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

Rungapiromnan, W. et al. (2020) Risk of major cardiovascular events in patients with psoriasis receiving biologic therapies: a prospective cohort study. Journal of the European Academy of Dermatology and Venereology, 34(4), pp. 769-778. (doi: 10.1111/jdv.16018) (PMID:31633837)

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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‐α 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.

Item Type:Articles
Additional Information:WR is funded by the Royal Thai Government to undertake her PhD at the University of Manchester. This study ispart of the PhD programme. CEMG, DMA and RBW are funded in part by the Medical Research Council (MR/L011808/1). CEMG is also a National Institute for Health Research Senior Investigator.
Keywords:Infectious diseases, dermatology.
Glasgow Author(s) Enlighten ID:Burden, Professor David
Authors: 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., Barker, J., Benham, M., Browne, F., Evans, I., Hussain, S., Kirby, B., Lawson, L., McPherson, T., Murphy, R., Owen, C., Ormerod, A., Pearson, E., Reynolds, N., Richards, J., Smith, C., and BADBIR Study Group, .
College/School:College of Medical Veterinary and Life Sciences > Institute of Infection Immunity and Inflammation
Journal Name:Journal of the European Academy of Dermatology and Venereology
ISSN (Online):1468-3083
Published Online:19 November 2019
Copyright Holders:Copyright © 2019 The Authors
First Published:First published in Journal of the European Academy of Dermatology and Venereology 34:769-778
Publisher Policy:Reproduced under a Creative Commons Licence

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