Patients with psoriasis being treated with tumor necrosis factor(TNF)-alpha inhibitors are not at greater risk for cardiovascular disease, suggested the results of a review article in The Permanente Journal.

To study the relationship between TNF-alpha inhibitors and cardiovascular disease in psoriasis, Thao Nguyen, MD, of Los Angeles Medical Center, reviewed 22 randomized controlled trials, which included 10,183 patients. The trials evaluated a possible association between biologic therapies for chronic plaque psoriasis and major adverse cardiac events.

The studies included in the review examined monotherapy of anti-interleukin(IL)-12/23 agents ustekinumab (Stelara) and briakinumab (withdrawn from the US and European markets in 2011) and anti-TNF-alpha agents adalimumab (Humira), etanercept (Enbrel) and infliximab (Remicade).

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During the placebo-controlled phases of the anti-IL-12/23 studies, 10 of the 3,179 patients treated with these therapies had a major adverse cardiac event compared with zero events in the 1,474 patients treated with placebo. In studies of patients taking anti-TNF-alpha agents, one of the 3,858 patients had a major adverse cardiac event compared with one of the 1,812 treated with placebo.

“This meta-analysis did not show a significant increase in the risk of major adverse cardiac events associated with the use of anti-IL-12/23 agents or anti-TNF-alpha agents,” wrote the researchers.

While some trials indicated no elevated risk of major adverse cardiac events, the results reflect that an increase in the use of TNF-alpha inhibitors may decrease the risk of major adverse cardiac events.

“As more patients receiving TNF-alpha inhibitor therapy are enrolled in postmarketing registries, more long-term data will help elucidate whether these agents may benefit the risk reduction for major adverse cardiac events,” concluded the researchers.


  1. Nguyen T. Perm J. 2014; 18(1): 49-54.


One author reports receiving research funding from AbbVie Inc., Amgen Inc. and Pfizer Inc.