Meta-analysis: anti-IL-12/23 agents or anti-tumor necrosis factor-alpha treatments have no effect on the cardiovascular risk of chronic plaque psoriasis patients

Key Points

Biologic agents (anti-IL-12/IL-23 antibodies or anti-tumor necrosis factor (TNF)-alpha treatments) have no effect on the rate of major adverse cardiovascular events (MACEs) in patients suffering from chronic plaque psoriasis, according to a meta-analysis in the August 24/31, 2011 edition of JAMA.

However, according to the researchers, "... a cardioprotective effect has been suggested with systemic agents such as methotrexate and TNF-alpha agents in rheumatoid arthritis and psoriasis populations." They continued, "Preliminary reports of MACEs in psoriasis patients receiving anti-IL-12/23 agents have prompted concern."

To evaluate the effect of these different biologic agents on the incidence of MACE, researchers conducted a meta-analysis of randomized controlled trials (RCTs). Following a systematic search of the medical literature, they identified 22 RCTs randomly assigning a total of 10,183 patients to a biologic agent or placebo. In the anti-IL-12/23 studies, 10 of 3,179 patients receiving an anti-IL-12/23 therapy experienced MACE compared with 0 of 1,474 patients receiving placebo (pooled risk difference, 0.012 events/person-year; 95% CI, -0.001 to 0.026; P=.12). In the anti–TNF-alpha blocker trials, 1 of 3,858 patients receiving an anti-TNF-alpha blocker and 1 of 1,812 patients receiving placebo experienced a MACE (pooled risk difference, -0.0005 events/person-year; 95% CI, -0.010 to 0.009; P=.94). Thus, the meta-analysis was unable to demonstrate an effect of either class of biologic agent on the occurrence of MACE, although the researchers themselves caution that the small number of MACEs and the limited duration of follow-up of included studies likely reduced their statistical power to detect a change in risk.

SOURCE

Ryan C, Leonardi CL, Krueger JG, et al. Association between biologic therapies for chronic plaque psoriasis and cardiovascular events: a meta-analysis of randomized controlled trials. JAMA. 2011;306(8):864–871.