Reducing Risks

Psoriasis is associated with multiple comorbidities, including cardiovascular diseases. With the advent of anti-inflammatory therapy, there has been much investigation into whether treatments for psoriasis may reduce the risk for cardiovascular events. In a Journal of the European Academy of Dermatology and Venereology article published online on October 10, Ahlehoff et al examined the rate of cardiovascular events—cardiovascular death, myocardial infarction, and stroke—in patients with severe psoriasis treated with systemic anti-inflammatory drugs.

Individual-level linkage of administrative registries was utilized to perform a longitudinal nationwide cohort study in Denmark. Time-dependent multivariable adjusted Cox regression was used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) of cardiovascular events associated with use of biological drugs, methotrexate, cyclosporine, retinoids, and other antipsoriatic therapies (ie, topical treatments, phototherapy, climate therapy).

The investigators included a total of 6902 patients (9662 treatment exposures) with a maximum follow-up of 5 years. Incidence rates per 1000 patient-years for cardiovascular events were highest for retinoids and other therapies (18.95 and 14.63, respectively) followed by methotrexate, cyclosporine, and biological drugs (6.28, 6.08, and 4.16, respectively). Relative to other therapies, methotrexate (HR, 0.53; 95% CI, 0.34-0.83) was associated with reduced risk for the composite end point. A comparable but nonsignificant protective effect was observed with biological drugs (HR, 0.58; 95% CI, 0.30-1.10), whereas no protective effect was apparent with cyclosporine (HR, 1.06; 95% CI, 0.26-4.27) and retinoids (HR, 1.80; 95% CI, 1.03-2.96). Tumor necrosis factor inhibitors (HR, 0.46; 95% CI, 0.22-0.98) were linked to reduced event rates but the IL-12/IL-23 inhibitor ustekinumab (HR, 1.52; 95% CI, 0.47-4.94) was not.

The authors concluded that systemic anti-inflammatory treatment with methotrexate was associated with lower rates of cardiovascular events during long-term follow-up compared to patients treated with other antipsoriatic therapies.

What’s the issue?

This study is consistent with other investigations evaluating the cardioprotective benefit of therapies for psoriasis. The cardioprotective benefits of methotrexate and tumor necrosis factor inhibitors have been previously reported. Further investigation will help to elucidate the role of these drugs as well as newer therapies in the reduction of comorbidities. Does this study influence your perception of therapies for psoriasis?

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