Risk of Major Cardiovascular Events in Patients with Psoriasis Receiving Biologic Therapies: a Prospective Cohort Study

Watcharee Rungapiromnan, K.J. Mason, Mark Lunt, Kathleen Mcelhone, A.D. Burden, M.K. Rutter, R.B. Warren, C.E.M. Griffiths, D.M. Ashcroft

Research output: Contribution to journalArticlepeer-review


BACKGROUND The cardiovascular safety profile of biologic therapies used for psoriasis is unclear.

OBJECTIVES To compare the risk of major cardiovascular events (CVEs; 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.

METHODS Prospective cohort study examining the comparative risk of major CVEs was conducted using the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR). The main analysis compared adults with chronic plaque psoriasis receiving ustekinumab with tumour necrosis-α inhibitors (TNFi: etanercept and adalimumab) while the secondary analyses compared ustekinumab, etanercept, or methotrexate against adalimumab. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using overlap weights by propensity score to balance baseline covariates among comparison groups.

RESULTS We included 5,468 biologic-naïve patients subsequently exposed (951 ustekinumab; 1,313 etanercept; and 3,204 adalimumab) in the main analysis. The secondary analyses also included 2,189 patients receiving methotrexate. The median (p25 - p75) follow up times for patients using ustekinumab, TNFi, adalimumab, etanercept and methotrexate were: 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, TNFi, adalimumab, etanercept and methotrexate groups had 7, 29, 23, 6 and 9 patients experiencing major CVEs, respectively. No differences in the risk of major CVEs were observed between biologic therapies (adjusted HR for ustekinumab vs TNFi: 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]).

CONCLUSIONS In this large prospective cohort study, we found no significant differences in the risk of major CVEs 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 CVEs.
Original languageEnglish
Pages (from-to)769-778
Number of pages10
JournalJournal of the European Academy of Dermatology and Venereology
Early online date21 Oct 2019
Publication statusPublished - 2020


  • adalimumab
  • etanercept
  • major cardiovascular events
  • methotrexate
  • psoriasis
  • ustekinumab


Dive into the research topics of 'Risk of Major Cardiovascular Events in Patients with Psoriasis Receiving Biologic Therapies: a Prospective Cohort Study'. Together they form a unique fingerprint.

Cite this