Biological, as opposed to classic antipsoriatic drug or apremilast, treatment mitigates the risk of death and cardiovascular disease in psoriasis

Khalaf Kridin; Katja Bieber; Artem Vorobyev; Eva Lotta Moderegger; Henning Olbrich; Marlene A. Ludwig; Bernard Gershater; Gema Hernandez; Henner Zirpel; Diamant Thaci; Ralf J. Ludwig

doi:10.1016/j.ebiom.2024.105485

Biological, as opposed to classic antipsoriatic drug or apremilast, treatment mitigates the risk of death and cardiovascular disease in psoriasis

Khalaf Kridin, Katja Bieber, Artem Vorobyev, Eva Lotta Moderegger, Henning Olbrich, Marlene A. Ludwig, Bernard Gershater, Gema Hernandez, Henner Zirpel, Diamant Thaci, Ralf J. Ludwig^*

^*Korrespondierende/r Autor/-in für diese Arbeit

9 Zitate (Scopus)

Abstract

Background: Cardiovascular comorbidity increases morbidity and mortality in psoriasis. Systemic treatments, particularly biologics, are effective in alleviating skin and joint inflammation. Conversely, the impact of systemic therapy on cardiovascular disease risk and mortality in psoriasis remains uncertain. Methods: Impact of systemic treatments on all-cause mortality and cardiovascular disease risk in psoriasis patients' electronic health records (EHRs) from TriNetX was assessed. Treatment categories included apremilast, IL-17 inhibitors (IL-17i), IL23i, TNFi, and classic antipsoriatic drugs. Index event was the first prescription of each treatment, requiring a two-year continuous treatment with exclusion of other systemic antipsoriatic drugs. Propensity-score matching was used to improve comparability. Sensitivity analyses ensured study robustness. Findings: In descriptive analysis, all-cause mortality rates were 0.61% (classic antipsoriatics, n = 7929), 0.91% (apremilast, n = 1101), 0.00% (IL17i, n = 677), 0.81% (IL23i, n = 1242), and 0.20% (TNFi, n = 6468). Major adverse cardiac events (MACE) were documented in 8.49% (classic antipsoriatics), 5.14% (apremilast), 2.99% (IL17i), 2.09% (IL23i), and 3.74% (TNFi) EHRs. Propensity-score matching showed all-cause mortality rates of 0.23% for any biologic vs. 0.49% for classic antipsoriatics or apremilast, resulting in an HR of 2.21 (95% CI 1.21–3.71, p = 0.0073). MACE risk was also higher with classic antipsoriatics or apremilast (HR 1.66, CI 1.43–1.93, p < 0.0001). The majority of findings were consistent across all four sensitivity analyses. No significant differences in all-cause mortality or MACE risk were observed among biologics. Interpretation: Biological treatment, as opposed to classic antipsoriatic drugs or apremilast, reduces risk of death and cardiovascular disease in psoriasis. Prospective trials are required to validate these findings. Funding: DFG: EXC 2167 and LU 877/25-1. State of Schleswig Holstein: Excellence-Chair Program.

Originalsprache	Englisch
Aufsatznummer	105485
Zeitschrift	eBioMedicine
Jahrgang	111
DOIs	https://doi.org/10.1016/j.ebiom.2024.105485
Publikationsstatus	Veröffentlicht - 01.2025

Fördermittel

This study was funded by the Cluster of Excellence “Precision Medicine in Chronic Inflammation” (EXC 2167), the Collaborative Research Centre “Pathomechanisms of Antibody-mediated Autoimmunity” (SFB 1526), the Individual Research Grant DFG LU 877/25-1, all from the Deutsche Forschungsgemeinschaft, the Schleswig-Holstein Excellence-Chair Program from the State of Schleswig Holstein,

Träger	Trägernummer
State of Schleswig-Holstein*
Deutsche Forschungsgemeinschaft

UN SDGs

Dieser Output leistet einen Beitrag zu folgendem(n) Ziel(en) für nachhaltige Entwicklung

SDG 3 – Gesundheit und Wohlergehen

Strategische Forschungsbereiche und Zentren

Forschungsschwerpunkt: Infektion und Entzündung - Zentrum für Infektions- und Entzündungsforschung Lübeck (ZIEL)
Zentren: Center for Research on Inflammation of the Skin (CRIS)
Zentren: Universitäres Herzzentrum Lübeck (UHZL)

DFG-Fachsystematik

2.21-05 Immunologie
2.22-19 Dermatologie
2.22-09 Pharmakologie
2.22-12 Kardiologie, Angiologie

