There is no compelling evidence to link some psoriasis medications with major adverse cardiovascular events, despite a number of preliminary reports that appeared to indicate so, researchers from the Baylor Research Institute, Dallas, Texas reported in JAMA (Journal of the American Medical Association). The authors had analyzed several studies which compared biologic therapies for chronic plaque psoriasis to placebos.
Over the last ten years, several studies have shown an association between autoimmune diseases and chronic systemic inflammation, and the subsequent cardiovascular risk that comes with inflammation. Psoriasis is an autoimmune disease. Researchers suggested that controlling inflammation could help minimize cardiovascular illness.
Preliminary reports suggested a number of MACEs (major adverse cardiovascular events), including heart attack, cerebrovascular accident or cardiovascular death in RCTs (randomized controlled trials) of individuals with psoriasis treated with anti-IL-12/23 agents. A smaller number of events were also reported from studies that evaluated anti-tumor necrosis factor alpha (TNF-α), also for psoriasis treatment.
Caitriona Ryan, M.B., B.A.O., B.Ch., and team carried out a meta-analysis to determine whether chronic plaque psoriasis medications might be linked to MACEs. They gathered and examined data on 22 randomized controlled trials of anti-IL-12/23 agents (ustekinumab and briakinumab) and anti-TNF-α agents (adalimumab, etanercept and infliximab) in adults with chronic plaque psoriasis. 10,183 participants were involved in those trials. Their primary outcome measured was a MACE during the placebo-controlled phase of treatment in participants who received at least 1 dose of the study drug or placebo.
Anti-IL-12/23 studies – out of 3,179 patients 10 had a mace, compared to zero out of 1,474 treated with a placebo.
Anti-TNF-α agents studies – out of 3,585 only 1 had a MACE, compared with 1 of 1,812 treated with placebo.
The authors wrote:
“This meta-analysis did not show a significant increase in the risk of MACEs associated with the use of anti-lL-12/23 agents. Limitations of this study, however, prevent us from determining whether these drugs expose psoriasis patients to increased cardiovascular risk. Access to patient-level data for these studies was not granted by any of the study sponsors, which precluded the use of a more statistically robust time-to-event analysis.
The small number of MACEs that occurred in placebo-controlled phases of these studies and the limited duration of the placebo-controlled phases reduce the power of this meta-analysis to detect a change in risk.”
They added:
“Although RCTs are currently the criterion standard for measuring clinical efficacy in psoriasis therapies, these studies are designed to detect differences in the severity of psoriasis in response to therapy over short periods of treatment and are often underpowered and of too short duration to detect rare or long-term adverse events. Careful consideration of these issues is warranted to best serve patients in these studies and those who are treated once drugs are approved.”
Approximately 80% to 90% percent of people with psoriasis have this type. The patient has raised areas of inflamed skin covered with plaques – silvery white scaly skin. A flaky, white accumulation of dead skin builds up on the plaques, this is known as scale.
Plaque psoriasis most commonly affects the elbows, nails, trunk, scalp and knees. However, it can appear on any surface of the skin.
The scale becomes dislodged and is shed from the plaques. Affected areas are generally very dry and itchy, sometimes painful – there might be cracking of the skin.
Written by Christian Nordqvist