From the Medical Board of the National Psoriasis Foundation: The risk of cardiovascular disease in individuals with psoriasis and the potential impact of current therapies - 18/12/13
Abstract |
Background |
Many studies have identified cardiovascular risk factors in patients with psoriasis. Some psoriasis therapies may increase cardiovascular disease (CVD) and others may decrease CVD.
Objective |
We reviewed the literature to define the impact of common psoriasis therapies on cardiovascular measures and outcomes.
Results |
Phototherapy has no major cardiovascular impact and may reduce levels of proinflammatory cytokines. Acitretin increases serum lipids and triglycerides, but has not been shown to increase cardiovascular risk. Cyclosporine A increases blood pressure, serum triglycerides, and total cholesterol. Methotrexate is associated with a decreased risk of CVD morbidity and mortality. Among the biologics, data for tumor necrosis factor inhibitors suggest an overall reduction in cardiovascular events. Most data on short-term ustekinumab use suggest no effect on major adverse cardiovascular events, however some authorities remain concerned. Nevertheless, ustekinumab use over a 4-year period shows a decrease in major adverse cardiovascular events when compared both with the general US population and with psoriatics in Great Britain.
Limitations |
Most studies lack the power and randomization of large clinical trials and long-term follow-up periods. In addition, the increased risk of CVD associated with psoriasis itself is a confounding factor.
Conclusion |
Some therapies for moderate to severe psoriasis, including methotrexate and tumor necrosis factor inhibitors, may reduce cardiovascular events in psoriatic patients. Ustekinumab appears to be neutral but there may be a long-term benefit. Appropriate patient counseling and selection and clinical follow-up are necessary to maximize safety with these agents. Further long-term study is necessary to quantify the benefits and risks associated with biologic therapies.
Le texte complet de cet article est disponible en PDF.Key words : adalimumab, biologic therapies, cardiovascular, cyclosporine, etanercept, infliximab, methotrexate, mycophenolate mofetil, psoralen plus ultraviolet A, psoriasis, ultraviolet therapy, ustekinumab
Abbreviations used : CHF, CVD, DM, HTN, IL, MACE, MI, MTX, PsA, PUVA, RA, TNF, TNFi, UV, VEGF
Plan
Funding sources: None. |
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Disclosure: Dr Van Voorhees has served on advisory boards for Amgen, Abbott Laboratories, Genentech, Novartis, Warner Chilcott, Centocor/Janssen Biotech, and LEO Pharma; has been an investigator and consultant for Amgen; and has been a speaker for Amgen, Abbott Laboratories, and Centocor/Janssen Biotech. Dr Bagel has served as consultant, on advisory boards, and as a speaker and investigator for Amgen and Abbott Laboratories. Dr Lebwohl has served as consultant and investigator for Abbott Laboratories, Amgen, Celgene, Eli Lilly & Co, Janssen Biotech, and LEO Pharma; as an investigator for Ranbaxy; and as a consultant for Anacor Pharmaceuticals, BioLineRX, Dermipsor, Galderma, GlaxoSmithKline-Stiefel, Maruho, Novartis, Pfizer, and Valeant. Dr Blauvelt has served on advisory boards and as investigator and consultant for Janssen Biotech, Novartis, and Eli Lilly & Co; as a speaker for Janssen Biotech; and as an investigator for Abbott Laboratories, Amgen, and Celgene. Dr Hsu has served on advisory boards for Abbott Laboratories, Amgen, Biogen Idec, Centocor/Janssen Biotech, and Genentech; and has been an investigator for Centocor/Janssen Biotech. Dr Weinberg has served as a speaker for Abbott Laboratories, Amgen, and Genentech, and has performed clinical research for Amgen, Celgene, and Janssen Biotech. Drs Hugh and Nijhawan have no conflicts of interest to declare. |
Vol 70 - N° 1
P. 168-177 - janvier 2014 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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