BIOLOGICS THERAPIES FOR PSORIASIS AND PSORIASIS ARTHRITIS AFFECT ON FUTURE RISK FOR DEVELOPING MAJOR ADVERSE CARDIOVASCULAR EVENTS

A. Dotan, N. Ben-Shabat, D. Mcgonagle, A. Watad, H. AmitalZabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel, Department of Medicine ‘B’, Ramat-Gan, Israel University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, United Kingdom  Background Major adverse cardiovascular events (MACE) are some of the numerous comorbidities associated with psoriasis (PsO) and psoriasis arthritis (PsA). Previous studies addressed the contribution of sufficient anti-inflammatory therapy for PsO and PsA in decreasing MACE incidence [1,2]. Objectives Assessing the risk of developing MACE in patients with pre-existing PsO treated with different treatment regimens; topical treatment, conventional disease-modifying anti-rheumatic drugs (cDMARDs), and biologic disease-modifying anti-rheumatic drugs (bDMARDs) which had not previously studies sufficiently on real-world data. Methods We conducted a retrospective exploratory study with real-world data using the databases of the third largest Israeli health maintenance organization, ‘Meuhedet’ which covers approximately 1,300,000 subjects. All patients of ‘Muehedat’ diagnosed with PsO from January 2000 until January 2020 were included in the analysis. Overall, 61,003 patients with PsO were detected. In addition, each PsO patient was paired with four control subjects by gender, age, and ethnicity (general, Arabic, or Orthodox). We defined PsO and PsA according to physicians’ diagnoses. MACE included patients with either cerebral vascular accident (CVA), ischemic heart disease (IHD), or peripheral artery disease (PVD). The date of the MACE incident was defined by the first occurrence of one of the diagnoses. We classified the patients diagnosed with PsA into a separate group; thus, patients were categorized according to their diagnosis (control, PsO or PsA). Furthermore, we analyzed the patients by the most advanced treatment prescribed to the patient; sub-grouped 1- topical therapy, sub-grouped 2 - cDMARDs (methotrexate or sulfasalazine), sub-grouped 3 - bDMARDs (anti-TNF, anti-IL17, or anti-IL12/23 agents) (Table 1). The Incident cases of MACE were analyzed according to the different lines of therapy mentioned above. In addition, Time-dependent Cox proportional hazard models were used to evaluate the adjusted risk of developing MACE by treatment group. Results 287,392 patients were included after exclusion by the defined criteria, contributing a total of 2,997,001 patient-years. Adjusted Cox proportional hazards regression analysis showed that the risk of developing MACE in PsO patients treated with topical treatment and those treated with cDMARDs was significantly higher in comparison to controls (Topical, HR: 1.1, CI: 1.02 - 1.1, p-value: <0.001; cDMARDs, HR: 1.2, CI: 1.0 - 1.5, p-value: 0.05). Yet, the risk of developing MACE in PsO patients treated with bDMARDs was not significantly different compared to controls (HR: 1.1, CI: 0.82 - 1.5, p-value: 0.55). On the contrary, the risk of developing MACE in all treatment groups of PsA patients was found to be significantly higher in comparison to controls (Topical, HR: 1.6, CI: 1.45 - 1.7, p-value: <0.001; cDMARDs, HR: 1.4, CI: 1.2 - 1.6, p-value: <0.001, bDMARDs, HR: 1.6, CI: 1.35 - 1.8, p-value: <0.001) (Figure 1). This analysis was adjusted to gender, body mass index (BMI), age of PsO diagnosis, lifetime diagnosis of diabetes mellitus type 2 (DM2), dyslipidemia, hypertension (HTN), and chronic heart failure (CHF); notably, male gender, higher BMI, older age, DM2, dyslipidemia, HTN, and CHF were all associated with a greater risk of developing MACE. Conclusion Despite that the psoriasis and arthritis severity is higher in patients treated with bDMARDs treatment compared to those treated with cDMARDs and topical treatment alone, bDMARDs have a protective effect on the risk of developing PsA. References Ogdie A, Yu D, Haynes K, Love J, Maliha S, Jiang Y, et al. Risk of major cardiovascular events in patients with psoriatic arthritis, psoriasis and rheumatoid arthritis: a population-based cohort study. Ann Rheum Dis 2015;74:326–32. Ogdie A, Haynes K, Troxel AB, Love J, Hennessy S, Choi H, et al. Risk of mortality in patients with psoriatic arthritis, rheumatoid arthritis and psoriasis: a longitudinal cohort study. Ann Rheum Dis 2014;73:149–53. Figure 1. Image/graph: Acknowledgements: NIL. Disclosure of Interests None Declared. Keywords: Cardiovascular disease, bDMARD, Psoriatic arthritis DOI: 10.1136/annrheumdis-2023-eular.6255Citation: , volume 82, supplement 1, year 2023, page 1123Session: Psoriatic arthritis - treatment (Poster View)