Meta-Analysis of Long-Term Major Adverse Cardiovascular Events of Different Biologics in Psoriatic Patients

BACKGROUND: Psoriasis is a chronic immune-mediated inflammatory disease associated with systemic inflammation and an increased risk of cardiovascular events. AREAS OF UNCERTAINTY: Although biologic therapies have transformed psoriasis treatment, the long-term impact of different biologic classes on major adverse cardiovascular events (MACE) remains unclear. DATA SOURCES: A systematic search of PubMed was performed up to May 27, 2026. We included Comparative cohort studies of biologic therapies for psoriasis with follow-up durations of at least 52 weeks, as well as long-term open-label extension phases of randomized controlled trials that reported MACE outcomes. Study quality was assessed using the Newcastle-Ottawa Scale for cohort studies. Hazard ratios (HR) with 95% confidence intervals (CI) were pooled using the generic inverse variance method. RESULTS: Four comparative cohort studies involving 57,331 patients were included in the quantitative synthesis. No significant difference in MACE risk was observed between interleukin (IL)-12/23 inhibitors and tumor necrosis factor alpha (TNF-α) inhibitors (HR: 0.91, 95% CI: 0.68-1.23), or between IL-12/23 inhibitors and IL-17 inhibitors (HR: 1.38, 95% CI: 0.73-2.62). Long-term open-label extension studies reported low MACE event rates (0%-1.33%) across biologic therapies. CONCLUSIONS: Among biologic therapies with available long-term comparative data, no significant differences in MACE risk were observed between IL-12/23, TNF-α, and IL-17 inhibitors in patients with psoriasis. Further long-term, large-scale studies are warranted to better define the cardiovascular safety profiles of emerging biologic therapies.