Association between biologic and nonbiologic systemic therapy for psoriasis and psoriatic arthritis and the risk of new-onset and recurrent major adverse cardiovascular events: A retrospective cohort study

BACKGROUND: Limited data exist on managing psoriasis and psoriatic arthritis (PsA) in survivors of major adverse cardiovascular events (MACEs). OBJECTIVE: To investigate the risk of recurrent and new-onset MACEs associated with systemic therapies for psoriasis and PsA. METHODS: A retrospective cohort study using Korean health insurance data (January 2008-October 2021) included patients diagnosed with psoriasis or PsA treated with biologics, nonbiologic systemic therapy, or phototherapy. The primary outcome was MACE (acute myocardial infarction, stroke, cardiac arrest, unstable angina, or heart failure). Multivariable time-dependent Cox regression models were used for risk analysis. RESULTS: The study included 183,212 patients, yielding 259,475 treatment episodes. Biologic therapy was associated with a lower risk of new-onset and recurrent MACEs compared to phototherapy (adjusted hazard ratio, 0.454; 95% confidence interval [CI], 0.359-0.574; 0.343, 95% CI, 0.245-0.479, respectively). Nonbiologic systemic therapy showed a lower MACE risk than did phototherapy only in patients with a history of MACE (adjusted hazard ratio, 0.789; 95% CI, 0.658-0.946). LIMITATIONS: Observational design limits causal inference and may involve residual confounding. CONCLUSION: The study supports the use of biologics in patients with moderate-to-severe psoriasis or PsA, particularly those with a MACE history where treatment options are limited.