Table 2.
Studies investigating the effects of different psoriasis treatments on the risk of cardiovascular disease in patients with psoriasis.
| Study | Treatment for Psoriasis | Cardiovascular Endpoint | Number of Patients | Relative Risk | Population/Type of Study |
|---|---|---|---|---|---|
| Abuabara et al., 2011 [262] | Systemic immunomodulatory therapies (methotrexate, cyclosporine, alefacept, efalizumab, adalimumab, etanercept, infliximab) | Myocardial infarction | Psoriasis: 25,554; Phototherapy: 4220; Systemic treatment: 20,094; Both treatments: 1240 | Hazard ratio (compared to UVB phototherapy): 1.33 (95% CI 0.90–1.96) | United States/Cohort study |
| Ahlehoff et al., 2013 [254] | Biological agents; Methotrexate | Cardiovascular death, myocardial infarction and stroke | Severe psoriasis: 2400; Biological agents: 693; Methotrexate: 799; Other therapies: 908 | Hazard ratio (compared to other therapies): Biological agents: 0.48 (95% CI 0.17–1.38); Methotrexate: 0.50 (95% CI 0.26–0.97) | Denmark/Retrospective cohort study |
| Ahlehoff et al., 2015 [252] | Methotrexate; Cyclosporine; Retinoids; TNF-α inhibitors; Ustekinumab | Cardiovascular events (cardiovascular death, myocardial infarction, stroke) | Severe psoriasis: 6902; Methotrexate: 3564; Cyclosporine: 244; Retinoids: 756; TNF-α inhibitors: 959; Ustekinumab: 178 | Hazard ratio (compared to other therapies): Methotrexate: 0.53 (95% CI 0.34–0.83); Cyclosporine: 1.06 (95% CI 0.26–4.27); Retinoids: 1.80 (95% CI 1.03–2.96); TNF-α inhibitors: 0.46 (95% CI 0.22–0.98); Ustekinumab: 1.52 (95% CI 0.47–4.94) |
Denmark/Cohort study |
| Chin et al., 2013 [179] | Methotrexate; Retinoid | Cardiovascular disease; Cerebrovascular disease | Psoriasis patients without arthritis: 7648 | Hazard ratio (compared to no methotrexate and no retinoid treatment): Cardiovascular disease: Methotrexate: 0.39 (95% CI 0.20–0.76); Retinoid 0.47 (95% CI 0.26–0.83); Cerebrovascular disease: Methotrexate: 0.42 (95% CI 0.19–0.95); Retinoid: 0.67 (95% CI 0.35–1.31) |
Taiwan/Retrospective cohort study |
| Lan et al., 2012 [48] | Methotrexate; Retinoid | Cerebrovascular disease | Psoriasis: 8180; Methotrexate: 258; Retinoid: 193 | Hazard ratio (compared to no methotrexate and no retinoid treatment): Methotrexate: 0.50 (95% CI 0.27–0.92); Retinoid: 0.70 (95% CI 0.39–1.23) |
Taiwan/Retrospective cohort study |
| Prodanovich et al., 2005 [251] | Methotrexate | Vascular disease (including cardiovascular disease, cerebrovascular disease, atherosclerosis) | Psoriasis: 7615 | Relative risk (compared to no methotrexate treatment): Methotrexate: 0.73 (95% CI 0.55–0.98); Low cumulative dose methotrexate: 0.50 (95% CI 0.31–0.79) |
United States/Retrospective cohort study |
| Wu et al., 2012 [263] | TNF inhibitor | Myocardial infarction | Psoriasis: 8845; TNF inhibitor: 1673 | Hazard ratio (compared to topical therapy): TNF inhibitor: 0.50 (95% CI 0.32–0.79) |
United States/Retrospective cohort study |
| Wu et al., 2013 [264] | TNF inhibitor; Oral/phototherapy | Myocardial infarction | Psoriasis: 8845; Caucasians: 4645 (TNF inhibitor: 857; Oral/phototherapy: 1011; Topical: 2777); Non-Caucasians: 4200 (TNF inhibitor: 816; Oral/phototherapy: 1086; Topical: 2298) | Hazard ratio (compared to topical therapy): Caucasians: TNF inhibitors: 0.35 (95% CI 0.20–0.62); Oral/phototherapy: 0.36 (95% CI 0.22–0.59); Non-Caucasians: TNF inhibitors: 0.27 (95% CI 0.11–0.67); Oral/phototherapy: 0.58 (95% CI 0.32–1.04) |
United States/Retrospective cohort study |
| Wu et al., 2013 [265] | TNF inhibitor (etanercept or monoclonal antibody) | Myocardial infarction | Etanercept: 976; Monoclonal antibody: 217; Topical therapy: 5075 | Hazard ratio (compared to topical agents): Etanercept: 0.53 (95% CI 0.31–0.92); Monoclonal antibody: 0.25 (95% CI 0.06–1.03) |
United States/Retrospective cohort study |
| Wu et al., 2014 [266] | TNF inhibitor | Myocardial infarction | Psoriasis (treated with TNF inhibitor): 846; Psoriasis (not treated with TNF inhibitor): 7172 | Hazard ratio (compared to psoriasis patients not treated with TNF inhibitors): 0.26 (95% CI 0.12–0.56) |
United States/Retrospective cohort study |
| Wu et al., 2017 [267] | TNF inhibitor | Major cardiovascular events (myocardial infarction, stroke or transient ischemic attack, unstable angina) | TNF inhibitor: 9148; Methotrexate: 8581 | Hazard ratio (compared to methotrexate): Major cardiovascular event: 0.55 (95% CI 0.45–0.67) Myocardial infarction: 0.49 (95% CI 0.34–0.71); Stroke or TIA: 0.55 (95% CI 0.42–0.71); Unstable angina: 0.58 (95% CI 0.41–0.82) |
United States/Retrospective cohort study |
CI = confidence interval.