Lower Heart Disease Risk in Psoriasis and PsA with Biologics DMARDs

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Biological therapies prescribed for rheumatic diseases may also reduce their long-term risks of cardiovascular diseases (CVD). 

That's the theory offered in a meta-analysis published in a February issue of Rheumatic and Musculoskeletal Diseases. According to authors Champs et al., biological therapies approved for treatment of psoriasis and psoriatic arthritis (PsA) “have demonstrated anti-inflammatory effects in inflammatory rheumatic and skin diseases that could theoretically prevent atherosclerosis...”

Although a causal relationship has not yet been demonstrated, the inflammatory nature of psoriasis and PsA has long suggested the potential for wider systemic effects on the cardiovascular system.

A 2017 meta-analysis found a 43 percent increased risk of CVD in patients with PsA comparison to the general population. Likewise, risks of myocardial infarction (MI), stroke, and heart failure were also substantially higher, at 68 percent, 22 percent and 31 percent, respectively. Similar studies of mild psoriasis also demonstrated increased risks of stroke and MI (10 and 20 percent, respectively). The impact of severe psoriasis was more pronounced, with increased risks of 37 percent and 70 percent for stroke and MI and a 37 percent increase in mortality compared to people who don’t have psoriasis.

Disease modifying anti-rheumatic drug (DMARD) therapies that reduce inflammation may positively influence those risks. Reduced risks of CVD events were reported in psoriasis patients taking anti-tumor necrosis factor (TNF) drugs compared to both methotrexate and phototherapy, while MI rates were reduced in patients with rheumatoid arthritis (RA) taking antic-TNFs compared to other DMARDs.

At the same time, some disturbing potential for adverse events (AEs) in the short term have been reported with interleukin (IL) therapies. In 2011, both European and U.S. agencies withdrew approval of the anti-IL-12/23 human monoclonal antibody briakinumab (used for the treatment of moderate to severe chronic plaque psoriasis) due to a higher reported incidence of cardiovascular adverse events (AEs) and non-melanoma skin cancers compared to placebo. No increased short-term risks were seen other anti-IL-23 agents, including guselkumab, risankizumab, and tilrakizumab.

While follow-up data from larger trials and registries will be needed to further clarify the impact of these drugs on CVD risks, the larger implications of these trends can help to inform clinical decisions for treatment of psoriasis and PsA.
 

REFERENCES

A. Champs B, Degboe Y, Barnetche T, et al. Short-term risk of major adverse cardiovascular events or congestive heart failure in patients with psoriatic arthritis or psoriasis initiating a biological therapy: a meta–analysis of randomised controlled trials. RMD Open. 2019;5:e000763. DOI:10.1136/rmdopen-2018-000763

B. Polachek A, Touma Z, Anderson M, Eder L. Risk of Cardiovascular Morbidity in Patients With Psoriatic Arthritis: A Meta-Analysis of Observational Studies. Arthritis Care Res(Hoboken) 2017 Jan;69(1):67-74. DOI: 10.1002/acr.22926.

C. Gordon KB, Langley RG, Gottlieb AB, et al. "A phase III, randomized, controlled trial of the fully human IL-12/23 mAb briakinumab in moderate-to-severe psoriasis."  Journal of Investigative Dermatology. 2012 Feb;132(2):304-14. doi: 10.1038/jid.2011.304.