与传统抗银屑病药物或阿普米司特不同，生物治疗可降低银屑病患者的死亡风险和心血管疾病风险。
Biological, as opposed to classic antipsoriatic drug or apremilast, treatment mitigates the risk of death and cardiovascular disease in psoriasis.
作者信息
Kridin Khalaf, Bieber Katja, Vorobyev Artem, Moderegger Eva Lotta, Olbrich Henning, Ludwig Marlene A, Gershater Bernard, Hernandez Gema, Zirpel Henner, Thaci Diamant, Ludwig Ralf J
机构信息
Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany; Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel; Unit of Dermatology and Skin Research Laboratory, Galilee Medical Center, Nahariya, Israel.
Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.
出版信息
EBioMedicine. 2025 Jan;111:105485. doi: 10.1016/j.ebiom.2024.105485. Epub 2024 Dec 6.
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.
背景
心血管合并症会增加银屑病的发病率和死亡率。全身治疗，尤其是生物制剂，在减轻皮肤和关节炎症方面有效。相反，全身治疗对银屑病患者心血管疾病风险和死亡率的影响仍不确定。
方法
评估了全身治疗对来自TriNetX的银屑病患者电子健康记录（EHR）中全因死亡率和心血管疾病风险的影响。治疗类别包括阿普斯特、白细胞介素-17抑制剂（IL-17i）、白细胞介素-23抑制剂（IL23i）、肿瘤坏死因子抑制剂（TNFi）和经典抗银屑病药物。索引事件是每种治疗的首次处方，需要连续治疗两年且排除其他全身抗银屑病药物。采用倾向评分匹配来提高可比性。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%（经典抗银屑病药物，n = 7929）、0.91%（阿普斯特，n = 1101）、0.00%（IL17i，n = 677）、0.81%（IL23i，n = 1242）和0.20%（TNFi，n = 6468）。在EHR中，记录到主要不良心脏事件（MACE）的比例分别为8.49%（经典抗银屑病药物）、5.14%（阿普斯特）、2.99%（IL17i）、2.09%（IL23i）和3.74%（TNFi）。倾向评分匹配显示，任何生物制剂的全因死亡率为0.23%，而经典抗银屑病药物或阿普斯特为0.49%，风险比（HR）为2.21（95%置信区间1.21 - 3.71，p = 0.0073）。经典抗银屑病药物或阿普斯特的MACE风险也更高（HR 1.66，置信区间1.43 - 1.93，p < 0.0001）。所有四项敏感性分析的结果大多一致。生物制剂之间在全因死亡率或MACE风险方面未观察到显著差异。
解读
与经典抗银屑病药物或阿普斯特相比，生物治疗可降低银屑病患者的死亡风险和心血管疾病风险。需要进行前瞻性试验来验证这些发现。
资助
德国研究基金会（DFG）：卓越集群2167和LU 877/25 - 1。石勒苏益格 - 荷尔斯泰因州：卓越主席计划。
Zotero 插件