Psoriasis Treatments Have Differing Risks of Cardiovascular Adverse Events

Because many patients with psoriasis also have cardiovascular diseases, these comorbidities must be considered when deciding on a treatment plan, according to investigators in a new article published in Chinese Medical Journal.

Some drugs commonly used for psoriasis can increase the risk of cardiovascular diseases, whereas other treatments can reduce the risk, according to the study. Psoriasis is a chronic autoimmune disease that results in patches of dry, scaly, and itchy skin, which the researchers said is challenging to manage and can often require various medications.

“There are many patients with psoriasis who also have cardiovascular diseases, such as hypertension, diabetes, hyperlipidemia, and coronary heart disease,” said researcher Min Chen, MD, in a press release. “Some of the drugs for psoriasis may increase the risks of these diseases, while some can reduce them.”

In their review, the investigators examined known associations between the different treatments for psoriasis and risks of cardiovascular disease. Various drugs can influence the long-term risks of MACE, an acronym that includes myocardial infarction, cerebrovascular accidents, and cardiovascular mortality. Some common treatments for psoriasis, such as tumor necrosis factor-α inhibitors and methotrexate, could actually reduce long-term MACE risk, whereas some interleukin (IL) inhibitors can increase the risk, according to the study.

For example, the investigators said the IL-12/23 inhibitors briakinumab increased MACE risks so much across multiple studies that investigators suspended all clinical trials. Other IL inhibitors, such as tildrakizumab and guselkumab, do not appear to increase MACE risks, according to the study authors.

Similarly, the widely used immunosuppressant cyclosporine A can cause damage to heart muscle tissues, the researchers noted. These findings suggest that more research is necessary before scientists can rank psoriasis treatments in terms of their effects on long-term MACE risks, according to the study authors.

Furthermore, the investigators noted that the medical community has no consensus on whether systemic treatments for psoriasis can mitigate or worsen arterial plaques, vascular function, and vascular inflammation. There is some evidence that treatments for psoriasis counter inflammation of coronary tissues and can lessen the coronary plaque burdens that contribute to coronary artery disease, according to the study authors.

Conversely, researchers have found that treatments with TNF-α inhibitors may contribute to increased body weight, but IL-17 and IL-12/23 inhibitors could help patients lose weight. Cyclosporine A can increase the risk of diabetes, worsen hypertension, and contribute to unhealthy lipid metabolism profiles.

Based on their findings, the investigators concluded that different psoriasis treatments have different effects on cardiovascular diseases and their risk factors, necessitating a more thorough consideration of each patient’s clinical situation before selecting a treatment. For example, TNF- α inhibitors and methotrexate could be good options for patients with psoriasis who are at a high risk of experiencing MACE, whereas IL-17 and IL-12/23 inhibitors could be beneficial for patients who have arterial plaques.

REFERENCE

Relationship between psoriasis treatments and cardiovascular risk explained [news release]. EurekAlert; March 29, 2021. https://www.eurekalert.org/pub_releases/2021-03/cc-rbp032921.php. Accessed April 2, 2021.