The Effect of TNF Inhibitors on Cardiovascular Events in Psoriasis and Psoriatic Arthritis: an Updated Meta-Analysis

Abstract

TNF inhibitors have been used in psoriasis (Pso) and psoriatic arthritis (PsA), which were associated with increased risk of cardiac and cerebrovascular events. However, whether TNF inhibitors reduce cardiovascular event is still unclear. Therefore, we aimed to evaluate the effect of TNF inhibitors on adverse cardiovascular events (CVEs) in Pso with or without PsA. We undertook a meta-analysis of clinical trials identified in systematic searches of MEDLINE, EMBASE, Wanfang database, Cochrane Database, and Google scholar through December 31, 2015. Five studies (49,795 patients) were included. Overall, compared with topical/photo treatment, TNF inhibitors were associated with a significant lower risk of CVE (RR, 0.58; 95 % CI, 0.43 to 0.77; P < 0.001; I (2) = 66.2 %). Additionally, compared with methotrexate (MTX) treatment, risk of CVE was also markedly decreased in the TNF inhibitor group (RR, 0.67; 95 % CI, 0.52 to 0.88; P = 0.003; I (2) = 9.3 %). Meanwhile, TNF inhibitors were linked to reduced incidence of myocardial infarction compared with topical/photo or MTX treatment (RR, 0.73; 95 % CI, 0.59 to 0.90; P = 0.003; I (2) = 56.2 % and RR, 0.65; 95 % CI, 0.48 to 0.89; P = 0.007; I (2) = 0.0 %, respectively). Furthermore, there was a trend of decreased rate of mortality in the TNF inhibitor group compared with other therapy (RR, 0.90; 95 % CI, 0.54 to 1.50; P = 0.68; I (2) = 70.9 %). TNF inhibitors appear to have net clinical benefits with regard to adverse cardiovascular events in Pso and/or PsA. Rigorous randomized controlled trials will need to evaluate whether TNF inhibitors truly result in reduction of cardiovascular diseases.

Systematic review of the real‐world evidence of adalimumab safety in psoriasis registries

“…26 The risk of cardiovascular events, such as MI and coronary artery disease, is increased among patients with psoriasis, especially those with severe disease. 43,44 Database studies have revealed similar results. 43,44 Database studies have revealed similar results.…”

“…41,42 Interestingly, some studies have suggested that TNF inhibitor therapy may help decrease the risk of cardiovascular events in patients with psoriasis. 43,44 Database studies have revealed similar results. 45,46 Large prospective studies designed to gather cardiovascular event data would definitively address the impact of TNF inhibitors on cardiovascular disease.…”

Psoriasis and Cardiovascular Risk: A Comprehensive Review

“…Specifically, in patients with psoriasis, Wu et al showed that the incidence of acute myocardial infarction was significantly lower in the group treated with anti-TNF compared with those who received topical treatments (3.05 vs. 6.73 events every 1000 patients/year), without finding differences from the group treated by other systemic treatments [118]. Likewise, another recent meta-analysis considering only studies that included patients with psoriasis or psoriatic arthritis showed that the use of anti-TNF was associated with a lower risk of acute myocardial infarction and cardiovascular events regarding topical treatment or phototherapy [119]. However, infliximab therapy was associated with an increase in hospitalizations and higher mortality in patients with heart failure, although etanercept did not show such effects [120].…”

Inflammageing: chronic inflammation in ageing, cardiovascular disease, and frailty

“…For example, treatment with TNF inhibitors in rheumatoid arthritis, an overt inflammatory disease, is associated with a decreased risk of cardiovascular events 182–187 . Treatment with TNF inhibitors in psoriasis is also associated with decreased incidence of major adverse cardiac events 186,188,189 . However, anti-inflammatory treatment does not always yield beneficial effects.…”