Analysis: No Added MACE Risk With Ustekinumab in Psoriasis and PsA

Key Takeaways

• Ustekinumab did not show increased MACE risk compared to adalimumab, etanercept, or secukinumab.

• Cardiovascular event rates were low across all biologic treatments.

New research suggests no difference in the risk of major adverse cardiovascular events (MACE) among patients with psoriasis (PsO) and psoriatic arthritis (PsA) initiating ustekinumab compared to adalimumab, etanercept, or secukinumab.

Publishing in the Journal of the American Academy of Dermatology, the study included more than 15,000 Swedish adults (with both prior biologic use and biolo treated between 2009 and 2021. Both incident user and biologic-naïve populations were analyzed. The primary outcome of interest, MACE, was defined as myocardial infarction, ischemic stroke, or cardiovascular-related death.

Crude MACE incidence rates were low across all groups. Ustekinumab showed 0.72 events per 100 person-years vs. 0.50 for adalimumab and etanercept and 0.71 for secukinumab. After adjustment, hazard ratios for ustekinumab versus comparators did not reach statistical significance

“In this nationwide study of Swedish PsO and PsA patients treated with ustekinumab, etanercept, adalimumab, or secukinumab, spanning more than 10 years, the overall risk of MACE was low across treatment groups and no meaningful difference in risk of MACE between ustekinumab and the other treatments was observed,” the authors concluded. 

Study limitations included its observational design and lack of data on lifestyle factors like smoking or BMI. 

Source: Banefelt J, et al. JAAD. 2025. doi:10.1016/j.jaad.2025.03.016