Biologics in Psoriasis May Have Little to No Effect on Cardiovascular Risk Factors, Study Finds

Annika Smith, MBBS
Credit: Dermatology Australasia

A study from investigators in Australia offers new insight into biologic therapy's effects on cardiovascular risk in patients with psoriasis.

An analysis of all patients with psoriasis treated with biologic therapies at a tertiary hospital in Australia over nearly a decade, results of the study indicate there was little to no evidence of an effect of biologic therapy on worsening or improving cardiovascular risk factors among the study cohort.

“Biologic therapy is overwhelmingly effective for psoriatic skin disease, with newer agents having the capacity to achieve clear or near clear skin in most cases,” wrote investigators.¹ “Although there are emerging data to suggest that biologic therapy may exert independent effects on the coronary circulation, this study did not demonstrate significant improvement in key cardiovascular parameters after 1 year of continuous biologic therapy.”

As outlined by investigators, among the chief concerns in the management of patients with psoriasis is the disease’s association with increased cardiovascular risk as a result of systematic inflammation. According to some estimates, patients with psoriasis were up to 50% more likely to develop cardiovascular disease than their counterparts without psoriasis.^1,2

In recent years, the advent of new therapies, including biologics, have revolutionized the ability for patients to achieve skin clearance, but much less is known about their effects on long-term cardiovascular risk. Citing deficiencies in previous research on the topic, the current endeavor was launched by to determine whether biologic therapy was associated with positive effects on traditional cardiovascular risk factors among patients with psoriasis.¹

To do so, investigators designed their study as a retrospective review of all patients prescribed biologic therapy for whole-body chronic plaque psoriasis at the Westmead Hospital from January 2012 through July 2021. A teaching hospital of Sydney Medical School at the University of Sydney, Westmead Hospital is billed as the principal referral center for Western Sydney and serves a population of roughly 1.5 million people.¹

The primary outcomes of interest for the study were the effect of biologic therapy on systolic blood pressure (SBP), diastolic BP (DBP), heart rate, and body mass index (BMI) at the 1-year follow-up mark. Of note, patients were excluded if they did not have data for the cardiovascular risk parameters of interest or did not receive continuous biologic therapy for 1 year.¹

A total of 147 patients were identified in the initial search. After exclusion of those with incomplete data, 106 patients were identified for inclusion in the final analyses. This cohort had a mean age of 44 (Standard Deviation [SD], 16) years, 63% were male, and the mean BMI at biologic therapy initiation was 30 (SD, 7) kg/m2.¹

When assessing biologic therapy use, initial analysis revealed ustekinumab (IL-12/23 inhibitor, 35.8%), ixekizumab (IL-17 inhibitor, 21.7%), and secukinumab (IL-17 inhibitor, 19.8%) were the most frequently used biologic agents among this cohort. When assessing the effect on psoriasis, results indicated biologic-naive patients experienced a mean improvement in final PASI of 19.2 (95% Confidence interval [CI], 17.9 to 20.5) and biologic-experienced patients improved their PASI by 6.2 (95% CI, 2.9 to 9.6) at 12 months.¹

Analysis of cardiovascular risk factors revealed there were no statistically significant differences from initiation to 12 months for SBP (mean difference, 2.3; 95% CI, 1.4 to 5.9, P = .222), DBP (mean difference, 0.6; 95% CI, –1.2 to 2.5, P = .492), heart rate (mean difference, 1.3; 95% CI, —3.9 to 6.4; P = .63) or BMI (mean difference, –0.1; 95% CI, —0.9 to 0.7; P = .827). Investigators called attention to subgroup analyses indicating biologic-experienced patients experienced a reduction in SBP of 5.7 mmHg (95% CI, 0.2–11.2; P = .042) and DBP by 3.6 mmHg (95% CI, 0.5 to 6.6; P = .023) at 12 months.¹

Investigators pointed out multiple limitations within their study for clinicians to consider when interpreting results. These limitations included the observation and retrospective design of the analysis, an inability to adjust for all potential confounders, and the lack of a control cohort.¹

“This study highlights the need for optimal cardiovascular preventative care and focused weight loss strategies in the psoriatic cohort, which can positively impact disease severity and response to biologic therapy,” investigators concluded.¹ “It is undeniable that biologic therapy can achieve excellent cutaneous control in psoriatic disease; further research however is needed to determine the impact of these therapies on systemic inflammation.”

References:

1. Joseph J, Truong K, Lo SN, et al. Impact of Biologic Therapy on Key Cardiovascular Risk Parameters in a Psoriatic Cohort-a Retrospective Review. Dermatol Ther (Heidelb). Published online April 25, 2024. doi:10.1007/s13555-024-01154-8
2. Garshick MS, Ward NL, Krueger JG, Berger JS. Cardiovascular Risk in Patients With Psoriasis: JACC Review Topic of the Week. J Am Coll Cardiol. 2021;77(13):1670-1680. doi:10.1016/j.jacc.2021.02.009