CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

August 20th, 2012

TNF Inhibitors Linked to Reduction in MI for Psoriasis Patients

Psoriasis patients who take TNF inhibitors have a significant reduction in the risk for myocardial infarction (MI), according to a retrospective cohort study published in Archives of Dermatology. Although previous research suggested that the anti-inflammatory effects of methotrexate, an older therapy, may be beneficial in this population, the cardiovascular effects of TNF inhibitors had not been well studied.

Researchers identified 8845 patients who were diagnosed with psoriasis or psoriatric arthritis within the Kaiser Permanente Southern California health plan. After a median of 4.3 years of observation, the overall rate of MI was 5.21 per 1000 patient-years.

  • In the 1673 patients who received a TNF inhibitor (etanercept, infliximab, or adalimumab), the MI rate was 3.05 per 1000 patient-years.
  • In the 2097 patients who received oral therapy or phototherapy, the MI rate was 3.85 per 1000 patient-years.
  • In the 5075 patients who received topical therapy, the MI rate was 6.73 per 1000 patient-years.

TNF inhibitors and oral therapy/phototherapy were each superior to topical therapy, but the difference between TNF inhibitors and oral therapy/phototherapy was not significant. Compared with topical agents, TNF inhibitors and oral agents/phototherapy had hazard ratios (adjusted for other risk factors) of 0.50 and 0.54, respectively.

The authors write, “This is the first large scale retrospective cohort study to show that the use of TNF inhibitors for psoriasis is associated with a clinically and statistically significant reduction in MI risk and incident rate compared with psoriatic patients treated with topical agents.” However, they note that “prospective studies are needed and warranted to determine whether the use of TNF inhibitors may reduce the risk of major adverse cardiovascular events in patients with systemic inflammatory conditions.”

Categories: General, Prevention
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One Response to “TNF Inhibitors Linked to Reduction in MI for Psoriasis Patients”

  1. Judith Andersen, AB, MD says:
    August 27, 2012 at 11:23 pm

    As a physician who sees a large number of patients with venous and arterial thrombosis, including MI, apparently related to inflammation alone as an identifiable issue — with increased plasma levels of Factor VIII, wWF activity, hs-CRP and PAI-1 , it seems very reasonable to me that systemic inhibitors of inflammation might reduce MI risk in psoriasis patients. Still association studies can be misleading — we need clinical trials of inhibitors of inflammation vs topical agents, with measurement of parameters of inflammation over time, and the proviso that patients deemed unable, for whatever reason, to receive TNF inhibitors, have comparable date obtained.