Choice of Biologic Immunotherapy for Psoriasis or Psoriatic Arthritis and Its Association With Risk of Major Adverse Cardiac Events

OBJECTIVE: Individuals with psoriasis (PsO) or psoriatic arthritis (PsA) have an elevated risk of major adverse cardiac events (MACE), which include congestive heart failure (CHF), myocardial infarction (MI), and cerebrovascular accident (CVA). Biologic disease-modifying antirheumatic drugs (bDMARDs) may reduce cardiovascular risk; however, whether MACE risk differs by bDMARD class for this population is unknown. METHODS: Using data from TriNetX database, we identified patients with PsO/PsA who were new bDMARD users, including tumor necrosis factor inhibitors (TNFi), interleukin (IL)-17A inhibitors (-i), IL-23i, or IL-12/23i. Time-dependent risk for MACE was calculated using weighted multinomial Cox proportional hazards regression with TNFi exposure as the referent. Additional analyses evaluated components of the primary outcome and baseline cardiovascular disease. A negative control outcome was used to assess bias. RESULTS: We identified 32,758 patients with PsO/PsA who were new bDMARD users. Patients had PsO/PsA for a mean of 3.5 (SD 4.5) years prior to starting a biologic, the most common being TNFi (62.9%), followed by IL-17i (15.4%), IL-23i (11%), and IL-12/23i (10.7%). In weighted multinomial Cox proportional hazards regression, the adjusted risk of MACE was similar for IL-17Ai (adjusted hazard ratio [aHR] 0.98, 95% CI 0.73-1.32), IL-23i (aHR 0.84, 95% CI 0.54-1.31), and IL-12/23i (aHR 1.08, 95% CI 0.80-1.47) as compared to TNFi. Subset analyses supported the primary analysis. Negative control outcomes suggested adequate control of bias confounding. CONCLUSION: MACE risk does not significantly differ across bDMARD classes in patients with PsO/PsA. Therefore, cardiovascular risk should not guide biologic selection in this population.