Association of systemic therapies for psoriatic disease with non-fatal major adverse cardiovascular events in older adults: A population-based cohort study

Summary: Abstract Body: The cardiovascular effect of systemic treatments for psoriatic disease is uncertain. We estimated the association between treatment classes and non-fatal MACE in a cohort study using population-based health administrative data (2007-2023) from Ontario, Canada. The cohort included residents aged ≥66 years with psoriasis and psoriatic arthritis who initiated systemic therapy between April 2007 and March 2022, categorized as methotrexate, other conventional medications, anti-TNF biologics, IL-17 inhibitors, IL-12 or 23 inhibitors, and tofacitinib. The primary outcome was incident non-fatal MACE (coronary heart disease, cerebrovascular events, heart failure, and peripheral arterial disease). An adjusted Andersen-Gill recurrent event model estimated the relative rate (RR) of MACE for each treatment class compared to time not on that treatment. There were 9,031 new users (median age 71 years [IQR 68-76], 51% female). Analyses showed methotrexate (RR 0.78, 95%CI 0.74-0.83), anti-TNF biologics (RR 0.79, 95%CI 0.72-0.87), and IL-12 or 23 inhibitors (RR 0.76, 95%CI 0.68-0.85) were associated with lower MACE rates, whereas IL-17 inhibitors (RR 0.90, 95%CI 0.79-1.02), other conventional medications (RR 0.96, 95%CI 0.90-1.03), and tofacitinib (RR 0.99, 95%CI 0.71-1.37) were not. This suggests that specific classes of anti-psoriatic therapy may have cardiovascular benefits. Rita J. Iskandar^{1, 2, 4}, Mina Tadrous^{1, 2, 4}, Rinku Sutradhar^{3, 4}, Swaleh Hussain^{2, 4}, Husam Abdel-Qadir^{1, 5, 4}, Lihi Eder^{5, 1}, Christine Fahim⁶, Michael Fralick^{5, 7}, Tara Gomes^{4, 6, 2}, Peter Backx⁸, Michael E. Farkouh¹⁰, Sue MacDougall⁹, Morris Manolson⁹, Paula Rochon^{5, 1, 4}, Aaron M. Drucker^{5, 1, 4} 1. Department of Medicine and Women’s College Research and Innovation Institute, Women's College Hospital, Toronto, ON, Canada. 2. Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada. 3. Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. 4. ICES, Toronto, ON, Canada. 5. Department of Medicine, University of Toronto, Toronto, ON, Canada. 6. Unity Health Toronto, Toronto, ON, Canada. 7. Department of Medicine, Sinai Health, Toronto, ON, Canada. 8. York University, Toronto, ON, Canada. 9. Patient research partner, Toronto, ON, Canada. 10. Cedars-Sinai Health System, Los Angeles, CA, United States. Clinical Research: Epidemiology and Observational Research