Cardiovascular safety of systemic psoriasis treatments: A prospective cohort study in the BIOBADADERM registry
Year: 2025
Type: article
Study design: Observational Study
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.
DOI: 10.1111/jdv.20705
Authors: Juan José Lluch‐Galcerá, José Manuel Carrascosa, Alicia González‐Quesada, Antonio Sahuquillo‐Torralba, Raquel Rivera‐Díaz, Esteban Daudén, Isabel Belinchón, Francisco José Gómez‐García, Enrique Herrera‐Acosta, Diana P. Ruiz‐Genao, José Luís Lopez‐Estebaranz, Ofelia Baniandrés‐Rodríguez, Marta Ferrán, Pablo de la Cueva, Lourdes Rodríguez, Almudena Mateu, Josep Riera‐Monroig, José Carlos Ruiz‐Carrascosa, Mariano Ara‐Martín, María Teresa Abalde‐Pintos, Mónica Roncero‐Riesco, Conrad Pujol‐Marco, Carmen García‐Donoso, Mar Llamas‐Velasco, Elena Del Alcázar, Jorge Alonso Suárez‐Pérez, Belén Rodríguez‐Sánchez, Kevin Díez‐Madueño, Ricardo Ruiz‐Villaverde, Victoria Lezcano‐Biosca, Beatriz González‐Sixto, Miguel Ángel Descalzo, Ignacio García‐Doval
Institutions: Universitat Autònoma de Barcelona, Hospital General de Granollers, Hospital Universitari Germans Trias i Pujol, Hospital Universitario de Gran Canaria Doctor Negrín, Hospital Universitari i Politècnic La Fe, Universidad Complutense de Madrid, Hospital Universitario 12 De Octubre, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa, Hospital General Universitario de Alicante Doctor Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Hospital Universitario Reina Sofía, Hospital Clínico Universitario Virgen de la Victoria, Hospital Universitario Fundación Alcorcón, Hospital General Universitario Gregorio Marañón, Hospital Del Mar, Parc de Salut, Hospital Universitario Infanta Leonor, Hospital Universitario Virgen del Rocío, Hospital Universitario Doctor Peset, Hospital Clínic de Barcelona, Instituto de Investigación Biosanitaria de Granada, Hospital Clínico Universitario Lozano Blesa, Complejo Hospitalario de Pontevedra, Complejo Hospitalario de Salamanca, Spanish Academy of Dermatology and Venereology, University Hospital Complex Of Vigo
Language: English
Subfield: Immunology
Field: Immunology and Microbiology
Domain: Life Sciences
Open Access status: bronze
OpenAlex ID: W4409967433