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Severe psoriasis is probably associated with increased risk for myocardial infarction (MI), stroke, and cardiovascular-related death. Some evidence from the mid-1990s implies that methotrexate decreases this risk, and recent studies suggest a similar effect from tumor necrosis factor α (TNF-α) antagonists.
Using data from Danish civil, medical, and death registries, these authors identified 2400 patients whose severe psoriasis was treated with ultraviolet (UV) light therapy or systemic agents (including biological agents in 693 patients and methotrexate in 799). Most of the biologic agents used by these patients were TNF-α antagonists; interleukin (IL)-12/23 antagonists were used by fewer than 20%. Age- and sex-adjusted hazard ratios for the composite end point of death, MI, and stroke were 0.28 (95% confidence interval, 0.12–0.64) and 0.65 (95% CI, 0.42–1.00) in users of biologic or methotrexate therapies, respectively, compared with other therapies. The authors conclude that use of methotrexate or a biologic agent decreases risk for cardiovascular events and related deaths.
Ahlehoff O et al. Cardiovascular disease event rates in patients with severe psoriasis treated with systemic anti-inflammatory drugs: A Danish real-world cohort study. J Intern Med 2012 Sep 11; [e-pub ahead of print]. (http://viajwat.ch/RCd5da)
Comment
Most of the patients treated with IL-12/23 antagonists in the U.S. have also received a TNF antagonist, and often these patients are treated with methotrexate prior to or concurrently with the biologic agent. Such mixed treatment histories may muddle the data; nevertheless, compared with other systemic agents (primarily acitretin and cyclosporine), or with UV or other phototherapies, these agents were associated with fewer events and related deaths. In addition, the authors note that patients selected for these therapies might be younger or healthier to begin with, but age adjustment may correct for this bias.