Choice of biologic immunotherapy for psoriasis or psoriatic arthritis not associated with risk of major adverse cardiac events

Objective Individuals with psoriasis or psoriatic arthritis (PsO/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 alpha inhibitors (TNFi), interleukin-17A inhibitors (IL17i), interleukin-23 inhibitors (IL-23i), or interleukin-12/23 inhibitors (IL-12/23i). Time-dependent risk for MACE was calculated using weighted multinomial Cox proportional hazards regression with TNF 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 years (SD 4.5) prior to starting a biologic, the most common being TNFi (62.9%) followed by IL-17i (15.4%), IL-23i (10.7%), and IL12/23i (10.7%). In weighted multinomial Cox proportional hazards regression, the adjusted risk of MACE was similar for IL-17A inhibitors (aHR 0.98, 95% CI 0.73-1.32), IL-23 inhibitors (aHR 0.84, 95% CI 0.54-1.31), and IL-12/23 inhibitors (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 biases confounding. Conclusion MACE risk does not significantly differ across bDMARD classes in PsO/PsA patients. Therefore, cardiovascular risk should not guide biologic selection in this population.