Patients with psoriasis who are treated with tumor necrosis factor-alpha inhibitors (TNFis) have a lower risk for experiencing major cardiovascular events compared with those who are treated with phototherapy, according to the results of an observational cohort study published in the Journal of the American Academy of Dermatology.

The investigators sought to evaluate the risk for major cardiovascular events and the impact of cumulative treatment exposure on cardiovascular event risk in patients with psoriasis who received TNFis vs those who received phototherapy.

Adult patients with psoriasis were selected from a large US administrative claims database between 2000 and 2014 and were categorized in 1 of 2 mutually exclusive cohorts, according to whether they received TNFi treatment or phototherapy.

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A total of 11,410 participants in the TNFi group and 12,433 in the phototherapy group (psoralen-plus ultraviolet=1117; ultraviolet B=11,316) were enrolled in the study.

Compared with the TNFi group, the phototherapy group was, on average, 4 years older (44.9 years vs 48.8 years, respectively; P <.001) and included a higher proportion of women (45.9% vs 59.0%, respectively; P <.001). Additionally, a higher proportion of patients in the TNFi arm vs the phototherapy arm had received prior conventional systemic therapy (20.9% vs 4.8%, respectively; P <.001).

Patients in the TNFi arm had a significantly lower risk for cardiovascular events compared with those in the phototherapy arm (adjusted hazard ratio [aHR] 0.77; 95% CI, 0.60-0.99; P <.05).

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Each incremental 6-month exposure to TNFis was associated with a significant reduction in the risk for major cardiovascular events over a median observational time of 15.4 months (aHR 0.73; 95% CI, 0.58-0.93; P =.010). Moreover, the risk reduction associated with 6 months of cumulative exposure was 11.2% greater (aHR 0.89; 95% CI, 0.79-0.99: P =.048) among TNFi-treated patients compared with those receiving phototherapy.

The investigators concluded that cumulative exposure to TNFis is linked with an incremental cardiovascular event risk reduction among adult patients with psoriasis compared with the same cumulative exposure to phototherapy.


Wu JJ, Sundaram M, Cloutier M, et al. The risk of cardiovascular events in psoriasis patients treated with tumor necrosis factor-alpha inhibitors versus phototherapy: an observational cohort study [published online February 27, 2018]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2018.02.050