Biologics for PsA not Associated with Higher Heart Disease Risk

April 9, 2019

Study shows there is no substantial difference in cardiovascular risk associated with different biologic therapies for psoriasis and psoriatic arthritis patients.

Patients receiving ustekinumab or TNFi therapies for psoriasis or psoriatic arthritis experience no substantial difference in risks for atrial fibrillationor major adverse cardiovascular events, a new study showed.

Expanding evidence indicates this patient population faces a higher risk of cardiovascular disease, making early intervention to control systemic inflammation preferable. Published in JAMA Dermatology, the study provides reassurance that these therapies affect this patient population in a similar way.

The study included 60,028 participants-9,071 received ustekinumab and 50,957 received TNFi. Men accounted for 49.1 percent of enrollees, totaling 29,495. Ustekinumab patients were slightly younger with a mean age of 46 years versus 47.3 for TNFi patients.

The patient groups had differences. The TNFi group had a higher proportion of patients with a diagnosis of psoriatic arthritis, nonbiological DMARD use, and steroids. They also had more office visits and more patients using NSAIDs, cyclooxygenase-2 inhibitors, and opioids.  Ustekinumab patients were more likely to have exposure to other biologic DMARDs, UV light, and topical therapies, as well as more inpatient and outpatient visits that resulted in psoriasis and psoriatic arthritis diagnoses.

For atrial fibrillation, during a nearly 18-month follow-up period, 383 cases were identified: 60 for ustekinumab patients and 323 for TNFi.

During the follow-up period, 495 major adverse cardiovascular event cases emerged:  74 in ustekinumab and 421 in TNFi.

The results support previous findings that there’s no substantial difference in cardiovascular risk associated with different biologic therapies.

Researchers said these results can be used to weigh the risks and benefits of various systemic treatment strategies for psoriatic disease.

“Although the risk of these cardiovascular outcomes appeared to be similar across the subpopulations included in our study,” they said, “further investigations on potentially modifying treatment effects stratified by important risk factors may be warranted.”

REFERENCE

Lee M, Desai R, Jin Y, Brill G, Ogdie A, Kim S, Association of Ustekinumab vs TNF Inhibitor Therapy With Risk of Atrial Fibrillation and Cardiovascular Events in Patients With Psoriasis or Psoriatic Arthiritis. JAMA Dermatology (2019), doi: 10.1001/jamadermatol.2019.0001