Dokumente

10.1016/j.ebiom.2024.105485

Weitere Links

Link to publication in Scopus

Zitieren

Kridin, K., Bieber, K., Vorobyev, A., Moderegger, E. L., Olbrich, H., Ludwig, M. A., Gershater, B., Hernandez, G., Zirpel, H., Thaci, D., & Ludwig, R. J. (2025). Biological, as opposed to classic antipsoriatic drug or apremilast, treatment mitigates the risk of death and cardiovascular disease in psoriasis. eBioMedicine, 111, Artikel 105485. https://doi.org/10.1016/j.ebiom.2024.105485

@article{21afb6a66b2042b08444336924286d93,

title = "Biological, as opposed to classic antipsoriatic drug or apremilast, treatment mitigates the risk of death and cardiovascular disease in psoriasis",

abstract = "Background: Cardiovascular comorbidity increases morbidity and mortality in psoriasis. Systemic treatments, particularly biologics, are effective in alleviating skin and joint inflammation. Conversely, the impact of systemic therapy on cardiovascular disease risk and mortality in psoriasis remains uncertain. Methods: Impact of systemic treatments on all-cause mortality and cardiovascular disease risk in psoriasis patients' electronic health records (EHRs) from TriNetX was assessed. Treatment categories included apremilast, IL-17 inhibitors (IL-17i), IL23i, TNFi, and classic antipsoriatic drugs. Index event was the first prescription of each treatment, requiring a two-year continuous treatment with exclusion of other systemic antipsoriatic drugs. Propensity-score matching was used to improve comparability. Sensitivity analyses ensured study robustness. Findings: In descriptive analysis, all-cause mortality rates were 0.61\% (classic antipsoriatics, n = 7929), 0.91\% (apremilast, n = 1101), 0.00\% (IL17i, n = 677), 0.81\% (IL23i, n = 1242), and 0.20\% (TNFi, n = 6468). Major adverse cardiac events (MACE) were documented in 8.49\% (classic antipsoriatics), 5.14\% (apremilast), 2.99\% (IL17i), 2.09\% (IL23i), and 3.74\% (TNFi) EHRs. Propensity-score matching showed all-cause mortality rates of 0.23\% for any biologic vs. 0.49\% for classic antipsoriatics or apremilast, resulting in an HR of 2.21 (95\% CI 1.21–3.71, p = 0.0073). MACE risk was also higher with classic antipsoriatics or apremilast (HR 1.66, CI 1.43–1.93, p < 0.0001). The majority of findings were consistent across all four sensitivity analyses. No significant differences in all-cause mortality or MACE risk were observed among biologics. Interpretation: Biological treatment, as opposed to classic antipsoriatic drugs or apremilast, reduces risk of death and cardiovascular disease in psoriasis. Prospective trials are required to validate these findings. Funding: DFG: EXC 2167 and LU 877/25-1. State of Schleswig Holstein: Excellence-Chair Program.",

author = "Khalaf Kridin and Katja Bieber and Artem Vorobyev and Moderegger, \{Eva Lotta\} and Henning Olbrich and Ludwig, \{Marlene A.\} and Bernard Gershater and Gema Hernandez and Henner Zirpel and Diamant Thaci and Ludwig, \{Ralf J.\}",

note = "Publisher Copyright: {\textcopyright} 2024 The Author(s)",

year = "2025",

month = jan,

doi = "10.1016/j.ebiom.2024.105485",

language = "English",

volume = "111",

journal = "eBioMedicine",

issn = "2352-3964",

publisher = "Elsevier B.V.",

}

TY - JOUR

T1 - Biological, as opposed to classic antipsoriatic drug or apremilast, treatment mitigates the risk of death and cardiovascular disease in psoriasis

AU - Kridin, Khalaf

AU - Bieber, Katja

AU - Vorobyev, Artem

AU - Moderegger, Eva Lotta

AU - Olbrich, Henning

AU - Ludwig, Marlene A.

AU - Gershater, Bernard

AU - Hernandez, Gema

AU - Zirpel, Henner

AU - Thaci, Diamant

AU - Ludwig, Ralf J.

