Biologic Therapy Linked to Lower 10-Year MACE Risk Across Racial Groups in Psoriasis

A retrospective cohort study found that biologic therapy was associated with a lower 10-year risk of major adverse cardiovascular events (MACE) among patients with psoriasis, with similar findings observed across multiple biologic classes and racial groups.¹ The findings add real-world evidence to previous research suggesting that biologic treatment may have a favorable cardiovascular profile in patients with psoriasis.^2,3

Study Design

The study used de-identified data from the TriNetX research platform collected between 2015 and 2025. Investigators identified adults aged 18 to 89 years with psoriasis and excluded those with a prior history of MACE. Patients receiving biologic therapy were compared with psoriasis patients who had not received biologics. After 1:1 propensity score matching, each cohort included 36,330 patients.

The analysis evaluated 4 biologic classes: tumor necrosis factor inhibitors (TNFi), interleukin (IL)-17 inhibitors, IL-23 inhibitors, and IL-12/23 inhibitors. To limit confounding from switching between mechanisms, class-specific analyses included mutually exclusive groups; patients with a history of exposure to another biologic class were excluded from the respective class analysis.

Reduction in MACE Hazard Across Biologic Classes

Over 10 years, 2160 patients in the biologic-treated cohort experienced a MACE compared with 3294 patients in the biologic-naïve cohort. Biologic therapy was associated with a 37% lower hazard of MACE (HR, 0.63; 95% CI, 0.60-0.67).

Each biologic class examined also demonstrated a lower MACE hazard compared with its independently matched biologic-naïve control group. TNFi therapy was associated with a 26% lower hazard (HR, 0.74; 95% CI, 0.69-0.80), while IL-17 inhibitors were associated with a 39% lower hazard (HR, 0.61; 95% CI, 0.53-0.72). IL-12/23 inhibitors were associated with a 27% lower hazard (HR, 0.73; 95% CI, 0.62-0.86), and IL-23 inhibitors with a 36% lower hazard (HR, 0.64; 95% CI, 0.54-0.76).

Consistent Cardiovascular Protection Across Racial Subgroups

The investigators also examined whether MACE risk differed by race among biologic-treated patients. White patients served as the reference group. Among patients receiving any biologic therapy, MACE risk did not differ significantly between pooled non-white and white populations (HR, 0.94; 95% CI, 0.80-1.09). Similar results were observed in comparisons of Black and Asian patients with white patients.

Class-specific analyses likewise showed no statistically significant differences between non-white and white patients for IL-17, IL-23, or IL-12/23 inhibitors. The exception was the TNFi group, in which non-white patients had a 21% lower hazard of MACE than White patients (HR, 0.79; 95% CI, 0.62-0.99). However, the investigators characterized this isolated finding as hypothesis-generating because of the number of race-stratified comparisons. The pattern was not consistently reproduced in separate Black-versus-White or Asian-versus-White analyses.

Contextualizing Race and Social Determinants of Health

The authors emphasized that race should not be interpreted as a biological determinant of cardiovascular response to biologic therapy. Instead, race recorded in electronic health records may reflect differences in health care access, specialist referral, comorbidity screening, cardiovascular risk management, and continuity of care.

The study has several limitations. Its retrospective observational design prevents conclusions about causality, and residual confounding may remain despite propensity matching. The database also had limited information on psoriasis severity, disease duration, body surface area, adherence, and some health care-access factors. Race was derived from electronic health record fields, and the pooled non-white category included heterogeneous racial groups. Additionally, excluding patients who switched between biologic classes limits the generalizability of class-specific findings to routine clinical practice.

Overall, the findings showed an association between biologic therapy and lower 10-year MACE risk across the biologic classes evaluated, with broadly consistent cardiovascular outcomes across racial groups. The authors concluded that the results support equitable access to biologic therapies for patients with psoriasis while noting that the observational findings remain hypothesis-generating.

References

1. Ro C, Ormaza Vera A, Adawi W, Enos CW. Assessment of Major Adverse Cardiovascular Event Across Diverse Racial Groups of Psoriasis Patients on Biologic Therapy: A Retrospective Cohort Study. J Dermatol. Published online July 26, 2026. doi:10.1111/1346-8138.70396

2. Song WJ, Oh S, Yoon HS. Association between biologic and nonbiologic systemic therapy for psoriasis and psoriatic arthritis and the risk of new-onset and recurrent major adverse cardiovascular events: A retrospective cohort study. J Am Acad Dermatol. 2025;93(1):141-149. doi:10.1016/j.jaad.2025.03.055

3. Chen TL, Huang JY, Lin HY, Chang YT, Li CY, Wei JC. Risk of major adverse cardiovascular events and venous thromboembolic events between patients with psoriasis or psoriatic arthritis on tumor necrosis factor inhibitors, interleukin 17 inhibitors, interleukin 12/23 inhibitors, and interleukin 23 inhibitors: An emulated target trial analysis. J Am Acad Dermatol. 2025;92(5):1015-1023. doi:10.1016/j.jaad.2024.12.025