No Difference Seen in Cardiac Effects Between Ustekinumab, Anti-TNF Drugs for Psoriasis

A recent study found no difference in the risk of developing atrial fibrillation (AF) or major adverse cardiovascular events (MACE) associated with ustekinumab versus anti—tumor necrosis factor (anti-TNF) therapy in patients with psoriasis or psoriatic arthritis.

However, the researchers said additional studies about potentially modifying treatment effects stratified by important risk factors may be warranted.

Evidence about the comparative cardiovascular CVD safety of current biologic treatments remains limited, even as a growing amount evidence indicates that there is an increased risk of cardiovascular disease among patients with psoriatic disease. Psoriatic disease is an independent risk factor for CVD with a 28% increase in risk of coronary heart disease, 6% to 12% increase in risk of stroke, and 20% increase in risk of a composite end point of myocardial infarction and stroke among patients with psoriatic disease compared with the general population.

Intervening early in psoriasis may control the systemic inflammation implicated in both diseases, researchers wrote. Psoriasis affects 125 million people worldwide. Newer biologics, such as ustekinumab, are more targeted to the inflammatory pathways involved in psoriasis. Ustekinumab works by blocking interleukin-17 and -23.

The study, published in JAMA Dermatology ,included data from a nationwide sample of 78,162 commercially insured patients in 2 databases (Optum and MarketScan) from September 25, 2009, through September 30, 2015. Patients were included if they were 18 years or older, had psoriasis or psoriatic arthritis, and began a ustekinumab or an anti-TNF therapy.

A total of 60,028 patients with psoriasis or psoriatic arthritis were included in the analysis (9071 using ustekinumab and 50,957 using an anti-TNF.). The mean age was 46 years in Optum and 47 in MarketScan; 29,495 (49.1%) were male. Overall crude incidence rates (reported per 1000 person-years) for AF were 5.0 (95% CI, 3.8-6.5) for ustekinumab initiators and 4.7 (95% CI, 4.2-5.2) for anti-TNF initiators. Incidence rates for MACE were 6.2 (95% CI, 4.9-7.8) for ustekinumab initiators and 6.1 (95% CI, 5.5-6.7) for anti-TNF initiators.

The combined adjusted hazard ratio for AF for those on ustekinumab was 1.08 (95% CI, 0.76-1.54); for MACE among those on ustekinumab, it was1.10 (95% CI, 0.80-1.52) compared with those on anti-TNF therapies.

The risks did not appear to substantially differ across the subgroups included in the study.

Reference

Lee MP, Desai RJ, Jin Y, Brill G, Ogdie A, Kim SC. Association of ustekinumab vs tnf inhibitor therapy with risk of atrial fibrillation and cardiovascular events in patients with psoriasis or psoriatic arthritis. JAMA Dermatol. 2019;155(6):700-707. doi:10.1001/jamadermatol.2019.0001.