A significantly lower risk for major adverse cardiovascular events (MACE) has been observed in patients with psoriasis who are treated with a tumor necrosis factor inhibitor (TNFi) compared with those who receive treatment with a topical agent or other oral agents/phototherapy, according to the results of a retrospective cohort study published in the Journal of the European Academy of Dermatology and Venereology.
The investigators sought to determine whether TNFi therapy is associated with decreased rates of MACE among patients with psoriasis. Patients who were evaluated had ≥3 International Classification of Diseases, 9th Revision, Clinical Modification recorded diagnosis codes for psoriasis and no antecedent MACE codes. Hazard ratios (HRs) of MACE associated with TNFi use were assessed using propensity score-adjusted multivariable Cox regression.
Patients were assigned to 1 of 3 cohorts: TNFi cohort (those who received ≥2 consecutive months of adalimumab, etanercept, or infliximab during the study period), oral/phototherapy cohort (TNFi-naive patients who received oral agents [acitretin, apremilast, cyclosporine, or methotrexate] or phototherapy [broadband ultraviolet light B, narrowband ultraviolet light B, or psoralen and ultraviolet A light]), or the topical cohort (patients not treated with TNFis, oral therapies, or phototherapy).
Among a total of 18,154 patients included in the study, 1463 received TNFi therapy for ≥2 months, 3579 received oral agents or phototherapy, and 13,112 received topical therapy. Overall, the mean duration of follow-up for the TNFi, oral/phototherapy, and topical cohorts was 3.3 years, 3.1 years, and 5.2 years, respectively, with an average follow-up across the entire group of 4.7 years.
The incident rates for MACE were 9.25, 14.19, and 12.79 per 1000 patient-years in the TNFi, oral/phototherapy, and topical cohorts, respectively. After adjusting for cardiovascular risk factors, the TNFi cohort exhibited significantly lower MACE hazard ratios [HR] vs the topical cohort (HR 0.80; 95% CI, 0.66-0.98). The oral/phototherapy cohort had similar MACE HRs vs the topical cohort (HR 1.19; 95% CI, 0.99-1.42).
The investigators concluded that the use of TNFi therapy in patients with psoriasis may be beneficial for reducing cardiovascular outcomes. They emphasized, however, that this association requires confirmation in large, prospective, randomized trials.
Wu JJ, Joshi AA, Reddy SP, et al. Anti-inflammatory therapy with tumor necrosis factor inhibitors is associated with reduced risk of major adverse cardiovascular events in psoriasis [published online March 24, 2018]. J Eur Acad Dermatol Venereol. doi: 10.1111/jdv.14951