Background/Purpose: Individuals with psoriasis or psoriatic arthritis (PsO/PsA) have an elevated risk of

major adverse cardiac events (MACE), which include congestive heart failure (CHF), myocardial

infarction (MI), and cerebrovascular accident (CVA). Biologic disease modifying antirheumatic

drugs (bDMARDs) may reduce cardiovascular risk through inflammation control and reduced

steroid exposure. Whether MACE risk differs by bDMARD class for individuals with psoriatic

disease is unknown.

Methods: We used data from the US-based TriNetX electronic health records database.

Patients were included if they had PsO/PsA and were new bDMARD users, including tumor

necrosis factor alpha inhibitors (TNFi), interleukin-17A inhibitors (IL17i), interleukin-23 inhibitors

(IL-23i), or interleukin-12/23 inhibitors (IL-12/23i). The time-dependent risk for MACE was

calculated using weighted multinomial Cox proportional hazards ratios with TNF exposure as

the referent. Subset analyses were performed to evaluate components of the primary outcome

measure and patients with or without baseline cardiovascular disease. A negative control

outcome (injury/trauma) was also evaluated.

Results: We identified 32,758 patients who initiated biological therapies for PsO/PsA. Patients

had PsO/PsA for a mean of 3.5 years (SD 4.5) prior to starting a biologic agent, the most

common of which was a TNFi (20,597/32,758, 62.9%) followed by IL-17i (5,043/32,758, 15.4%),

IL-23i (3,502/32,758, 10.7%), and IL12/23i (3,502/32,758, 10.7%). In a weighted multinomial

cox proportional hazards regression, the adjusted risk of MACE was similar for IL-17A inhibitors

(aHR 0.98, 95% CI 0.73-1.32), IL-23 inhibitors (aHR 0.84, 95% CI 0.54-1.31), and IL-12/23

inhibitors (aHR 1.08, 95% CI 0.80-1.47) as compared to TNF inhibitors. The results of subset

analyses supported the primary analysis. Negative control outcomes (injury/trauma) suggested

adequate control of time related biases and confounding.

Conclusion: Despite the differences in efficacy and safety profiles of bDMARD classes for

individuals with PsA/PsO, this real world analyses did not observe significant differences in

MACE risk with respect to biologic choice. Risk of MACE should not be a determining factor

when choosing a biologic agent for patients with psoriatic arthritis and psoriasis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/choice-of-biologic-immunotherapy-for-psoriasis-or-psoriatic-arthritis-not-associated-with-risk-of-major-adverse-cardiac-events/