TNF inhibitors are commonly used to treat psoriasis and psoriatic arthritis patients, who are also at high risk of cardiovascular disease. Researchers investigated whether these drugs play a role in elevating that risk, and determined they do not — in fact, they found that TNF inhibitors may further benefit patients by actually lowering their chances of a heart attack or stroke.
The review article, “The Effect of TNF Inhibitors on Cardiovascular Events in Psoriasis and Psoriatic Arthritis: an Updated Meta-Analysis,” was published in Clinical Reviews in Allergy and Immunology.
Previous research has indicated a high prevalence of cardiovascular risk factors in psoriatic patients. However, cardiovascular morbidity and mortality in patients with psoriasis and psoriatic arthritis is still under question, as it is difficult to assess what is attributable to the disease and what to confounding factors. Nonetheless, education, screening and management of cardiovascular risk are important in the care of these patients.
Tumor necrosis factor (TNF) inhibitors are used to treat this autoimmune disease, but their effects on cardiovascular events remains unclear. Researchers conducted an analysis of five clinical studies, identified through databases, that included nearly 50,000 psoriasis patients, with or without psoriatic arthritis.
Results showed that, compared to patients treated with topical agents or phototherapy, TNF inhibitor use was associated with a significantly lower risk of cardiovascular events, 42 percent lower. Likewise, people treated with TNF inhibitors had a 33 percent lower risk of such events compared to those treated with methotrexate, a drug also used with cancer and autoimmune diseases.
Recorded incidents of myocardial infarction were also found to be lower in the TNF inhibitors group as opposed to people given the three other treatments, and a trend toward lower mortality rates was also seen in the inhibitors group.
The researchers point out, however, that the study had some limitations, such as missing information on potential study confounders like comorbid diabetes and blood pressure. Despite this, they believe it stands out from previous research as, here, the scientists evaluated TNF inhibitors alone, as opposed to in conjugation with methotrexate, and in a large patient group with long-term follow-up.
“TNF inhibitors appear to have net clinical benefits with regard to adverse cardiovascular events in [psoriasis] and/or [psoriatic arthritis]. Rigorous randomized controlled trials will need to evaluate whether TNF inhibitors truly result in reduction of cardiovascular diseases,” the scientists concluded.