- 作者：Jeremy Hugh ; Abby S. Van Voorhees ; Rajiv I. Nijhawan ; Jerry Bagel ; Mark Lebwohl ; Andrew Blauvelt ; Sylvia Hsu ; Jeffrey M. Weinberg
- 关键词：adalimumab ; biologic therapies ; cardiovascular ; cyclosporine ; etanercept ; infliximab ; methotrexate ; mycophenolate mofetil ; psoralen plus ultraviolet A ; psoriasis ; ultraviolet therapy ; ustekinumab
- 刊名：Journal of the American Academy of Dermatology
- 出版年：January, 2014
- 年：2014
- 卷：70
- 期：1
- 页码：168-177
- 全文大小：318 K
Background
Many studies have identified cardiovascular risk factors in patients with psoriasis. Some psoriasis therapies may increase cardiovascular disease (CVD) and others may decrease CVD.Objective
We reviewed the literature to define the impact of common psoriasis therapies on cardiovascular measures and outcomes.
Results
Phototherapy has no major cardiovascular impact and may reduce levels of proinflammatory cytokines. Acitretin increases serum lipids and triglycerides, but has not been shown to increase cardiovascular risk. Cyclosporine A increases blood pressure, serum triglycerides, and total cholesterol. Methotrexate is associated with a decreased risk of CVD morbidity and mortality. Among the biologics, data for tumor necrosis factor inhibitors suggest an overall reduction in cardiovascular events. Most data on short-term ustekinumab use suggest no effect on major adverse cardiovascular events, however some authorities remain concerned. Nevertheless, ustekinumab use over a 4-year period shows a decrease in major adverse cardiovascular events when compared both with the general US population and with psoriatics in Great Britain.
Limitations
Most studies lack the power and randomization of large clinical trials and long-term follow-up periods. In addition, the increased risk of CVD associated with psoriasis itself is a confounding factor.
Conclusion
Some therapies for moderate to severe psoriasis, including methotrexate and tumor necrosis factor inhibitors, may reduce cardiovascular events in psoriatic patients. Ustekinumab appears to be neutral聽but there may be a long-term benefit. Appropriate patient counseling and selection and clinical聽follow-up are necessary to maximize safety with these agents. Further long-term study is necessary聽to quantify the benefits and risks associated with biologic therapies.