Psoriasis Biologic Therapy Linked to Lower Cardiovascular Risk

Major adverse cardiovascular events (MACEs) occurred in roughly 5.9% of biologic-treated patients (2160 of 36,330) living with psoriasis compared with 9.1% of biologic-naive patients (3294 of 36,330) over a 10-year follow-up period in a recent investigation. The findings show a 3.12 percentage-point absolute reduction, according to a new retrospective cohort study published in The Journal of Dermatology. Psoriasis is a chronic inflammatory disease that affects roughly 2% to 3% of the global population, and patients with psoriasis face an increased risk of MACEs. This study compared patients treated with biologic therapies with biologic-naive patients, and whether MACE risk among biologic-treated patients varied by race.¹

Racial Disparities in Psoriasis Treatments

Biologic therapies directly target psoriasis inflammation, and prior clinical trials have generally found no increased cardiovascular risk associated with biologic therapy use. A 2019 study published in JAMA Cardiology followed 134 patients with psoriasis over 1 year and found that biologic therapy was associated with reduced coronary artery inflammation, which was measured using a CT-based imaging biomarker.²

Nehal N. Mehta, MD, a cardiologist at the National Heart, Lung, and Blood Institute, who worked on the study, noted in a statement, “Treating underlying inflammatory conditions may reduce the risk of cardiovascular diseases,” which aligns with the findings of this new 10-year, real-world analysis of more than 72000 patients.^1,2

However, as the present authors point out, those trials were designed to evaluate dermatologic efficacy and safety rather than long-term cardiovascular outcomes, and they often underrepresent minority populations. Psoriasis is less common among Black and Asian populations than in White populations but tends to present more severely when it occurs. The researchers also note racial minorities face greater barriers to accessing biologic therapies. The retrospective cohort study sought to address both gaps by assessing long-term, real-world MACE risk according to specific biologic class and evaluating whether that risk holds consistent across race.¹

MACE Risk Lowered Across Biologic Classes, Consistent by Race

Researchers used de-identified data from TriNetX, a global research platform that provides real-time access to data from a range of health care organizations, spanning 2015 to 2025. They identified adult psoriasis patients aged 18 to 89 years and, after excluding anyone with a prior history of MACEs, used 1:1 propensity score matching to build a cohort of 36,330 biologic-treated patients and 36,330 biologic-naive patients.

For class-specific analyses, each biologic class—tumor necrosis factor (TNF) inhibitors, interleukin (IL)-17 inhibitors, IL-12/23 inhibitors, and IL-23 inhibitors—was evaluated as a mutually exclusive cohort. Additionally, patients who had used more than 1 biologic class were excluded from these class-specific comparisons, with each matched separately against its own biologic-naive control group.

As White patients were the majority, making up more than 70% of the matched cohort, race-stratified evaluations used White patients as the reference group. Within each biologic grouping, pooled non-White, Black, and Asian cohorts were separately matched 1:1 to White patients receiving the same biologic therapy. Patients categorized as Unknown Race were not included in the race assessment. Propensity score matching also balanced patients by demographics, comorbidities, medication use, and body mass index. Researchers tracked incident MACEs over a standardized 10-year follow-up window.

Patients with psoriasis treated with any biologic had a 37% lower risk of MACE compared with biologic-naive controls, according to the study’s findings. Among the 4 biologic classes assessed: use of TNF inhibitors showed a 26% lower risk of MACEs, IL-17 inhibitor use was associated with a 39% lower risk of MACEs, IL-12/23 inhibitor use was associated with a 27% lower risk of MACEs, and IL-23 inhibitor use was associated with a 36% lower risk of MACEs over the 10-year follow-up. Each was compared against its own independently matched biologic-naive control group, meaning results were not directly comparable across classes.

MACE outcomes that were stratified by different racial groups to evaluate the cardiovascular benefits of biologic therapies consistently showed no significant difference in risk over the 10-year follow-up. The same held true whether comparing the pooled non-White cohort and White patients, or comparing Black patients and Asian patients separately with White patients. One exception was the TNF inhibitor group, which showed non-White patients had a 21% lower MACE risk than White patients. However, this finding was not reproduced when Black and Asian patients were compared with White patients, and the authors caution that it should be viewed as a signal for further study rather than a definitive race-specific effect.

Observational Study Limitations

The authors point to several limitations to be considered. As an observational study, it cannot establish causality. Although the study adjusted for numerous confounders, residual confounding from factors such as insurance coverage, specialist access, or unmeasured psoriasis severity can still potentially impact results in detecting and managing cardiovascular risks. Additionally, the pooled non-White category combined heterogeneous groups that could obscure within-group differences.

The Black vs White and Asian vs White group analyses evaluated the largest individual racial groups in the dataset. The race-stratified analyses also involved multiple comparisons, meaning isolated significant findings, such as the TNF inhibitor result, should be treated as signals for further study rather than definitive evidence. Lastly, excluding patients who switched biologic classes improved the precision of class-specific comparisons but limited how well the findings generalize to patients who switch therapies in routine practice.

Need for Equity in Psoriasis Treatments

The study adds real-world, long-term evidence that biologic therapy’s cardiovascular benefits in psoriasis extend across racial groups. For patients who face barriers to accessing biologic therapy, the findings underscore the need for more equitable access to these treatments. Notably, because of the study’s observational design, the evidence is hypothesis-generating rather than definite proof of a cardioprotective effect.

“Our findings advocate for equitable access to biologic therapies, especially in underserved populations where systemic healthcare disparities persist. Addressing these disparities could enhance cardiovascular outcomes and improve overall disease management in these populations,” the authors note.

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. Psoriasis therapy linked to reduced coronary inflammation in patients with the skin condition. National Heart, Lung, and Blood Institute. News release. July 31, 2019. Accessed July 29, 2026. https://www.nih.gov/news-events/news-releases/psoriasis-therapy-linked-reduced-coronary-inflammation-patients-skin-condition