There were no significant differences among 3 biologic therapies and methotrexate used to treat chronic plaque psoriasis and the risk for major cardiovascular events (CVEs), according to results published in the Journal of the European Academy of Dermatology and Venereology.
This cohort study examining the comparative risk for major CVEs was conducted using the British Association of Dermatologists Biologics and Immunomodulators Register. For the main analysis, data from adults with chronic plaque psoriasis receiving ustekinumab were compared with those of patients taking a tumor necrosis factor inhibitor (TNFi; etanercept or adalimumab) as the reference group. For the secondary analyses, data from patients receiving first-line adalimumab were compared with data from patients taking ustekinumab, etanercept, or methotrexate. Patients were observed from the date of receiving therapy to first major CVE or the earliest date of change of treatment, end of recorded data in the register, death, or end of the study follow-up (median follow-up between 1.43 and 2.01 years). Investigators examined the risk for major CVE occurrence once during treatment as well as within a 90-day window following the last dose.
The study included 5468 biologic-naive patients with moderate to severe psoriasis who subsequently began a treatment regimen using 1 of 3 therapies: adalimumab (n=3204), etanercept (n=1313), or ustekinumab (n=951). The secondary analyses included an additional 2189 patients receiving methotrexate as an example of a conventional systemic therapy. No differences in the risk for major CVEs were observed between biologic therapies (adjusted hazard ratio for ustekinumab vs adalimumab: 0.81 [95% CI, 0.30-2.17]; etanercept vs adalimumab: 0.81 [95% CI, 0.28-2.30]; ustekinumab vs TNFi: 0.96 [95% CI, 0.41-2.22]; and methotrexate vs adalimumab 1.05 [95% CI, 0.34-3.28]).
During treatment, major CVEs occurred in the following number of patients per agent: 19 taking adalimumab, 7 taking methotrexate, 7 taking ustekinumab, and 5 taking etanercept. In the extended exposure window, major CVEs were experienced by the following number of patients per agent: 29 taking TNFi, 23 taking adalimumab, 9 taking methotrexate, 7 taking ustekinumab, and 6 taking etanercept.
“Overall, we found no difference in the risk of major CVEs between etanercept, adalimumab, and ustekinumab in adult patients with moderate-severe plaque psoriasis following short-to-medium term exposure,” researchers wrote. Future studies are needed to assess longer-term impact.
Disclosure: Multiple authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Rungapiromnan W, Mason KJ, Lunt M, et al; BADBIR Study Group. Risk of major cardiovascular events in patients with psoriasis receiving biologic therapies: a prospective cohort study [published online October 21, 2019]. J Eur Acad Dermatol Venereol. doi:10.1111/jdv.16018