The Effect of TNF Inhibitors on Cardiovascular Events in Psoriasis and Psoriatic Arthritis: an Updated Meta-Analysis.
TNF inhibitors have been used in psoriasis (Pso) and psoriatic arthritis (PsA), which were associated with increased risk of cardiac and cerebrovascular events. However, whether TNF inhibitors reduce cardiovascular event is still unclear. Therefore, we aimed to evaluate the effect of TNF inhibitors on adverse cardiovascular events (CVEs) in Pso with or without PsA. We undertook a meta-analysis of clinical trials identified in systematic searches of MEDLINE, EMBASE, Wanfang database, Cochrane Database, and Google scholar through December 31, 2015. Five studies (49,795 patients) were included. Overall, compared with topical/photo treatment, TNF inhibitors were associated with a significant lower risk of CVE (RR, 0.58; 95 % CI, 0.43 to 0.77; P < 0.001; I (2) = 66.2 %). Additionally, compared with methotrexate (MTX) treatment, risk of CVE was also markedly decreased in the TNF inhibitor group (RR, 0.67; 95 % CI, 0.52 to 0.88; P = 0.003; I (2) = 9.3 %). Meanwhile, TNF inhibitors were linked to reduced incidence of myocardial infarction compared with topical/photo or MTX treatment (RR, 0.73; 95 % CI, 0.59 to 0.90; P = 0.003; I (2) = 56.2 % and RR, 0.65; 95 % CI, 0.48 to 0.89; P = 0.007; I (2) = 0.0 %, respectively). Furthermore, there was a trend of decreased rate of mortality in the TNF inhibitor group compared with other therapy (RR, 0.90; 95 % CI, 0.54 to 1.50; P = 0.68; I (2) = 70.9 %). TNF inhibitors appear to have net clinical benefits with regard to adverse cardiovascular events in Pso and/or PsA. Rigorous randomized controlled trials will need to evaluate whether TNF inhibitors truly result in reduction of cardiovascular diseases.
Department of Dermatology, The First Hospital of Qinhuangdao, No. 258, Wenhua Road, Qinhuangdao, Hebei, China. ylxd285@163.com.
Zheng-Sheng
ZS
Yang
Department of Dermatology, The First Hospital of Qinhuangdao, No. 258, Wenhua Road, Qinhuangdao, Hebei, China.
Ning-Ning
NN
Lin
Department of Infection, The First Hospital of Qinhuangdao, Qinhuagdao, Hebei, China.
Li
L
Li
Department of Scientific Research Management, The First Hospital of Qinhuangdao, Qinhuagdao, Hebei, China.
Yang
Y
Li
D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015535:Arthritis, Psoriatic / Q000150:complications* / Q000188:drug therapy; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D002986:Clinical Trials as Topic; D006801:Humans; D015994:Incidence; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use; D016017:Odds Ratio; D063868:Patient Outcome Assessment; D011565:Psoriasis / Q000150:complications* / Q000188:drug therapy; D000079424:Tumor Necrosis Factor Inhibitors
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D000079424:Tumor Necrosis Factor Inhibitors; D008727:Methotrexate
Cardiovascular event; Meta-analysis; Methotrexate; Myocardial infarction; Tumor necrosis factor inhibitor