TNF Inhibitor Therapy for Psoriasis May Also Lower CVD Risk

Susan London

July 06, 2016

When used to treat psoriasis, agents that inhibit tumor necrosis factor (TNF) may have the added benefit of reducing the excess cardiovascular risk associated with this disease, according to an updated meta-analysis published online June 14 in Clinical Reviews in Allergy & Immunology.

The analysis of five studies and nearly 50,000 patients with psoriasis found that those treated with TNF inhibitors had a 42% lower risk (relative risk [RR], 0.58; 95% confidence interval [CI], 0.43 - 0.77; P < .001; I 2 = 66.2%) for cardiovascular disease events when compared with peers treated with topical agents or phototherapy, and a 33% lower risk (RR, 0.67; 95% CI, 0.52 - 0.88; P = .003; I 2 = 9.3%) when compared with peers treated with methotrexate.

"Given the clinical benefit, targeting systemic inflammation with TNF inhibitors could provide cardioprotective effect in patients with [psoriasis] and/or [psoriatic arthritis]," write the authors, led by Zheng-sheng Yang, from the Department of Dermatology, The First Hospital of Qinhuangdao, Hebei, China.

"Randomized clinical trials will need to be conducted to evaluate whether TNF inhibitors truly result in reduction of cardiac and cerebrovascular events," they add. "Efforts are necessary to decide if patients with moderate to severe psoriasis with or without psoriatic arthritis should be targeted for more intense goals for lipid control, as has been recommended for rheumatoid arthritis."

For the meta-analysis, the investigators performed a search of five databases (MEDLINE, EMBASE, Wanfang database, Cochrane Database, and Google Scholar) through December 31, 2015. Studies were eligible if they involved patients with psoriasis, with or without psoriatic arthritis, who received TNF inhibitors, and if they reported cardiovascular events.

The search identified five eligible studies having a total of 49,795 patients that were published between 2011 and 2015. Follow-up in the studies averaged 38 months.

Compared with peers given topical agents or phototherapy, patients given TNF inhibitors had a reduced risk for cardiovascular events — a composite of death from any cause, myocardial infarction, and stroke (RR, 0.58; 95% CI, 0.43 - 0.77; P < .001; I 2 = 66.2%) — according to the study results. Similarly, compared with peers given methotrexate, patients given TNF inhibitors had a lower risk for these events (RR, 0.67; 95% CI, 0.52 - 0.88; P = .003; I 2 = 9.3%).

In analyses looking at individual components of the composite outcome, TNF inhibitors were also associated with a reduced risk for myocardial infarction relative to both topical agents or phototherapy (RR, 0.73; 95% CI, 0.59 - 0.90; P = .003; I 2 = 56.2%) and methotrexate (RR, 0.65; 95% CI, 0.48 - 0.89; P = .007; I 2 = 0.0%).

Findings were similar in subgroup analyses that excluded individual studies one at a time and that considered different anti-inflammatory regimens individually.

The meta-analysis stands out from previous ones because of its size and assessment of long-term follow-up, according to the researchers. In addition, previous meta-analyses have largely assessed TNF inhibitors as used in combination with methotrexate.

At the same time, the meta-analysis is limited by heterogeneity of data, differences in patient populations and treatment strategies across studies, and missing information on potential confounders, such as comorbid diabetes, dyslipidemia, and blood pressure, they acknowledge.

The authors have disclosed no relevant financial relationships.

Clinic Rev Allerg Immunol. Published online June 14, 2016. Abstract

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