Reduced Cardiovascular Risk with Biologics in Psoriasis and PsA

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Psoriasis and psoriatic arthritis (PsA) are chronic inflammatory conditions that have been linked to an increased risk of major adverse cardiovascular events (MACE).¹ Recent research has investigated the comparative effects of biologic and nonbiologic systemic therapies on the incidence of both new-onset and recurrent MACE in affected patients. A study published in TheJournal of the American Academy of Dermatology provided an objective analysis of a retrospective cohort study assessing this association and its clinical implications.²

Researchers behind the study concluded that, “biologic therapy in patients with psoriasis or PsA offers protective effects against MACEs, regardless of MACE history. This suggests that biologic therapies should be actively considered not only for their efficacy in managing psoriasis or PsA but also for their potential cardiovascular benefits. Clinicians should carefully weigh these benefits when selecting treatment plans, particularly for patients with a history of CVD or a high cardiovascular risk.”

Methodology

The study utilized a retrospective cohort design, analyzing patient records from a comprehensive database. Participants included individuals diagnosed with psoriasis or PsA who were prescribed either biologic or nonbiologic systemic therapies. Data on cardiovascular events, including myocardial infarction, stroke, and cardiovascular-related mortality, were collected and analyzed using multivariate statistical models to control for confounding variables.

Key Findings

The study yielded several significant findings:

• Differential Risk of MACE: Patients receiving biologic therapies exhibited a lower incidence of new-onset and recurrent MACE compared to those on nonbiologic systemic treatments. The risk reduction was particularly notable in patients with a history of cardiovascular disease.
• Inflammatory Pathways and Cardiovascular Risk: The study highlighted the role of systemic inflammation in cardiovascular risk, with biologics demonstrating superior efficacy in reducing inflammatory markers associated with atherosclerosis.
• Comparative Safety Profiles: While biologic therapies were associated with a reduced cardiovascular risk, nonbiologic systemic treatments showed a neutral or slightly increased risk, potentially due to their different mechanisms of action and adverse event profiles.
• Longitudinal Outcomes: Patients who adhered to biologic therapy over extended periods had a sustained reduction in cardiovascular risk factors, suggesting long-term benefits beyond dermatologic symptom control.

Clinical Implications

These findings have several important implications for clinical practice:

1. Personalized Treatment Selection: Clinicians should consider cardiovascular risk profiles when selecting systemic therapies for patients with psoriasis and PsA.
2. Inflammation as a Therapeutic Target: The ability of biologics to reduce systemic inflammation highlights their potential role in mitigating cardiovascular complications.
3. Need for Cardiovascular Monitoring: Patients receiving systemic therapy for psoriasis or PsA should undergo regular cardiovascular screening to identify and manage potential risks early.
4. Future Research Directions: Further studies are needed to elucidate the precise mechanisms by which biologic therapies confer cardiovascular protection and to explore potential differences among various biologics.

Limitations and Considerations

While the study provides valuable insights, certain limitations must be acknowledged. The retrospective nature of the study introduces potential biases related to data collection and patient selection. Additionally, the follow-up period may not have been sufficient to capture long-term cardiovascular outcomes comprehensively. Researchers suggested future prospective studies and randomized controlled trials are necessary to validate these findings further.

Conclusion

This retrospective cohort study offers important evidence linking biologic therapy for psoriasis and PsA to a reduced risk of MACE compared to nonbiologic systemic treatments. The findings underscore the importance of considering cardiovascular health in treatment decisions and highlight the need for ongoing research into optimizing therapeutic strategies for patients with chronic inflammatory conditions.

References

1. Samarasekera EJ, Neilson JM, Warren RB, Parnham J, Smith CH. Incidence of cardiovascular disease in individuals with psoriasis: a systematic review and meta-analysis. J Invest Dermatol. 2013;133(10):2340-2346. doi:10.1038/jid.2013.149
2. Song WJ, Oh S, Yoon HS. Association between biologic and nonbiologic systemic therapy for psoriasis and psoriatic arthritis and the risk of new-onset and recurrent major adverse cardiovascular events: A retrospective cohort study. J Am Acad Dermatol. Published online March 26, 2025. doi:10.1016/j.jaad.2025.03.055