab compared with adalimumab, etanercept, or secukinumab in patients with psoriasis or psoriatic arthritis (PsA) in real-world clinical practice.1

“There is a need for more data on the comparative CV safety of these treatments to help inform on their impact on cardiovascular risks and benefits in PsO and PsA. Well-designed observational studies with large patient cohorts and longer treatment durations are required to comprehensively assess the impact of biologics on CV risk,” lead investigator Jonas Banefelt, MA, Quantify Research, Stockholm, Sweden, and colleagues wrote.1

Banefelt and colleagues conducted a new-user, active-comparator, observational cohort study of patients with PsO and PsA initiating treatment with ustekinumab or a comparator between 2009-2021, with patients assigned to mutually exclusive cohorts, from Swedish national registers. The investigators primarily looked at incident major adverse CV events (MACE), defined as myocardial infarction, ischemic stroke, or CV-related death. They calculated cause-specific Cox regression with stabilized inverse probability of treatment weighting by propensity scores to estimate adjusted hazard ratios (HR).

The study included a total of 15,502 patients, 852 treated with ustekinumab, and included 147 MACE during follow-up. Banefelt and colleagues found that, compared to ustekinumab, the MACE adjusted HR was 1.07 (95% CI, 0.49-2.33) for adalimumuab. 1.08 (95% CI, 0.48-2.42) for etanercept, and 1.19 (95% CI, 3.10) for secukinumab.1

“In this nationwide study of Swedish PsO and PsA patients treated with ustekinumab, etanercept, adalimumab, or secukinumab, spanning more than 10 years, the overall risk of MACE was low across treatment groups and no meaningful difference in risk of MACE between ustekinumab and the other treatments was observed,” Banefelt and colleagues and colleagues concluded.1

Other recent research, led by Philip Mease, MD, Clinical Professor, University of Washington School of Medicine and Director, Rheumatology Research, Swedish Medical Center, has highlighted differences between patient and clinician perspectives in aspects of PsA care.

Mease and colleagues conducted 4 focus groups of patients with PsA across 3 US rheumatology practices using mixed methods to identify attributes of PsA important to patients. They combined these attributes with extant attributes identified by a steering committee to create a comprehensive list. In separate patient and physician Delphi exercises, participants distributed 100 points across items on the list according to importance in relation to PsA.2

When comparing prioritization between groups using group mean score per item, they found that items with the top 10 mean scores for both groups included arthritis, disease activity, pain, fatigue, physical function, and spine symptoms. Disparity was seen across other prioritized domains including access to care, daily activities, stiffness, future health uncertainty, and sleep quality for patients compared with specific disease skin and joint manifestations, comorbidities, structural damage, and disease management goals for clinicians.

Our study highlights the need for clinicians to ask and address “what matters” with patients to increase clinician empathy and empower patients to articulate their concerns, with the goal of improving communications, understanding, and patient-centered outcomes,” Mease and colleagues wrote.2

REFERENCES

1. Banefelt J, Skröder H, Azzabi A, Sheahan A, Suruki R, Geldhof A. Long-term Cardiovascular Safety of Ustekinumab in Psoriasis and Psoriatic Arthritis: Results from an Observational Post-Authorization Safety Study Based on Swedish National Registers. J Am Acad Dermatol. Published online March 13, 2025. doi:10.1016/j.jaad.2025.03.016

2. Mease PJ, Husni ME, Siegel E, et al. What Matters in Psoriatic Arthritis: A Comparison of Patient and Clinician Perspectives. ACR Open Rheumatol. Published online January 12, 2025. doi: 10.1002/acr2.11781