Biologics Most Likely to Be Continued After MACE: Study

KEY TAKEAWAYS

• Biologic therapies had the highest post-major adverse cardiovascular events (MACE) treatment persistence in psoriasis patients (79.7%).

• Non-biologic systemic therapies and phototherapy were associated with higher discontinuation rates.

• Researchers said the study shows the need for updated, evidence-based guidelines on psoriasis management following cardiovascular events.

Biologic therapies were linked with greater treatment persistence than non-biologic systemic agents or phototherapy among patients with psoriasis who experience major adverse cardiovascular events (MACE), according to findings from a retrospective study of Korean national claims data.

The study included data from 3,993 patients with psoriasis (with or without psoriatic arthritis) who experienced a MACE after initiating treatment between 2008 and 2021. Patients were categorized by treatment type: biologics, non-biologic systemic agents (methotrexate or cyclosporine), and phototherapy. The endpoint of interest was whether patients continued, switched, or discontinued treatment within 3 months following MACE.

In patients actively receiving treatment prior to MACE, 79.7% of those on biologics continued therapy vs 46.9% on non-biologic systemic agents and 47.0% on phototherapy. Treatment switching was rare across all groups (range: 0.8% to 6.4%). Biologic therapies were significantly more likely to be continued post-MACE than cyclosporine (OR = 4.854; 95% CI, 2.476 to 9.516), methotrexate (OR = 3.616; 95% CI, 1.760 to 7.431), or phototherapy (OR = 4.556; 95% CI, 2.340 to 8.873) following multivariable analysis.

Almost half of patients receiving non-biologic agents or phototherapy discontinued treatment post-event, with minimal switching to safer alternatives. The authors suggested this reflects both a lack of clinical guidance and potentially restrictive reimbursement policies.

“Biologic therapy was associated with significantly higher treatment persistence following MACE compared to non-biologic systemic agents and phototherapy,” the authors wrote. “These findings support the preferential continuation of biologic therapy in the post-MACE setting and highlight the need to consider cardiovascular safety in the long-term management of psoriasis.”

Source: Ahn HK, Oh S, Yoon H-S. J Dermatol. 2025;0:1–8. doi:10.1111/1346-8138.17949.