Patients with Psoriasis on Biologics More Likely to Continue Use Following MACE

Individuals with psoriasis treated with biologic drugs are more likely to continue treatment following a cardiovascular event than patients given other therapies, new findings suggest.1

Before these findings, several studies demonstrated potential cardiovascular benefits of systemic anti-inflammatory medications for psoriasis, though there is limited data on the modification of such treatments following the occurrence of major adverse cardiovascular events (MACE). Hyun-Sun Yoon, from the Department of Dermatology at the SMG-SNU Boramae Medical Center in South Korea, led a team of investigators in authoring this new research.

The investigators sought to explore shifts in prescription patterns following MACE. Yoon and colleagues highlighted the uniquely high risk for cardiovascular events faced by patients with severe psoriasis.2

“This population-based nationwide study aimed to evaluate how the prescription patterns of biologics, non-biologic systemic agents, and phototherapy are altered following the occurrence of MACE in patients with psoriasis,” Yoon and coauthors wrote.1

Study Design

The investigative team's study involved an analysis of claims data from the Health Insurance Review and Assessment Service (HIRA) in South Korea, spanning January 2008 - October 2021. The team noted that the HIRA database captures healthcare claims submitted for reimbursement under the National Health Insurance (NHI) system, representing medical services delivered nationwide across the country's population.

Those deemed eligible included individuals who reported having at least 2 outpatient visits or one hospitalization carrying a principal diagnostic code for either plaque psoriasis or psoriatic arthritis (PsA). The study participants were stratified into 1 of 3 potential treatment arms according to the therapies initiated for their condition.

• The biologic therapy cohort, including all subjects prescribed biologics regardless of prior or concurrent non-biologic therapy or phototherapy
• The non-biologic systemic therapy cohort, which the investigators restricted to biologic-naïve patients treated with cyclosporine or methotrexate, irrespective of phototherapy use
• The phototherapy cohort, made up of participants managed exclusively with phototherapy and without prior exposure to biologic or non-biologic systemic drugs.

For each patient, the index date was designated as the start of the relevant treatment, provided that it occurred after their initial claim listing plaque psoriasis as the primary diagnosis.

Yoon and coauthors' main outcome of interest was MACE, and the team defined such events as hospitalizations with a principal diagnostic code for unstable angina, acute myocardial infarction, ischemic or hemorrhagic stroke, cardiac arrest, or heart failure. Patients were classified as having a prior history of MACE if these diagnoses appeared before their treatment index date.

MACE taking place thereafter were classified by the investigative team as being either new-onset MACEs or recurrent MACEs. They only involved those experiencing a MACE following the index date in the analytic cohort. Treatment persistence within 3 months after a MACE was assessed. Multivariable logistic regression, adjusted for baseline demographic and clinical factors, was applied by Yoon et al to evaluate patients' likelihood of remaining on therapy. Analyses were also stratified by history of prior cardiovascular events.

A total of 3993 subjects were included in the study: 1012 with pre-existing MACE and 2981 without such events. Among these individuals, persistence rates were noted by the investigators to have varied markedly by type of drug. Individuals on biologics demonstrated the highest continuation rate at 79.7%, in contrast to 46.9% for non-biologic systemics and 47.0% for phototherapy. Shifting between medications was relatively uncommon across all of the study's cohorts, ranging from 0.8% - 1.9%.

Yoon and colleagues' regression analyses reinforced the advantage of biologics. Compared with cyclosporine, it was noted that biologics were linked with an odds ratio (OR) of 4.854 (95% CI, 2.476–9.516) for persistence with a treatment. Similarly, the investigators found that odds of persistence were greater when biologics were compared with methotrexate (OR, 3.616; 95% CI, 1.760–7.431) and with phototherapy (OR, 4.556; 95% CI, 2.340–8.873).

Importantly, these associations were consistent in subgroup analyses of both new-onset and recurrent MACE populations. No meaningful difference in persistence emerged between the non-biologic systemic and phototherapy groups. Overall, Yoon et al concluded that those who experienced cardiovascular events were substantially more likely to continue their course of psoriasis therapy if treated with biologics compared to those given non-biologic systemic agents or phototherapy.

“These findings support the preferential continuation of biologic therapy in the post-MACE setting and highlight the need to consider cardiovascular safety in the long-term management of psoriasis,” the investigators wrote.1 “Incorporating these insights into future clinical guidelines and shared decision-making processes may help optimize outcomes for patients with both dermatological and cardiovascular comorbidities.”

References

1. HK Ahn, S Oh, and H.-S. Yoon. Treatment Persistence After Major Cardiovascular Events in Psoriasis: A Retrospective Cohort Study Comparing Biologic, Systemic, and Phototherapy. The Journal of Dermatology (2025): 1–8, https://doi.org/10.1111/1346-8138.17949.

2. Egeberg A, Skov L, Mehta NN, et al. The relationship between duration of psoriasis, vascular inflammation, and cardiovascular events. J Am Acad Dermatol. 2017 Oct;77(4):650-656.e3. doi: 10.1016/j.jaad.2017.06.028. Epub 2017 Aug 18. PMID: 28826925; PMCID: PMC5657544.