BackgroundThe cardiovascular safety profile of biologic therapies used for psoriasis is unclear.ObjectivesTo compare the risk of major cardiovascular events (CVE s; acute coronary syndrome, unstable angina, myocardial infarction and stroke) in patients with chronic plaque psoriasis treated with adalimumab, etanercept or ustekinumab in a large prospective cohort.MethodsProspective cohort study examining the comparative risk of major CVE s was conducted using the British Association of Dermatologists Biologics and Immunomodulators Register. The main analysis compared adults with chronic plaque psoriasis receiving ustekinumab with tumour necrosis-a inhibitors (TNF i: etanercept and adalimumab), whilst the secondary analyses compared ustekinumab, etanercept or methotrexate against adalimumab. Hazard ratios (HR s) with 95% confidence intervals (CI s) were calculated using overlap weights by propensity score to balance baseline covariates among comparison groups.ResultsWe included 5468 biologic-naïve patients subsequently exposed (951 ustekinumab; 1313 etanercept; and 3204 adalimumab) in the main analysis. The secondary analyses also included 2189 patients receiving methotrexate. The median (p25–p75) follow-up times for patients using ustekinumab, TNF i, adalimumab, etanercept and methotrexate were as follows: 2.01 (1.16–3.21), 1.93 (1.05–3.34), 1.94 (1.09–3.32), 1.92 (0.93–3.45) and 1.43 (0.84–2.53) years, respectively. Ustekinumab, TNF i, adalimumab, etanercept and methotrexate groups had 7, 29, 23, 6 and 9 patients experiencing major CVE s, respectively. No differences in the risk of major CVE s were observed between biologic therapies [adjusted HR for ustekinumab vs. TNF i: 0.96 (95% CI 0.41–2.22); ustekinumab vs. adalimumab: 0.81 (0.30–2.17); etanercept vs. adalimumab: 0.81 (0.28–2.30)] and methotrexate against adalimumab [1.05 (0.34–3.28)].ConclusionsIn this large prospective cohort study, we found no significant differences in the risk of major CVE s between three different biologic therapies and methotrexate. Additional studies, with longer term follow-up, are needed to investigate the potential effects of biologic therapies on incidence of major CVE s
