Are Biologic Therapies for Psoriasis Associated With Increased Risk for Cardiovascular Events?

In patients with psoriasis, no reduction in the risk for myocardial infarction (MI) has been reported in the current era of biologic therapy, and the increased MI risk in patients with hospital-diagnosed psoriasis relative to the general population is unchanged during the initial years of biotherapy, according to the results of a cohort study conducted in Denmark.

The results of the analysis, which used nationwide prospectively collected data from population-based registries, were published in the Journal of the European Academy of Dermatology and Venereology.

The investigators sought to determine the risk for MI following hospital-diagnosed psoriasis compared with that in the general population in the eras preceding and following the introduction of biologic therapy. In the early-era cohort, participants with first-time hospital-diagnosed psoriasis between 1995 and 2002 were identified; in the late-era cohort, patients diagnosed between 2006 and 2013 were identified. Comparison cohorts from the general population were matched in a 10:1 ratio based on sex and birth year.

All participants were followed from the date of psoriasis diagnosis (ie, index date for matched controls) until the incidence of MI, death, emigration, or end of study (January 1, 2002, in the early-era cohort and January 1, 2013, in the late-era cohort). Cumulative incidence of MI at 5-year follow-up was computed, with Cox regression models used to calculate hazard ratios (HRs) of MI, comparing patients with psoriasis with individuals in the general population.

A total of 4302 individuals with psoriasis and 43,791 individuals in the general population were identified in the early-era group, while 4577 individuals with psoriasis, 4% of whom were receiving biologic therapy, and 46,376 participants in the general population were identified in the late-era group.

The cumulative incidence of MI in participants in the early-era vs late-era group was 2.5% vs 2.2%, respectively. The HRs comparing MI risk in the psoriasis and general population cohorts were 1.40 (95% CI, 1.09-1.80) in the early-era group and 1.39 (95% CI, 1.10-1.75) in the late-era group, which was adjusted for educational level and the use of cardiovascular (CV) medications. Although the risk for MI was increased in individuals with psoriasis compared with the general population, the relative risk for MI was identical in the 2 eras evaluated.

The investigators concluded that during the initial years in which increased attention was focused on CV disease prevention and availability of biologic therapy, the risk for MI in patients with hospital-diagnosed psoriasis relative to the general population remained the same.

Reference

Leisner MZ, Riis JL, Gniadecki R, Iversen L, Olsen M. Psoriasis and risk of myocardial infarction before and during an era with biological therapy: a population-based follow-up study [published online May 2, 2018]. J Eur Acad Dermatol Venereol.
doi:10.1111/jdv.15021