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Updated: May 9, 2025
The Goeckerman Regimen for the Treatment of Moderate to Severe Psoriasis
Published on: July 11, 2013
Cardiovascular safety of systemic psoriasis treatments: A prospective cohort study in the BIOBADADERM registry
Juan José Lluch-Galcerá1, José Manuel Carrascosa2, Alicia González-Quesada3
1Department of Dermatology, Hospital General de Granollers, Granollers, Universitat Autònoma de Barcelona, Departament de Medicina, Barcelona, Spain.
Insights
Apremilast (APR) and IL-17 inhibitors show lower major adverse cardiovascular events (MACE) risk in psoriasis patients compared to methotrexate (MTX). Cyclosporine increases MACE risk, highlighting the need to consider cardiovascular outcomes in systemic psoriasis treatment selection.
Area of Science:
- Cardiovascular Medicine
- Dermatology
- Pharmacology
Background:
- Psoriasis is a chronic inflammatory condition linked to increased cardiovascular risk.
- Limited evidence exists comparing cardiovascular event rates across systemic psoriasis treatments.
- Major Adverse Cardiovascular Events (MACE) are a significant comorbidity in psoriasis patients.
Purpose of the Study:
- To compare the incidence of MACE across various systemic psoriasis treatments.
- To evaluate the relative risk of MACE associated with biologics, conventional therapies, and apremilast (APR) versus methotrexate (MTX).
Main Methods:
- Prospective cohort study utilizing the BIOBADADERM registry.
- Propensity score matching to control for baseline differences between treatment groups.
- Incidence rates (IR) of MACE calculated for each treatment class and compared to MTX using Poisson regression.
Main Results:
- Apremilast (APR) and IL-17 inhibitors demonstrated a significantly lower risk of MACE compared to methotrexate (MTX).
- Cyclosporine was associated with a significantly higher risk of MACE compared to MTX.
- Other systemic treatments showed no significant difference in MACE risk compared to MTX.
Conclusions:
- Real-world evidence suggests APR and IL-17 inhibitors may be associated with reduced MACE incidence in psoriasis patients.
- Cyclosporine use in psoriasis patients may be linked to an increased MACE incidence.
- Cardiovascular risk assessment is crucial when selecting systemic therapies for psoriasis management.
Background:
Psoriasis is a chronic inflammatory disease with multiple comorbidities, including an increased risk of major adverse cardiovascular events (MACE). There is limited and contradictory evidence comparing the impact of systemic treatments for psoriasis on MACE.
Objectives:
To evaluate the incidence of MACE associated with each systemic treatment used for patients with psoriasis and compare these rates to those observed with methotrexate (MTX).
Methods:
We conducted a prospective cohort study using data from the BIOBADADERM registry. Propensity score matching was used to adjust for baseline differences between treatment groups. We calculated the incidence rate (IR) of MACE for each systemic treatment class, including biologics (anti-TNF, IL-12/23, IL-17 and IL-23 inhibitors), conventional systemic therapies (MTX, cyclosporine, dimethyl fumarate and acitretin) and apremilast (APR). The IR for each group was compared to those observed in patients treated with MTX using Poisson regression models adjusted for potential confounders, with 95% confidence intervals (95% CI). The primary outcome was the adjusted incidence rate ratios (IRR) for MACE between patients receiving MTX and those receiving another systemic treatment.
Results:
We analysed data from 5622 patients, 11,368 treatment cycles and 21,762 person-years (PYs). APR (IRR = 0.17; 95% CI, 0.04-0.70) and IL-17 (IRR = 0.43; 95% CI, 0.20-0.91) were associated with a significant reduction in the risk of MACE compared to MTX. Cyclosporine was associated with an increased risk of MACE (IRR = 3.59; 95% CI, 1.17-10.99) compared to MTX. The remaining systemic psoriasis treatments were not significantly associated with an increased or decreased risk of MACE.
Conclusions:
This real-world evidence study indicates a potential association between APR and IL-17 with a lower incidence of MACE, while CYC showed a higher incidence compared to MTX. These findings underscore the importance of considering cardiovascular outcomes when selecting systemic therapies for patients with psoriasis.
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