title: Effects of biologic agents and other disease-modifying antirheumatic drugs on cardiovascular outcomes in psoriasis and psoriatic arthritis: a systematic review.
abstract: BACKGROUND
  Whether systemic treatments for psoriasis or psoriatic arthritis affect cardiovascular comorbidities is a clinically significant question.
  
  
  OBJECTIVE
  To examine the effects of biologic agents and other Disease-Modifying Antirheumatic Drugs (DMARDs) used to treat psoriasis and psoriatic arthritis on cardiovascular risk factors and adverse cardiovascular outcomes.
  
  
  METHODS
  MEDLINE (1980-October 2012), Web of Science, the EULAR abstract database, and the AAD annual meeting abstract archive were searched for studies evaluating biologic and other DMARD therapy for psoriasis and psoriatic arthritis that reported cardiovascular events as primary outcomes.
  
  
  RESULTS
  From 20 studies that met the search criteria for the review, 81,469 patients with psoriasis and/or psoriatic arthritis were included in the data synthesis of the current literature. While the data on the cardioprotective effect of methotrexate exist in patients with rheumatoid arthritis, its effect on the psoriasis and psoriatic arthritis populations with regards to cardiovascular outcomes are inconclusive at this time. The association of hypertension with long-term cyclosporine use prompts discontinuation of cyclosporine in selected patients. The use of TNF inhibitors may be associated with reduced risk of adverse cardiovascular events in preliminary epidemiologic studies; however, large randomized controlled trials and epidemiologic studies with well-characterized populations will be necessary to elucidate their exact effects. The short-term data regarding the safety of IL-12/23 inhibitors showed that, to date, there are no increased cardiovascular events compared to the general population.
  
  
  CONCLUSIONS
  To date, epidemiologic data is insufficient to reach definitive conclusions with regards to the effects of biologics and other DMARDs on cardiovascular outcomes in psoriasis and psoriatic arthritis patients. Adequately powered, long-term, controlled studies are necessary to determine the cardioprotective effects of TNF inhibitors observed in preliminary studies on psoriasis and psoriatic arthritis populations.
authors.forename: April W
authors.initials: AW
authors.lastname: Armstrong
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Brezinski
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Follansbee
authors.affiliation: University of California Davis, Department of Dermatology 3301 C St., Suite 1400 Sacramento, CA 95816. aprilarmstrong@post.harvard.edu.
authors.forename: Ehrin J
authors.initials: EJ
authors.lastname: Armstrong
mesh_terms: D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D015897:Comorbidity; D006801:Humans; D011565:Psoriasis / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D011993:Recombinant Fusion Proteins / Q000009:adverse effects / Q000627:therapeutic use; D012307:Risk Factors
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D002317:Cardiovascular Agents; D011993:Recombinant Fusion Proteins