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Abstract: Background: Psoriasis has been related to a large number of cardiovascular risk factors such as hypertension, diabetes mellitus and arteriosclerosis. The increased carotid intima‐media thickness (IMT) could be considered to be a marker of generalized arteriosclerosis. Objective: To assess the effect of systemic and biological drugs on psoriatic patients' carotid IMT. Methods: A prospective study was performed. We studied 53 patients with moderate and severe psoriasis from our psoriasis dermatological unit, analysing lipid and glucose metabolism and performing a carotid IMT sonography before introduction of systemic and biological drugs. After that, we performed an 8‐month closely analytic and sonographic follow‐up. Results: The IMT of the patients with psoriasis treated with biological drugs tended to decrease, although this occurrence was not statistically significant (P = 0.086). The subgroup analysis revealed that patients treated with methotrexate (P = 0.045) and anti‐IL‐12/23 (P = 0.010) presented a decrease in their IMT levels. This analysis also showed a decrease in glycaemia and insulin levels in patients treated with TNF‐alpha inhibitors and ustekinumab. Conclusions: Our study suggests that the carotid IMT may benefit from treatment with biological drugs, particularly anti‐IL‐12/23 and methotrexate in patients suffering from moderate and severe psoriasis. However, larger longitudinal studies should be performed to fully confirm these results. [ABSTRACT FROM AUTHOR]