Background/Purpose: Psoriasis, psoriatic arthritis (PsA), and axial spondyloarthritis (axSpA) are associated with increased risk of cardiovascular (CV) disease driven by chronic systemic inflammation, with IL-17A thought to play a central pathogenic role. This inflammation contributes to endothelial dysfunction, an early and pivotal step in the development of atherosclerosis, as well as increased arterial stiffness, an important factor in its progression. Secukinumab, a selective IL-17A inhibitor approved across the three indications, may have potential implications for CV health. This review aimed to evaluate the evidence available in the scientific literature on the impact of secukinumab on CV disease in patients with psoriasis, PsA and axSpA, including its effects on vascular function, inflammatory markers, and long-term safety.

Methods: A systematic review of PubMed was performed from database inception to May 2025 according to a pre-defined search strategy (Table 1). Results were screened and evaluated for inclusion according to the following criteria: publications describing prospective or retrospective studies or meta-analyses; studies including at least 10 patients treated with secukinumab; studies reporting on at least one of the outcomes of interest (endothelial function, arterial stiffness, systemic inflammation, vascular imaging outcomes, and incidence of major adverse CV events [MACE] including CV death, acute myocardial infarction, stroke, unstable angina, and heart failure). Systematic reviews without meta-analysis, case studies, letters to the editor and commentaries were excluded, as were non-English language publications.

Results: From 198 articles initially returned by the search, 46 were eligible for inclusion (Figure 1). These comprised 9 meta-analyses or other pooled analyses, 13 randomised controlled trials, 11 retrospective studies or analyses, 9 prospective studies and 4 observational studies. Twenty publications included patients with psoriasis, 5 included patients with PsA, 11 included patients with axSpA, and 10 included multiple indications. Based on data from over twenty thousand patient-years of exposure, secukinumab did not associate with increased MACE in patients with psoriasis, PsA, or axSpA. Additionally, multiple studies reported improvements in systemic inflammatory markers including C-reactive protein, neutrophil to lymphocyte ratio and markers of oxidative stress, with others reporting favorable impact on vascular health including improvement in endothelial function, reduction in arterial stiffness, and improvement in coronary flow reserve.

Conclusion: Secukinumab was associated with a reduction in systemic inflammation and oxidative stress in multiple studies which also reported a consistent CV safety profile across psoriasis, PsA, and axSpA in terms of incidence of MACE. Emerging evidence from vascular imaging suggests that secukinumab may benefit risk factors of CV disease and markers of vascular health; however, larger, prospective randomized trials are needed to confirm this. Finally, these data suggest that secukinumab may provide benefit beyond the primary disease treatment through important reductions in systemic inflammation.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-secukinumab-on-cardiovascular-disease-in-patients-with-psoriasis-psa-and-axial-spondyloarthritis-a-systematic-review-of-existing-evidence/