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Newer Psoriasis Drugs May Lower Heart Attack Risk for Patients

By Denise Mann
HealthDay Reporter

MONDAY, Aug. 20 (HealthDay News) -- People with psoriasis who take a new class of drugs known as tumor necrosis factor (TNF) inhibitors may be at a lower risk for heart attack than their counterparts who only use topical medications to treat this inflammatory skin condition, a new study shows.

And patients taking older systemic medicines and phototherapy may also have a reduced heart attack risk compared to those using topical preparations, the study found.

Of 8,845 study participants, about 57 percent were treated with topical therapy only, 19 percent received a TNF inhibitor for at least two months and about 24 percent were treated with other medications or phototherapy. People who were treated with TNF inhibitors had a 50 percent lower risk, and those treated with other psoriasis drugs or phototherapy had a 46 percent lower risk for heart attack, than those who used topical medications alone.

The findings appear online Aug. 20 in the Archives of Dermatology.

TNF inhibitors, or blockers, are part of a class of drugs called biologics. They work by blocking key players in the inflammation cascade. Phototherapy uses laser or ultraviolet light to slow the rapidly growing skin cells that lead to psoriasis.

Psoriasis is marked by raised, reddish and itchy skin patches or plaques that may be covered with a silvery-white coating. Still, psoriasis is more than skin deep. People with this condition are at higher risk for developing heart attacks, strokes and certain types of cancer. This is likely related to underlying inflammation.

The new study can't say how, or even if, TNF blockers lower heart risks in people with psoriasis. "We know that reducing inflammation reduces risk of diabetes and other inflammatory processes, which could reduce risk for heart attack and stroke," said study author Dr. Jashin Wu, at the Kaiser Permanente Los Angeles Medical Center.

One group of study patients took TNF blockers etanercept (Enbrel), infliximab (Remicade) or adalimumab (Humira).

Other patients randomly assigned to a second group received either oral medicines -- cyclosporine, acitretin or methotrexate -- or phototherapy. The third group received topical medications alone.

TNF blockers have changed the treatment of psoriasis and other inflammatory diseases such as rheumatoid arthritis, but they do have their share of side effects including infection and certain types of cancer. "In psoriasis, the immune system is hyperactive so we try to reduce it, but anytime you lower immune activity, there is always the risk of infection or reactivation of a latent infection," Wu said.

Not everyone with psoriasis does or should take biologic medications. "I usually determine the severity of the psoriasis first," he said. "If 10 percent of their body is covered or if they have psoriatic arthritis and/or have failed other medications, they are eligible," he said.

These drugs are not inexpensive; a November 2011 study in Arthritis & Rheumatism found that for patients taking various TNF drugs for psoriatic arthritis, costs ranged from about $13,500 to nearly $25,000 per year.

The study findings are welcome news, said Dr. Bruce Strober, an associate professor of dermatology at the University of Connecticut in Farmington.

"There is previous and well-replicated evidence that patients with [rheumatoid arthritis] treated successfully with TNF inhibitors demonstrate a lowered risk of heart attack, and perhaps even heart failure. But similar data in psoriasis have been lacking," he said. "This analysis is the first demonstration that, potentially, the use of TNF inhibitors may prevent heart attacks in psoriasis patients."

Still, Strober said, "these data must be viewed as preliminary and not conclusive, as more studies from different source databases must replicate and confirm these findings."

TNF-inhibitors should be viewed broadly as "anti-inflammatory" drugs, he said. "Psoriasis is an inflammatory disease of not only the skin but also multiple other organs, including the joints, ligaments, tendons, and the blood vessels," he explained. "TNF-inhibitors therefore reduce inflammation of the blood vessels, and therefore block a root cause of [heart disease]."

More information

Learn all about psoriasis at the American Academy of Dermatology.

SOURCES: Bruce Strober, M.D., associate professor, dermatology, University of Connecticut, Farmington, Conn.; Jashin J. Wu, M.D., Kaiser Permanente Los Angeles Medical Center, Calif.; Aug. 20, 2012, Archives of Dermatology, online

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