THE RELATIONSHIP between biologic therapies and the risk of major adverse cardiovascular events (MACEs) and venous thromboembolic events (VTEs) in patients with psoriatic disease has not been fully established. This study aimed to evaluate whether novel biologics, such as interleukin 17 inhibitors (IL-17i), interleukin 12/23 inhibitors (IL-12/23i), and interleukin 23 inhibitors (IL-23i), pose different risks of MACE and VTE compared with tumour necrosis factor inhibitors (TNFi) in biologic-naïve patients with psoriasis or psoriatic arthritis (PsA).
Using data from the TriNetX Research Network, researchers conducted an emulated target trial involving 32,098 biologic-naïve patients treated between 2014 and 2022. Participants were categorised based on their first biologic prescription, forming four cohorts: 20,314 patients receiving TNFi, 5073 with IL-17i, 3573 with IL-12/23i, and 3138 with IL-23i. Three propensity-matched groups were analysed to compare the incidence rates and incidence rate ratios of MACE and VTE among IL-17i, IL-12/23i, and IL-23i versus TNFi users.
The results showed no significant differences in the risks of MACE or VTE between patients treated with IL-17i, IL-12/23i, or IL-23i and those treated with TNFi. This lack of difference was consistent across subgroup analyses for patients with either psoriasis or PsA. However, among patients with pre-existing conditions such as hyperlipidaemia and diabetes mellitus, the risks of MACE and VTE were lower in those using newer biologics (IL-17i, IL-12/23i, or IL-23i) compared to TNFi.
Although the findings are robust, the study was limited by the lack of data on psoriasis severity, which may have influenced outcomes. Nevertheless, these results suggest that IL-17i, IL-12/23i, and IL-23i are not associated with increased cardiovascular or thromboembolic risks compared with TNFi. These insights can assist healthcare providers and patients in making informed clinical decisions and contribute to future pharmacovigilance efforts.
Katie Wright, EMJ
Reference
Chen TL et al. Risk of major adverse cardiovascular events and venous thromboembolic events between patients with psoriasis or psoriatic arthritis on tumor necrosis factor inhibitors, interleukin 17 inhibitors, interleukin 12/23 inhibitors, and interleukin 23 inhibitors: An emulated target trial analysis. J Am Acad Dermatol. 2024;DOI:10.1016/j.jaad.2024.12.025.
