Targeted therapies for psoriasis (PsO) and psoriatic arthritis (PsA) are not associated with an increased risk for cardiovascular events (CVEs), according to study findings published in International Journal of Rheumatic Diseases.
Researchers conducted a comprehensive review of randomized placebo-controlled trials (RCTs) published through October 28, 2021, to evaluate how biological disease-modifying antirheumatic drugs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs) therapies influenced the short-term risk for CVEs in adults. Those RCTs that did not report precise CVEs or major adverse cardiovascular events (MACEs) were recorded as 0 events. The researchers used the Mantel-Haenszel fixed-effect method to calculate outcome risk ratios (RR).
There were a total of 81 articles and 88 RCTs included in the final analysis, for a total of 46,718 eligible participants. Follow-up was 12 to 24 weeks.
A total of 89 patients experienced CVEs. Incidence of CVEs was 8.8 per 1000 patient-years for targeted therapies groups and 5.7 per 1000 patient-years in placebo groups. Rates of CVEs did not statistically significantly vary between the study medications and placebo in patients with PsA, or for targeted therapies compared with placebo in PsO or PsA.
Incidence of CVEs was higher among patients receiving low doses compared with high doses across targeted therapies (RR, 1.97; 95% CI, 1.19-3.27; P =.008) and anti-interleukin-17 agents (RR, 2.20; 95% CI, 1.05-4.58; P =.04).
Study limitations include possible misestimated incidence of CVEs and the possibility of bias of primary and secondary outcomes due to incomplete medical histories of the participants.
Researchers conclude, “[T]he present evidence suggested that the targeted DMARDs were safe on cardiovascular risk in adult patients with PsO/PsA in the short term. It might be better to keep an adequate dosage of targeted therapies instead of cutting them down in patients with a high risk of CVDs.”
Cai R, Jin Y, Chen B, et al. Impact of targeted therapies on the risk of cardiovascular events in patients with psoriasis and psoriatic arthritis: a systematic review and aggregate data meta-analysis of randomized controlled trials. Int J Rheum Dis. Published online February 9, 2023. doi:10.1111/1756-185X.14603