Biologics reduce adverse cardiovascular outcomes in statin-treated psoriasis patients: A global population study

Summary: <br /> Psoriasis (PsO) directly increases cardiovascular (CV) risks, such as hyperlipidemia. Thus many patients require statins. While biologics may improve CV outcomes in PsO, their stain-independent-impact is unclear. Our retrospective cohort study aimed to assess biologics’ impact on adverse CV outcomes in statin-treated PsO patients and compare effects across classes. Multivariate analysis of 32,552 statin-treated PsO patients in the TriNetX global database (median follow-up: 2.5 yrs) compared CV outcomes between biologic users and other systemic/phototherapy users, adjusting for age, sex, BMI, smoking, diabetes, CKD, and circulatory disorders. Biologics significantly reduced adverse CV events, such as percutaneous coronary intervention (PCI) (aOR 0.48, CI 0.31–0.75), heart failure (HF) (aOR 0.69, CI 0.63–0.75), vascular disease (VD) (aOR 0.70, CI 0.63–0.79), cerebrovascular events (CVE) (aOR 0.73, CI 0.65–0.81), myocardial infarction (MI) (aOR 0.75, CI 0.68–0.82), and ischemic heart disease (IHD) (aOR 0.80, CI 0.76–0.84). Among classes, IL-23 inhibitors were most effective, reducing CVE (aOR 0.30, CI 0.23–0.39), HF (aOR 0.40, CI 0.33–0.48), VD (aOR 0.45, CI 0.36–0.57), MI (aOR 0.52, CI 0.43–0.62), and IHD (aOR 0.63, CI 0.57–0.69). IL-17 inhibitors ranked second, lowering PCI (aOR 0.43, CI 0.21–0.91), HF (aOR 0.55, CI 0.46–0.66), VD (aOR 0.63, CI 0.51–0.78), CVE (aOR 0.64, CI: 0.52–0.80), IHD (aOR 0.73, CI: 0.67–0.80), and MI (aOR 0.77, CI 0.65–0.92). IL-12/23 inhibitors followed, reducing MI (aOR 0.64, CI 0.50–0.81), HF (aOR 0.71, CI 0.57–0.89), VD (aOR 0.72, CI 0.54–0.95), and IHD (aOR 0.86, CI 0.76–0.98). TNF-α inhibitors also reduced VD (aOR 0.76, CI 0.66–0.88), MI (aOR 0.78, CI 0.69–0.88), CVE (aOR 0.78, CI 0.67–0.90), HF (aOR 0.79, CI 0.70–0.88), and IHD (aOR 0.81, CI 0.76–0.86). While all biologics reduced adverse CV outcomes, IL-23 inhibitors were most impactful (mean aOR: 0.46), followed by IL-17 (0.63), IL-12/23 (0.73), and TNF-α inhibitors (0.78). Nicole A. Johnsen¹, Elaine J. Ma¹, Matthew Yan¹, Peichi Chou¹, Abigail Katz¹, Charlotte Jeong¹, Alyssa Roberts¹, Yvonne Nong¹, April Armstrong¹ 1. University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States. Clinical Research: Epidemiology and Observational Research