Systemic antipsoriatic therapy is associated with cardio-cerebrovascular disease (CCVD) risk diminishment for individuals with psoriasis, according to new findings, suggesting that this type of therapy may help to slow the development of CCVD in this patient group.¹

These findings resulted from a population-based study in South Korea examining systemic antipsoriatic therapy’s effects for psoriasis patients, given mixed data from prior studies on the use of this form of therapy.²

The research was authored by Chong Won Choi and Sang Woong Youn from the Department of Dermatology at Seoul National University Bundang Hospital in South Korea.

“Using these integrated and comprehensive analyses, we can assess the effect of systemic antipsoriatic therapy on CCVD risk, which reflects the real-world psoriasis treatment pattern,” Choi, Youn, and colleagues wrote.

Background and Findings

The investigators conducted a nested case-control study through the use of nationwide data drawn from the Health Insurance Review and Assessment Service in South Korea to examine systemic antipsoriatic therapy and cardio-cerebrovascular disease (CCVD) risk’s relationship in a psoriasis population aged ≥20 years.

The database uses comprehensive medical claims information on the Korean population. The investigators’ cohort was made up of psoriasis patients aged ≥20 years, having a reported diagnosis code for psoriasis logged a minimum of 2 times a year from January of 2011 to March of 2021.

The research team excluded participants with a history of psoriasis or CCVD during the 1-year time prior to entry into the study, and those with diagnoses of certain chronic conditions or a follow-up time of less than a single year. The remaining individuals were followed up until the first occurrence of a CCVD outcome, their death, or the period of study’s end.

The team defined CCVD cases as individuals with diagnosis codes for cardiovascular events such as ischemic heart disease and myocardial infarction or cerebrovascular events such as cerebral infarction/hemorrhage during the study. Controls were chosen by the investigators from the remaining individuals with psoriasis, excluding ones with CCVD.

The exposure the investigators used was the amount of systemic antipsoriatic treatment duration following onset of psoriasis, represented as the proportion of systemic antipsoriatic therapy treatment period (PTP, %). The calculated PTP by dividing the sum of all systemic antipsoriatic therapy durations by the total observation period.

The research team categorized systemic antipsoriatic therapy into conventional agents (such as methotrexate, cyclosporine, or retinoids) and biologics (including anti-IL-12/23p40, TNF-α inhibitors, IL-17A antagonists, or IL-23 antagonists). The team’s overall treatment period for conventional agents was decided upon by adding the days prescribed for each drug.

They calculated the overall treatment period for biologics through the use of the administration days for each of the injections, with the assumption of continuous treatment if prescribed within 12 total weeks. Psoriasis prevalence was determined as the total number of days from onset of the disease to the end of the follow-up period.

Overall, the study investigators reported that 251,813 participants were included, among whom 6,262 were found to have experienced CCVD events at the time of the study period (CCVD arm). The control arm was made up of 245,551 individuals without a history of CCVD during the study period (non-CCVD arm).

Interestingly, the research team noted that the non-CCVD arm showed a higher proportion of the treatment period with systemic antipsoriatic therapy (PTP) versus the CCVD group (CCVD: 2.12 ± 7.92, non-CCVD: 2.64 ± 9.64; P < 0.001). Following an adjustment for sex, age, hypertension, diabetes, and dyslipidemia in multiple logistic regression analysis, the PTP was reported to have had an inverse association with the risk of CCVD.

Specifically, the investigators found that a 10% increase in PTP led to a substantial 0.96 reduction in the risk of CCVD development (95% CI, 0.93 - 0.99). Additionally, this diminished risk of CCVD was shown to be consistent for both conventional antipsoriatic therapy and for biologic treatments.

“In conclusion, we found that systemic antipsoriatic therapy was inversely associated with the risk of developing CCVDs in psoriasis patients,” they wrote. “Furthermore, as antipsoriatic therapy duration increased, CCVD risk in psoriasis patients decreased. Our findings suggested that effective and long-term continuous control of psoriasis could lower CCVD risk in psoriasis patients.”

References

1. ^{Kim BR, Lee KH, Kim J, et al. Association between cardio-cerebrovascular disease and systemic antipsoriatic therapy in psoriasis patients using population-based data: A nested case-control study [published online ahead of print, 2023 Jul 30]. J Dermatol. 2023;10.1111/1346-8138.16904. doi:10.1111/1346-8138.16904.}
2. ^{Boehncke WH. Systemic inflammation and cardiovascular co- morbidity in psoriasis patients: causes and consequences. Front Immunol. 2018;9:579.}