Navigating the Complexities of Biologic Therapy Persistence in Psoriasis Management

The challenge of managing psoriasis is an intricate balancing act, especially when considering the persistent threat of cardiovascular risks. For appropriate candidates—such as those with moderate-to-severe plaque psoriasis per common guideline criteria—biologic therapy can be an important component of long-term care. Biologic therapy persistence emerges as a pivotal element, reframing outcomes by emphasizing sustained treatment over time.

Greater persistence with biologic therapy is associated with improved psoriasis control, likely reflecting sustained adherence and ongoing drug efficacy. In practice, this means fewer treatment interruptions and more consistent symptom control for patients who are able to stay on therapy.

The intersection of cardiovascular risks with biologic therapy use is particularly significant. Observed persistence may reflect clinician and patient confidence in long-term safety and efficacy; treatment decisions remain individualized, particularly in the context of cardiovascular comorbidities.

In cohorts evaluated after a major adverse cardiovascular event (MACE), continuation of biologics has often been observed. A recent report summarizes a study on continuation of biologics after MACE, and its findings may be context-dependent.

By sustaining disease control over time, consistent biologic therapy is associated with tangible quality-of-life improvements. Patients frequently describe fewer flares and less disruption to daily routines when treatment remains stable.

Extending the persistence theme beyond post-MACE scenarios, some real-world analyses report higher adherence with biologics compared with certain non-biologic therapies; however, estimates vary by setting and methodology. These differences underscore the need to interpret adherence and persistence data within the clinical and health-system contexts in which they are generated.

Clinical choices should be grounded in shared decision-making that weighs disease severity, comorbid conditions, patient preferences, and access considerations. Such an approach helps align persistence goals with what matters most to the individual patient.

Some studies suggest potential cardiovascular risk modulation with certain biologics, but evidence is mixed and causality remains uncertain; the primary benefit remains dermatologic disease control. Because psoriasis involves immune pathways that intersect with systemic inflammation, biologics may offer benefits beyond rapid skin relief.

Importantly, the decision to initiate or continue biologic therapy after cardiovascular events should integrate input from dermatology and cardiology, along with careful monitoring. This coordination supports safety while helping maintain disease control.

As the evidence base evolves, clinicians can revisit persistence strategies, reassess risk–benefit profiles, and tailor regimens to minimize flares and maximize quality of life. Real-world data will continue to inform when and how persistence translates into meaningful outcomes for diverse patient populations.

Key takeaways

• Biologic therapy can be an important option for appropriately selected patients; persistence is associated with steadier disease control.
• After MACE, continuation of biologics has often been observed in real-world cohorts, though findings are context-dependent.
• Adherence and persistence patterns vary by setting and methodology, reinforcing the need for individualized, shared decision-making that considers comorbidities.
• The principal benefit of biologics is psoriasis control; any cardiovascular effects remain uncertain and require cautious interpretation.