Treatment Persistence After Major Cardiovascular Events in Psoriasis: A Retrospective Cohort Study Comparing Biologic, Systemic, and Phototherapy.

Patients with psoriasis experience significantly higher cardiovascular morbidity compared to the general population. Although certain psoriasis treatments may confer cardioprotective effects, current clinical guidelines addressing treatment continuation following major adverse cardiovascular events (MACE) are lacking. Therefore, we conducted a retrospective cohort study using Korean health insurance data (January 2008-October 2021) to examine treatment modifications after MACE in patients with psoriasis. Patients were categorized based on treatment type: biologics, non-biologic systemic agents (cyclosporine or methotrexate), and phototherapy. Treatment persistence within 3 months after MACE was assessed using multivariable logistic regression, adjusted for demographic and clinical factors. Subgroup analyses were conducted based on previous MACE history. This retrospective cohort study included 1012 patients with MACE history and 2981 without. Biologic therapies demonstrated significantly superior treatment persistence (79.7%) compared to non-biologic systemic therapies (46.9%) and phototherapy (47.0%). Switching therapies was uncommon across all treatment groups (0.8%-1.9%). Multivariable logistic regression analysis confirmed that biologics were associated with greater treatment persistence than cyclosporine (odds ratio [OR], 4.854; 95% confidence interval [CI], 2.476-9.516), methotrexate (OR, 3.616; 95% CI, 1.760-7.431), and phototherapy (OR, 4.556; 95% CI, 2.340-8.873). These findings remained consistent in both the new-onset and recurrent MACE subgroups. No significant difference in treatment persistence was observed between the non-biologic systemic therapy and phototherapy groups. In conclusion, patients receiving biologic therapies were more likely to continue treatment after a cardiovascular event compared to those receiving other therapies. These findings suggest that biologics are perceived as safer options in this high-risk population and underscore the need for clear, evidence-based guidance on psoriasis treatment following cardiovascular events.