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

IF 9.7 1区医学 Q1 MEDICINE, RESEARCH & EXPERIMENTAL

EBioMedicine Pub Date : 2025-01-01 Epub Date: 2024-12-06 DOI:10.1016/j.ebiom.2024.105485

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

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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.

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与传统的抗银屑病药物或阿普米司特不同，生物疗法可以降低银屑病患者死亡和心血管疾病的风险。

背景：心血管合并症增加牛皮癣的发病率和死亡率。全身治疗，特别是生物制剂，在减轻皮肤和关节炎症方面是有效的。相反，全身治疗对牛皮癣患者心血管疾病风险和死亡率的影响仍不确定。方法：评估系统治疗对TriNetX银屑病患者电子健康记录（EHRs）中全因死亡率和心血管疾病风险的影响。治疗类别包括阿普米司特、IL-17抑制剂（IL-17i）、il - 23i、TNFi和经典抗银屑病药物。指标事件是每种治疗的第一个处方，需要连续治疗两年，排除其他全身抗银屑病药物。采用倾向-得分匹配提高可比性。敏感性分析确保了研究的稳健性。结果：在描述性分析中，全因死亡率分别为0.61%（经典抗银屑病药，n = 7929）、0.91%（阿普利司特，n = 1101）、0.00% （IL17i, n = 677）、0.81% （IL23i, n = 1242）和0.20% （TNFi, n = 6468）。主要心脏不良事件（MACE）记录在8.49%（经典抗银屑病药）、5.14%（阿普米司特）、2.99% （IL17i）、2.09% （IL23i）和3.74% （TNFi）的电子病历中。倾向评分匹配显示，任何生物制剂的全因死亡率为0.23%，而经典抗银屑病药或阿普米司特的全因死亡率为0.49%，HR为2.21 （95% CI 1.21-3.71, p = 0.0073）。经典抗银屑病药物或阿普米司特的MACE风险也更高（HR 1.66, CI 1.43-1.93, p）解释：与经典抗银屑病药物或阿普米司特相比，生物治疗可降低银屑病患者的死亡和心血管疾病风险。需要前瞻性试验来验证这些发现。资助：DFG: EXC 2167和LU 877/25-1。石勒苏益格-荷尔斯泰因州：卓越主席计划。

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来源期刊

EBioMedicine Biochemistry, Genetics and Molecular Biology-General Biochemistry,Genetics and Molecular Biology

CiteScore

17.70

自引率

0.90%

发文量

579

审稿时长

5 weeks

期刊介绍： eBioMedicine is a comprehensive biomedical research journal that covers a wide range of studies that are relevant to human health. Our focus is on original research that explores the fundamental factors influencing human health and disease, including the discovery of new therapeutic targets and treatments, the identification of biomarkers and diagnostic tools, and the investigation and modification of disease pathways and mechanisms. We welcome studies from any biomedical discipline that contribute to our understanding of disease and aim to improve human health.