Authors: Sara Mahfoud Alghamdi , Mohammed A Alahmadi , Ahmed K Alsaif , Lama S Alghamdi , Shahad A Alshehri , Salma A Alhussaini , Ghaida B Alanazi , Abdullah S Algarni

Abstract

Chronic inflammatory skin diseases, including psoriasis and atopic dermatitis, are associated with an increased risk of cardiovascular disease (CVD), largely due to systemic inflammation. Biologic therapies that target key inflammatory cytokines have shown promise not only in improving skin outcomes but also in potentially modifying cardiovascular risk. This study aims to evaluate the impact of biologic treatments used in dermatology on CVD risk through a systematic review and single-arm meta-analysis. Databases including PubMed, Google Scholar, Web of Science, Medline, Scopus, Wiley, EBSCO, and ScienceDirect were searched for studies reporting cardiovascular outcomes in patients receiving biologics for dermatologic conditions. Eligible studies included randomized controlled trials (RCTs), observational cohorts, and case series. Cardiovascular outcomes assessed included major adverse cardiovascular events (MACE), myocardial infarction, stroke, and changes in cardiovascular risk factors. A total of 21 studies were included. The pooled proportion of patients experiencing cardiovascular outcomes after biologic therapy was 7.82% (95% CI: 5.31%–11.37%) under the random-effects model. A modest but significant correlation (r = 0.2051, p = 0.0126) between biologics and cardiovascular benefit was observed. Sensitivity analyses supported the robustness of findings. Risk of bias ranged from low to moderate. Biologic therapies in dermatology, particularly TNF-α, IL-17, and IL-23 inhibitors, may reduce cardiovascular risk through systemic inflammation suppression. However, heterogeneity, publication bias, and a predominance of observational data limit the strength of conclusions. Further RCTs are needed to confirm these findings.

Keywords: Psoriasis, biologic therapy, cardiovascular disease, meta-analysis, MACE, TNF inhibitors.