PY - 2025/1

Y1 - 2025/1

N2 - Background: Cardiovascular comorbidity increases morbidity and mortality in psoriasis. Systemic treatments, particularly biologics, are effective in alleviating skin and joint inflammation. Conversely, the impact of systemic therapy on cardiovascular disease risk and mortality in psoriasis remains uncertain. Methods: Impact of systemic treatments on all-cause mortality and cardiovascular disease risk in psoriasis patients' electronic health records (EHRs) from TriNetX was assessed. Treatment categories included apremilast, IL-17 inhibitors (IL-17i), IL23i, TNFi, and classic antipsoriatic drugs. Index event was the first prescription of each treatment, requiring a two-year continuous treatment with exclusion of other systemic antipsoriatic drugs. Propensity-score matching was used to improve comparability. Sensitivity analyses ensured study robustness. Findings: In descriptive analysis, all-cause mortality rates were 0.61% (classic antipsoriatics, n = 7929), 0.91% (apremilast, n = 1101), 0.00% (IL17i, n = 677), 0.81% (IL23i, n = 1242), and 0.20% (TNFi, n = 6468). Major adverse cardiac events (MACE) were documented in 8.49% (classic antipsoriatics), 5.14% (apremilast), 2.99% (IL17i), 2.09% (IL23i), and 3.74% (TNFi) EHRs. Propensity-score matching showed all-cause mortality rates of 0.23% for any biologic vs. 0.49% for classic antipsoriatics or apremilast, resulting in an HR of 2.21 (95% CI 1.21–3.71, p = 0.0073). MACE risk was also higher with classic antipsoriatics or apremilast (HR 1.66, CI 1.43–1.93, p < 0.0001). The majority of findings were consistent across all four sensitivity analyses. No significant differences in all-cause mortality or MACE risk were observed among biologics. Interpretation: Biological treatment, as opposed to classic antipsoriatic drugs or apremilast, reduces risk of death and cardiovascular disease in psoriasis. Prospective trials are required to validate these findings. Funding: DFG: EXC 2167 and LU 877/25-1. State of Schleswig Holstein: Excellence-Chair Program.

AB - Background: Cardiovascular comorbidity increases morbidity and mortality in psoriasis. Systemic treatments, particularly biologics, are effective in alleviating skin and joint inflammation. Conversely, the impact of systemic therapy on cardiovascular disease risk and mortality in psoriasis remains uncertain. Methods: Impact of systemic treatments on all-cause mortality and cardiovascular disease risk in psoriasis patients' electronic health records (EHRs) from TriNetX was assessed. Treatment categories included apremilast, IL-17 inhibitors (IL-17i), IL23i, TNFi, and classic antipsoriatic drugs. Index event was the first prescription of each treatment, requiring a two-year continuous treatment with exclusion of other systemic antipsoriatic drugs. Propensity-score matching was used to improve comparability. Sensitivity analyses ensured study robustness. Findings: In descriptive analysis, all-cause mortality rates were 0.61% (classic antipsoriatics, n = 7929), 0.91% (apremilast, n = 1101), 0.00% (IL17i, n = 677), 0.81% (IL23i, n = 1242), and 0.20% (TNFi, n = 6468). Major adverse cardiac events (MACE) were documented in 8.49% (classic antipsoriatics), 5.14% (apremilast), 2.99% (IL17i), 2.09% (IL23i), and 3.74% (TNFi) EHRs. Propensity-score matching showed all-cause mortality rates of 0.23% for any biologic vs. 0.49% for classic antipsoriatics or apremilast, resulting in an HR of 2.21 (95% CI 1.21–3.71, p = 0.0073). MACE risk was also higher with classic antipsoriatics or apremilast (HR 1.66, CI 1.43–1.93, p < 0.0001). The majority of findings were consistent across all four sensitivity analyses. No significant differences in all-cause mortality or MACE risk were observed among biologics. Interpretation: Biological treatment, as opposed to classic antipsoriatic drugs or apremilast, reduces risk of death and cardiovascular disease in psoriasis. Prospective trials are required to validate these findings. Funding: DFG: EXC 2167 and LU 877/25-1. State of Schleswig Holstein: Excellence-Chair Program.

UR - https://www.scopus.com/pages/publications/85211052448

U2 - 10.1016/j.ebiom.2024.105485

DO - 10.1016/j.ebiom.2024.105485

M3 - Journal articles

C2 - 39644770

AN - SCOPUS:85211052448

SN - 2352-3964

VL - 111

JO - eBioMedicine

JF - eBioMedicine

M1 - 105485

ER -

Biological, as opposed to classic antipsoriatic drug or apremilast, treatment mitigates the risk of death and cardiovascular disease in psoriasis

Abstract

Fördermittel

UN SDGs

Strategische Forschungsbereiche und Zentren

DFG-Fachsystematik

Dokumente

Weitere Links

Fingerprint

Zitieren