“The findings do not surprise me. TNF inhibitors control inflammation better than methotrexate,” lead author Dr. Jashin J. Wu of Kaiser Permanente Los Angeles Medical Center in Calif. tells Reuters Health by email.
The findings were published online on Oct. 26 in the Journal of the American Academy of Dermatology.
Using data from Truven MarketScan Database, Dr. Wu and his colleagues classified adult psoriasis patients who had two or more TNF inhibitors or MTX prescriptions as either TNF inhibitors or MTX users.
At 12 months, the 9,148 TNF inhibitor users had fewer CV events than the 8,581 MTX users (Kaplan-Meier rates: 1.45% vs. 4.09%: p<0.01). Over a median follow up of 24 months, every six-month period of cumulative exposure to TNF inhibitors was associated with an 11% drop in CV event risk (p=0.02).
Co-author and data analyst Annie Guerin, vice president at Analysis Group in Boston, tells Reuters Health by email, “The impact of psoriasis treatment goes beyond the management of skin symptoms. In this study, TNF inhibitors were associated with a reduced risk of cardiovascular events, and cumulative exposure to TNF inhibitors resulted in an incremental cardiovascular event risk reduction. When making treatment decisions, the concurrent reduction in cardiovascular risk should be considered.”
“It was important to do this study to see if treating patients with TNF inhibitors improves more than just psoriasis,” Dr. Wu says. “Perhaps TNF inhibitors should be prescribed first, ahead of MTX, although many health plans require that patients fail methotrexate first.”
The authors acknowledged that the lack of clinical assessment measures was a limitation of their study.
“Further studies are warranted to compare the cardiovascular risk among other treatment options for psoriasis,” Ms. Guerin says.
Dr. Wu agreed, explaining that he would like to explore whether other biologics for psoriasis also improve major adverse cardiovascular events.
AbbVie helped design, conduct and fund the study. Dr. Wu is a consultant for the drugmaker, and two of his co-authors are employees at AbbVie.
Reference
- Wu JJ, Guérin A, Sundaram M. et al. Cardiovascular event risk assessment in psoriasis patients treated with tumor necrosis factor-α inhibitors versus methotrexate. J Am Acad Dermatol. 2016 Oct 26. doi: http://dx.doi.org/10.1016/j.jaad.2016.07.042