Abstract
TNF inhibitors have been used in psoriasis (Pso) and psoriatic arthritis (PsA), which were associated with increased risk of cardiac and cerebrovascular events. However, whether TNF inhibitors reduce cardiovascular event is still unclear. Therefore, we aimed to evaluate the effect of TNF inhibitors on adverse cardiovascular events (CVEs) in Pso with or without PsA. We undertook a meta-analysis of clinical trials identified in systematic searches of MEDLINE, EMBASE, Wanfang database, Cochrane Database, and Google scholar through December 31, 2015. Five studies (49,795 patients) were included. Overall, compared with topical/photo treatment, TNF inhibitors were associated with a significant lower risk of CVE (RR, 0.58; 95 % CI, 0.43 to 0.77; P < 0.001; I 2 = 66.2 %). Additionally, compared with methotrexate (MTX) treatment, risk of CVE was also markedly decreased in the TNF inhibitor group (RR, 0.67; 95 % CI, 0.52 to 0.88; P = 0.003; I 2 = 9.3 %). Meanwhile, TNF inhibitors were linked to reduced incidence of myocardial infarction compared with topical/photo or MTX treatment (RR, 0.73; 95 % CI, 0.59 to 0.90; P = 0.003; I 2 = 56.2 % and RR, 0.65; 95 % CI, 0.48 to 0.89; P = 0.007; I 2 = 0.0 %, respectively). Furthermore, there was a trend of decreased rate of mortality in the TNF inhibitor group compared with other therapy (RR, 0.90; 95 % CI, 0.54 to 1.50; P = 0.68; I 2 = 70.9 %). TNF inhibitors appear to have net clinical benefits with regard to adverse cardiovascular events in Pso and/or PsA. Rigorous randomized controlled trials will need to evaluate whether TNF inhibitors truly result in reduction of cardiovascular diseases.
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References
Sunbul M, Seckin D, Durmus E, et al. (2015) Assessment of arterial stiffness and cardiovascular hemodynamics by oscillometric method in psoriasis patients with normal cardiac functions. Heart Vessel 30:347–354
Gerdes S, Osadtschy S, Buhles N, et al. (2014) Cardiovascular biomarkers in patients with psoriasis. Exp Dermatol 23:322–325
Khan R, Spagnoli V, Tardif JC, et al. (2015) Novel anti- inflammatory therapies for the treatment of atherosclerosis. Atherosclerosis 240:497–509
Pieringer H, Pichler M, Pohanka E, et al. (2014) Will antirheumatic treatment improve cardiovascular outcomes in patients with rheumatoid arthritis? Curr Pharm Des 20:486–495
Hugh J, Van Voorhees AS, Nijhawan RI, et al. (2014) From the Medical Board of the National Psoriasis Foundation: the risk of cardiovascular disease in individuals with psoriasis and the potential impact of current therapies. J Am Acad Dermatol 70:168–177
Wu JJ, Poon KY, Channual JC, et al. (2012) Association between tumor necrosis factor inhibitor therapy and myocardial infarction risk in patients with psoriasis. Arch Dermatol 148:1244–1250
Roubille C, Richer V, Starnino T, et al. (2015) The effects of tumour necrosis factor inhibitors, methotrexate, non-steroidal anti-inflammatory drugs and corticosteroids on cardiovascular events in rheumatoid arthritis, psoriasis and psoriatic arthritis: a systematic review and meta-analysis. Ann Rheum Dis 74:480–489
Armstrong AW, Brezinski EA, Follansbee MR, et al. (2014) Effects of biologic agents and other disease-modifying antirheumatic drugs on cardiovascular outcomes in psoriasis and psoriatic arthritis: a systematic review. Curr Pharm Des 20:500–512
Moher D, Liberati A, Tetzlaff J, PRISMA Group, et al. (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 62:1006–1012
Wells GSB, O’Connel D. The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-analysisOttawa Hospital Research Institute Web site http://www.ohri.ca/programs/clinicalepidemiology/oxford.asp
