Psoriasis is associated with an increased risk of major adverse cardiovascular events (MACE), and biologic therapy may reduce this risk by targeting systemic inflammation. However, limited data exist on whether long term MACE risk differs by biologic class or across racial groups. We conducted a retrospective cohort study to assess the risk of primary MACE in psoriasis patients receiving biological therapies, stratified by biological class, compared with biologic-naïve psoriasis patients. Whether MACE risk among biologic-treated patients varied by race was further examined. After 1:1 propensity score matching, 36 330 biologic-treated patients were compared with 36 330 non-biologic-treated patients. Incident MACE was assessed over 10 years. Class-specific analyses evaluated mutually exclusive biologic exposure groups, including TNF inhibitors (TNFi), IL-17 inhibitors (IL-17i), IL-12/23 inhibitors (IL-12/23i), and IL-23 inhibitors (IL-23i), each compared with an independently matched nonbiologic psoriasis comparator cohort. Race stratified analyses were restricted to biologic-treated patients, with White patients serving as the reference group. Psoriasis patients treated with biologics exhibited a 37% lower hazard of MACE compared with non-biologic users over the 10-year follow-up period [2160 vs. 3294; HR 0.63 (0.60-0.67)]. Class-specific analyses revealed reductions in MACE risk for TNFi [1403 vs. 1844; HR: 0.74 (0.69-0.80)], IL-17i [285 vs. 450; HR: 0.61 (0.53-0.72)], IL-12/23i [280 vs. 374; HR: 0.73 (0.62-0.86)], and IL-23i [238 vs. 363; HR: 0.64 (0.54-0.76)]. Race stratified analyses showed broadly similar MACE risk across racial groups; although, patients identifying as Non-White treated with TNFi did experience a reduced MACE risk compared to White patients [127 vs. 162; HR: 0.79 (0.62-0.99)]. This isolated finding should be interpreted cautiously given multiple race stratified comparisons. Overall, biologic therapy is associated with lower 10-year MACE risk among patients with psoriasis, with findings observed across biologic classes and largely consistent across racial strata.
