Do Certain Psoriasis Treatments Decrease Risk of Cardiovascular Events?
Psoriasis is linked with cardiovascular disease. The underlying immune response of psoriasis consists of increased antigen presentation, T-cell activation, and cytokine release from T-helper cells and is associated with other markers of inflammation, such as increased C-reactive protein. Patients with more severe psoriasis, and the associated greater immune activity, have higher levels of systemic inflammation and therefore are at higher risk for cardiovascular (CV) events.
A recent study hypothesized that psoriasis treatments that decrease inflammation would also decrease the risk for CV events. The study specifically looked at treatment with tumor necrosis factor alpha inhibitors (TNFis) compared with methotrexate (MTX), a conventional systemic therapy (CST). The study directly compared the risk for major CV events between patients treated with TNFis and MTX and evaluated the association between TNFi treatment duration and long-term risk for major CV events. Patients were classified into 2 mutually exclusive cohorts: those treated with TNFi cohort or those treated with MTX, and followed for 24 months. At the one-year mark, TNFi users (N = 9148) had fewer cardiovascular events than methotrexate users (N = 8581). Cardiovascular events were myocardial infarction, stroke or transient ischemic attack, and unstable angina. After 24 months, the study found that every 6 months of cumulative exposure to TNFis was associated with an 11% cardiovascular event risk reduction. The authors note that the study’s design, a retrospective study using claims data, has some inherent limitations such as the inability to provide clinical assessments of psoriasis severity, or information about treatment response. In addition, this study does not distinguish among the use of different TNFi agents, which could each affect the CV risk differently.
Despite these limitations, the authors conclude that treatment with TNFi agents was associated with a lower risk of experiencing major CV events compared with patients treated with MTX. Cumulative exposure to TNFi agents was further associated with reduced risk for major CV events.
Byline: Martha L. Sikes, MS, RPh, PA-C
Posted: January 30, 2017
Adapted from the original article.