Systemic Psoriasis Therapies Cut MI Risk



Systemic treatments for psoriasis – including tumor necrosis factor inhibitors, oral drugs, and phototherapy – reduce the risk of myocardial infarction by approximately half, according to a study published online Aug. 20 in the Archives of Dermatology.

Psoriasis is a systemic inflammatory disease known to raise the risk of cardiovascular disorders, which also have a major inflammatory component. "It seems that controlling psoriasis with aggressive therapy and, thus, lowering inflammation, leads to a reduction in MI risk," said Dr. Jashin J. Wu of Kaiser Permanente Los Angeles Medical Center, and his associates.

The effect of systemic psoriasis therapy on cardiovascular disease "has been largely unexplored" until now. Dr. Wu and his colleagues performed a retrospective cohort study to examine the issue, using their HMO’s large database to examine the medical and prescription data on 8,845 adults who were diagnosed as having psoriasis between 2004 and 2009, and were followed for a median of 4 years for incident MI. The mean age of these study subjects was 53 years at baseline; half were men and half were women.

In all, 1,673 subjects (19%) were treated with TNF inhibitors, 2,097 (24%) were treated with oral systemic agents or phototherapy, and the remaining 5,075 received only topical treatment.

There were 221 incident MIs during follow-up.

For patients who took TNF inhibitors, the rate of MI was 3.05 per 1,000 patient-years, and for those who received systemic drugs or phototherapy, the rate of MI was 3.85 per 1,000 patient-years. These rates were not significantly different from each other, but were significantly lower than the rate of 6.73 MIs per 1,000 patient-years seen in the topical therapy–only group.

Compared with patients who used only topical treatment, those who took TNF inhibitors showed a 55% reduction in MI incidence and those who used other systemic treatments showed a 43% reduction in MI incidence, the investigators said (Arch. Dermatol. 2012 Aug. 20 [doi:10.1001/archdermatol.2012.2502]).

This is the first large-scale study to show that TNF inhibitors in particular, when they are taken for the treatment of psoriasis, reduce the incidence of MI. A previous study using a large database of patients with rheumatoid arthritis, another inflammatory disease associated with cardiovascular disease, found that therapy with TNF agonists also reduced the rate of cardiovascular events in that patient population, Dr. Wu and his associates noted.

In their study, an analysis of the data that stratified study subjects by age suggested that TNF inhibitors, oral agents, and phototherapy all exerted stronger protective effects in those older than 60 years, compared with younger patients. One explanation may be that older patients are more likely to develop type 2 diabetes, and these systemic therapies may cut the risk of that disease as well, they said.

This study was limited in that it could not account for study subjects’ use of nonprescription drugs, such as NSAIDs.

This study was supported by Kaiser Permanente’s Garfield Memorial Fund. Dr. Wu reported ties to Abbott Laboratories, Amgen, and Pfizer.

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