Effects of Biologic Agents and Other Disease-Modifying Antirheumatic Drugs on Cardiovascular Outcomes in Psoriasis and Psoriatic Arthritis: A Systematic Review
April W. Armstrong, Elizabeth A. Brezinski, Matthew R. Follansbee and Ehrin J. Armstrong
Affiliation: University of California Davis, Department of Dermatology 3301 C St., Suite 1400 Sacramento, CA 95816.
Keywords: Psoriasis, psoriatic arthritis, biologics, cardiovascular disease, TNF inhibitors, ustekinumab, methotrexate, systematic review.
Background: Whether systemic treatments for psoriasis or psoriatic arthritis affect cardiovascular comorbidities is a clinically
Objective: To examine the effects of biologic agents and other Disease-Modifying Antirheumatic Drugs (DMARDs) used to treat psoriasis
and psoriatic arthritis on cardiovascular risk factors and adverse cardiovascular outcomes.
Methods: MEDLINE (1980-October 2012), Web of Science, the EULAR abstract database, and the AAD annual meeting abstract archive
were searched for studies evaluating biologic and other DMARD therapy for psoriasis and psoriatic arthritis that reported cardiovascular
events as primary outcomes.
Results: From 20 studies that met the search criteria for the review, 81,469 patients with psoriasis and/or psoriatic arthritis were included
in the data synthesis of the current literature. While the data on the cardioprotective effect of methotrexate exist in patients with rheumatoid
arthritis, its effect on the psoriasis and psoriatic arthritis populations with regards to cardiovascular outcomes are inconclusive at this
time. The association of hypertension with long-term cyclosporine use prompts discontinuation of cyclosporine in selected patients. The
use of TNF inhibitors may be associated with reduced risk of adverse cardiovascular events in preliminary epidemiologic studies; however,
large randomized controlled trials and epidemiologic studies with well-characterized populations will be necessary to elucidate their
exact effects. The short-term data regarding the safety of IL-12/23 inhibitors showed that, to date, there are no increased cardiovascular
events compared to the general population.
Conclusions: To date, epidemiologic data is insufficient to reach definitive conclusions with regards to the effects of biologics and other
DMARDs on cardiovascular outcomes in psoriasis and psoriatic arthritis patients. Adequately powered, long-term, controlled studies are
necessary to determine the cardioprotective effects of TNF inhibitors observed in preliminary studies on psoriasis and psoriatic arthritis
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