DerSimonian R, Laird N, et al. (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188
Deeks JJ, Altman DG, Bradburn MJ (2001) Statistical methods for examining heterogeneity and combining results from several studies in meta-analysis. In: Egger M, Smith GD, Altman DG (eds) Systematic reviews in health care: meta-analysis in context, 2nd edn. BMJ Publishing Group, London, pp. 285–312
Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50:1088–1101
Egger M, Davey Smith G, Schneider M, et al. (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634
Abuabara K, Lee H, Kimball AB (2011) The effect of systemic psoriasis therapies on the incidence of myocardial infarction: a cohort study. Br J Dermatol 165:1066–1073
Ahlehoff O, Skov L, Gislason G, et al. (2013) Cardiovascular disease event rates in patients with severe psoriasis treated with systemic anti-inflammatory drugs: a Danish real-world cohort study. J Intern Med 273:197–204
Wu JJ, Poon KY, Bebchuk JD (2013) Association between the type and length of tumor necrosis factor inhibitor therapy and myocardial infarction risk in patients with psoriasis. J Drugs Dermatol 12:899–903
Ahlehoff O, Skov L, Gislason G, et al. (2015) Cardiovascular outcomes and systemic anti-inflammatory drugs in patients with severe psoriasis: 5-year follow-up of a Danish nationwide cohort. J Eur Acad Dermatol Venereol 29:1128–1134
Tobin AM, Veale DJ, Fitzgerald O, et al. (2010) Cardiovascular disease and risk factors in patients with psoriasis and psoriatic arthritis. J Rheumatol 37:1386–1394
Horreau C, Pouplard C, Brenaut E, et al. (2013) Cardiovascular morbidity and mortality in psoriasis and psoriatic arthritis: a systematic literature review. J Eur Acad Dermatol Venereol 27:12–29
Wu JJ, Poon KY (2014) Tumor necrosis factor inhibitor therapy and myocardial infarction risk in patients with psoriasis, psoriatic arthritis, or both. J Drugs Dermatol 13:932–934
Levine B, Kalman J, Mayer L, et al. (1990) Elevated circulating levels of tumor necrosis factor in severe chronic heart failure. N Engl J Med 323:236–241
Kadokami T, Frye C, Lemster B, et al. (2001) Anti-tumor necrosis factor-alpha antibody limits heart failure in a transgenic model. Circulation 104:1094–1097
Mann DL, McMurray JJ, Packer M, et al. (2004) Targeted anticytokine therapy in patients with chronic heart failure: results of the Randomized Etanercept Worldwide Evaluation (RENEWAL). Circulation 109:1594–1602
Chung ES, Packer M, Lo KH, Anti-TNF Therapy Against Congestive Heart Failure Investigators, et al. (2003) Randomized, double-blind, placebo-controlled, pilot trial of infliximab, a chimeric monoclonal antibody to tumor necrosis factor-alpha, in patients with moderate-to-severe heart failure: results of the anti-TNF Therapy Against Congestive Heart Failure (ATTACH) trial. Circulation 107:3133–3140
Solomon DH, Rassen JA, Kuriya B, et al. (2013) Heart failure risk among patients with rheumatoid arthritis starting a TNF antagonist. Ann Rheum Dis 72:1813–1818
Ryan C, Leonardi CL, Krueger JG, et al. (2011) Association between biologic therapies for chronic plaque psoriasis and cardiovascular events: a meta-analysis of randomized controlled trials. JAMA 306:864–871
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Yang, Zs., Lin, Nn., Li, L. et al. The Effect of TNF Inhibitors on Cardiovascular Events in Psoriasis and Psoriatic Arthritis: an Updated Meta-Analysis. Clinic Rev Allerg Immunol 51, 240–247 (2016). https://doi.org/10.1007/s12016-016-8560-9
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DOI: https://doi.org/10.1007/s12016-016-8560-9