Looking beyond the Skin: Pathophysiology of Cardiovascular Comorbidity in Psoriasis and the Protective Role of Biologics
Abstract
1. Introduction
2. Link between Atherosclerosis and Psoriasis
3. Biologics in the Treatment of Psoriasis. Do They Also Address the Increased Cardiovascular Risk?
3.1. Anti-TNFα Drugs
3.2. Drugs That Target the IL-23/Th17 Axis
3.2.1. Anti-IL-17 Drugs
3.2.2. Anti-IL12/23 Drugs
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Drug | N of Trials or Patients | MACE Risk |
---|---|---|
Anti-TNFα | 5 studies (49795 patients with psoriasis or psoriatic arthritis, mean duration follow-up: 38 months) comparing TNFi (adalimumab, etanercept, golimumab, and infliximab) vs. topical/photo therapy or MTX [117] | vs. topical/photo therapy: RR, 0.58; 95% CI, 0.43 to 0.77; p < 0.001; I2 = 66.2% vs. MTX: RR, 0.67; 95% CI, 0.52 to 0.88; p = 0.003; I2 = 9.3% overall, vs. control group: RR, 0.60; 95% CI, 0.48 to 0.74; p < 0.001; I2 = 57.3% |
4762 psoriasis patients (1058 patients treated with TNFi (adalimumab, etanercept, infliximab); 1331 treated with MTX; 2372 treated with topical agents); a median of 3.9 years follow-up [118] | IR per 1000 SY (95% CI): TNFi: 4.88 (2.5–7.2) (significantly lower than topical cohort, p = 0.01) MTX: 5.38 (3.04–8.3) (significantly lower than topical cohort, p = 0.02) Topical: 12.34 (9.6–20.8) No significant difference between TNFi and MTX | |
11410 TNFi vs. 12433 phototherapy patients [119] | HR = 0.77; p < 0.05 | |
9148 TNFi users vs. 8581 MTX users [120] | HR = 0.55; p < 0.01 | |
18 RCTs comparing TNFi (4 adalimumab, 9 etanercept, 5 infliximab) vs. placebo [121] | OR, 0.67 (95% CI, 0.10–4.63, p = 0.69) | |
15 RCTs comparing TNFi (8 etanercept, 4 infliximab, 3 adalimumab) vs. placebo [147] | (Mantel–Haenszel risk difference, −0.0005/SY; 95% CI, −0.010 to 0.009; p = 0.94) | |
Anti-IL17 (Secukinumab) | 28 clinical trials and post-marketing surveillance data, 12,637 patients (15063, 5985 and 3527 patient-years of exposure in psoriasis, psoriatic arthritis and ankylosing spondylitis patients, respectively); 5 years cumulative data [139] | IR < 0.4/100 SY for psoriasis and psoriatic arthritis, with no apparent increases over time |
10 phase II/III clinical trials, 52 weeks follow-up [140] | IR: 0.42/100 SY (300 mg dose) IR: 0.35/100 SY (150 mg dose) | |
Anti-IL12/23 | 7 RCTs (ustekinumab vs. placebo), 30 weeks follow-up [121] | OR, 4.48 (95% CI, 0.24–84.77; p = 0.32) |
1582 ustekinumab vs. 732 placebo-treated patients. 20 weeks follow-up [146] | IR, 0.3%; (95% CI, 0.1–0.70) vs. 0.0% (95% CI, 0.0–0.5%) | |
9 RCTs comparing anti-IL-12/23 (5 ustekinumab, 4 briakinumab) vs. placebo [147] | (Mantel–Haenszel risk difference, 0.012/SY; 95% CI, −0.001 to 0.026; p = 0.12 | |
9 RCTs (ustekinumab vs. placebo), 30 weeks follow-up [149] | OR, 4.23, 95% CI: 1.07–16.75, p = 0.04) | |
Case-time-control study with 9290 ustekinumab [151] | Patients with high CV risk: OR, 4.17; 95% CI, 1.19–14.59 Patients with low CV risk: OR, 0.30; 95% CI, 0.03–3.13 | |
4 phase II and phase III studies, 3177 patients, 5 years follow-up [152] | IR (45 mg) 0.56/100 SY IR (90 mg) 0.36/100 SY | |
Psoriasis Longitudinal Assessment and Registry (PSOLAR), 12093 patients [153] | IR 0.33/100 SY | |
1465 patients (981 briakinumab vs. 484 placebo) [148] | Exposure-adjusted rate: 1.06/100SY, 95% CI 0.43, 2.18. | |
9 RCTs (briakinumab vs. placebo), 30 weeks follow-up [149] | OR, 4.47 (95% CI, 0.69–28.89; p = 0.12) |
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Andújar, I.; Esplugues, J.V.; García-Martínez, P. Looking beyond the Skin: Pathophysiology of Cardiovascular Comorbidity in Psoriasis and the Protective Role of Biologics. Pharmaceuticals 2022, 15, 1101. https://doi.org/10.3390/ph15091101
Andújar I, Esplugues JV, García-Martínez P. Looking beyond the Skin: Pathophysiology of Cardiovascular Comorbidity in Psoriasis and the Protective Role of Biologics. Pharmaceuticals. 2022; 15(9):1101. https://doi.org/10.3390/ph15091101
Chicago/Turabian StyleAndújar, Isabel, Juan V. Esplugues, and Patricia García-Martínez. 2022. "Looking beyond the Skin: Pathophysiology of Cardiovascular Comorbidity in Psoriasis and the Protective Role of Biologics" Pharmaceuticals 15, no. 9: 1101. https://doi.org/10.3390/ph15091101
APA StyleAndújar, I., Esplugues, J. V., & García-Martínez, P. (2022). Looking beyond the Skin: Pathophysiology of Cardiovascular Comorbidity in Psoriasis and the Protective Role of Biologics. Pharmaceuticals, 15(9), 1101. https://doi.org/10.3390/ph15091101