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Risk of major cardiovascular events in patients with psoriasis receiving biologic therapies: a prospective cohort study.

Rungapiromnan, W.; Mason, K.J.; Lunt, M.; McElhone, K.; Burden, A.D.; Rutter, M.K.; Warren, R.B.; Griffiths, C.E.M.; Ashcroft, D.M.; Study Group, BADBIR

Risk of major cardiovascular events in patients with psoriasis receiving biologic therapies: a prospective cohort study. Thumbnail


Authors

W. Rungapiromnan

M. Lunt

K. McElhone

A.D. Burden

M.K. Rutter

R.B. Warren

C.E.M. Griffiths

D.M. Ashcroft

BADBIR Study Group



Abstract

BACKGROUND: The cardiovascular safety profile of biologic therapies used for psoriasis is unclear. OBJECTIVES: To compare the risk of major cardiovascular events (CVEs; acute coronary syndrome, unstable angina, myocardial infarction and stroke) in patients with chronic plaque psoriasis treated with adalimumab, etanercept or ustekinumab in a large prospective cohort. METHODS: Prospective cohort study examining the comparative risk of major CVEs was conducted using the British Association of Dermatologists Biologics and Immunomodulators Register. The main analysis compared adults with chronic plaque psoriasis receiving ustekinumab with tumour necrosis-a inhibitors (TNFi: etanercept and adalimumab), whilst the secondary analyses compared ustekinumab, etanercept or methotrexate against adalimumab. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using overlap weights by propensity score to balance baseline covariates among comparison groups. RESULTS: We included 5468 biologic-naïve patients subsequently exposed (951 ustekinumab; 1313 etanercept; and 3204 adalimumab) in the main analysis. The secondary analyses also included 2189 patients receiving methotrexate. The median (p25-p75) follow-up times for patients using ustekinumab, TNFi, adalimumab, etanercept and methotrexate were as follows: 2.01 (1.16-3.21), 1.93 (1.05-3.34), 1.94 (1.09-3.32), 1.92 (0.93-3.45) and 1.43 (0.84-2.53) years, respectively. Ustekinumab, TNFi, adalimumab, etanercept and methotrexate groups had 7, 29, 23, 6 and 9 patients experiencing major CVEs, respectively. No differences in the risk of major CVEs were observed between biologic therapies [adjusted HR for ustekinumab vs. TNFi: 0.96 (95% CI 0.41-2.22); ustekinumab vs. adalimumab: 0.81 (0.30-2.17); etanercept vs. adalimumab: 0.81 (0.28-2.30)] and methotrexate against adalimumab [1.05 (0.34-3.28)]. CONCLUSIONS: In this large prospective cohort study, we found no significant differences in the risk of major CVEs between three different biologic therapies and methotrexate. Additional studies, with longer term follow-up, are needed to investigate the potential effects of biologic therapies on incidence of major CVEs.

Journal Article Type Article
Acceptance Date Sep 30, 2019
Publication Date Oct 19, 2019
Publicly Available Date Mar 28, 2024
Journal Journal of the European Academy of Dermatology and Venereology
Print ISSN 0926-9959
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 34
Issue 4
Pages 769 - 778
DOI https://doi.org/10.1111/jdv.16018
Publisher URL https://onlinelibrary.wiley.com/doi/full/10.1111/jdv.16018

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