Psoriasis patients who take TNF inhibitors have a significant reduction in the risk for myocardial infarction (MI), according to a retrospective cohort study published in Archives of Dermatology. Although previous research suggested that the anti-inflammatory effects of methotrexate, an older therapy, may be beneficial in this population, the cardiovascular effects of TNF inhibitors had not been well studied.
Researchers identified 8845 patients who were diagnosed with psoriasis or psoriatric arthritis within the Kaiser Permanente Southern California health plan. After a median of 4.3 years of observation, the overall rate of MI was 5.21 per 1000 patient-years.
- In the 1673 patients who received a TNF inhibitor (etanercept, infliximab, or adalimumab), the MI rate was 3.05 per 1000 patient-years.
- In the 2097 patients who received oral therapy or phototherapy, the MI rate was 3.85 per 1000 patient-years.
- In the 5075 patients who received topical therapy, the MI rate was 6.73 per 1000 patient-years.
TNF inhibitors and oral therapy/phototherapy were each superior to topical therapy, but the difference between TNF inhibitors and oral therapy/phototherapy was not significant. Compared with topical agents, TNF inhibitors and oral agents/phototherapy had hazard ratios (adjusted for other risk factors) of 0.50 and 0.54, respectively.
The authors write, “This is the first large scale retrospective cohort study to show that the use of TNF inhibitors for psoriasis is associated with a clinically and statistically significant reduction in MI risk and incident rate compared with psoriatic patients treated with topical agents.” However, they note that “prospective studies are needed and warranted to determine whether the use of TNF inhibitors may reduce the risk of major adverse cardiovascular events in patients with systemic inflammatory conditions.”
Here is the press release from Archives of Dermatology:
Study Examines Risk of Heart Attack Associated with Various Psoriasis Treatments
CHICAGO– Use of tumor necrosis factor (TNF) inhibitors for treatment of psoriasis is associated with a significantly reduced risk for heart attack (myocardial infarction) compared to other forms of treatment, according to a report published Online First by Archives of Dermatology, a JAMA Network publication.
“The effect of systemic treatment for psoriasis on cardiovascular disease has been largely unexplored,” the authors write as background information in the study. “The primary objective of this study was to assess whether patients with psoriasis treated with TNF inhibitors have a decreased risk of MI [myocardial infarction] compared with those not treated with TNF inhibitors (i.e., those who received oral agents/phototherapy or topical agents).”
Jashin J. Wu, M.D., of the Kaiser Permanente Los Angeles Medical Center, and colleagues, conducted a retrospective study that included patients with at least three ICD-9-CM codes for psoriasis or psoriatic arthritis, without antecedent MI, between January 2004 and November 2010.
Of the 8,845 patients included in the study, 5,075 (57.4 percent) were not treated with any systemic therapy or phototherapy (topical treatment group), 1,673 (18.9 percent) received a TNF inhibitor for at least two consecutive months (TNF treatment group) and 2,097 (23.7 percent) were treated with oral systemic agents or phototherapy (oral/phototherapy treatment group).
After adjusting for other MI risk factors, patients in TNF inhibitor treatment group and the oral/phototherapy treatment group had a significantly lower risk of MI (50 percent and 46 percent, respectively) compared with patients in the topical treatment group. Differences in risk between the TNF inhibitor group and oral/phototherapy group did not reach statistical significance.
“Future prospective studies are needed and warranted to determine whether the use of TNF inhibitors may reduce the risk of major adverse cardiovascular events in patients with systemic inflammatory conditions,” the authors conclude.
(Arch Dermatol. Published online August 20, 2012. doi:10.1001/archdermatol.2012.2502.)
Editor’s Note: Dr. Wu has received research grants from Abbott Laboratories, Amgen and Pfizer that were not directly related to this study. This project was supported in whole by Kaiser Permanente’s Garfield Memorial Fund. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.