Are drug treatments for psoriasis a cardiovascular risk?

Multiple studies have shown psoriasis to be an independent risk factor for cardiovascular disease, particularly in patients with moderate-to-severe disease. Chronic, systemic inflammation is the proposed etiology for the increase in cardiovascular morbidity. Previous studies had suggested that the control of systemic inflammation with the use of methotrexate and antitumor necrosis factor agents had a cardioprotective effect in patients with psoriasis. While our recent meta-anlaysis of 22 randomized controlled trials (RCTs) did not show a statistically significant association between anti-IL-12/23 therapies and anti-TNF agents and major adverse cardiovascular events (MACE), the study had limited power to detect changes in rare events over a short period of time. Collection of comprehensive postmarketing safety data, and the use of observational pharmacoepidemiological studies plus drug registries will play an important role in addressing this limitation in addition to providing more conclusive data regarding the impact of established and future psoriasis therapies on cardiovascular events. Psoriasis is a common autoimmune disease of cutaneous inflammation and keratinocyte hyperproliferation, manifesting clinically as scaly, raised, erythematous plaques. While the pathogenesis remains to be fully elucidated, a complex interplay between genetic and environmental influences is paramount in the development of the disease [1]. Recent studies have shown that patients with moderate-to-severe psoriasis have a clinically significant increased risk of cardiovascular disease together with cardiovascular risk factors such as Type 2 diabetes mellitus, obesity, smoking and the metabolic syndrome compared to the general population, with an overall increase in all-cause mortality [2]. The mechanistic link between psoriasis and this observed increase in cardiovascular comorbidities has not been fully defined. It is clear, however, that common inflammatory pathways are at play in the pathophysiology of psoriasis, obesity and coronary artery disease.