Novel anti‐inflammatory therapies to reduce cardiovascular burden of psoriasis

Abstract

Psoriasis mainly affects the skin and joints and has serious impacts on the physical, emotional, and financial life of patients. Recent studies have demonstrated that other comorbidities are frequently detected in psoriatic patients. A strong association with the development of cardiovascular diseases, such as hypertension, myocardial infarction, and stroke is responsible for the shortened (by 4.5‐5 years) life expectancy of severe psoriatic patients. Systemic inflammation plays an important role in the interrelationship between psoriasis and atherosclerotic plaque formation, which is a common immunopathogenic pathway that explains the multiorgan involvement in psoriasis. As far life‐threatening cardiovascular diseases are very often symptom‐free, the treating dermatologist's responsibility is to initiate interdisciplinary holistic patient care, which may lead to directly saved patients' lives. Holistic care of severe psoriatic patients should include regular cardiac monitoring using cardiovascular imaging modalities and functional testing to detect even subclinical coronary artery disease. Effective anti‐inflammatory treatment with biologic therapies may have beneficial effects on the cardiovascular state and may reduce the incidence of cardiac events. The authors review the latest findings on the shared immunopathogenic background of psoriasis and cardiovascular diseases and discuss the available data about the cardiovascular responses to the currently used biologic treatments.

Major cardiovascular events under biologic psoriasis therapies: a 19-year real-world analysis of FAERS data

“…However, other experimental data and pre-clinical trials do not support a protective effect of biologics against atherosclerotic plaque development (41,42). Some researchers (2,43) summarized the available data about the MACEs risk for the biological products and concluded that TNF inhibitors might reduce the risk of adverse cardiovascular events, the only IL- Paired EBGM values by drug and age groups for MACEs. Note the signal strength (EB05 value by color and the numerical EB05 value being within each minigraph).…”

“…However, other experimental data and pre-clinical trials do not support a protective effect of biologics against atherosclerotic plaque development ( 41 , 42 ). Some researchers ( 2 , 43 ) summarized the available data about the MACEs risk for the biological products and concluded that TNF inhibitors might reduce the risk of adverse cardiovascular events, the only IL-12/23 inhibitor ustekinumab appeared to be neutral, and the IL-17 inhibitors and IL-23 inhibitors were unclear, although more researches are needed to confirm these findings. A review of current data suggested positive or neutral effect of TNF, IL-17, and IL-12/23 inhibitors on cardiovascular events, but conflicting for IL-23 inhibitors ( 14 ).…”

The Renin-Angiotensin System: The Challenge behind Autoimmune Dermatological Diseases

“…While numerous proatherogenic cytokines are elevated in psoriasis, it is worth noting that IL-6, IL-17, IFN-γ and TNF-α assume a prominent role in causing endothelial dysfunction and the development of atherosclerosis. Furthermore, there is an impaired production of vascular NO, which contributes to the occurrence of coronary microvascular dysfunction [60][61][62].…”

Psoriasis and Atherosclerosis—Skin, Joints, and Cardiovascular Story of Two Plaques in Relation to the Treatment with Biologics

“…In a recently published review by Piros et al [ 165 ], the authors underline the need for holistic care of patients with severe PSO, which goes beyond skin and joints and by self-reinforcing Th1 and Th17 cell-dependent systemic inflammation, accelerating the progression of metabolic and cardiovascular diseases. Although the intrinsic anti-atherotic potential of novel systemic biologic treatment is still improving, their action should be accompanied, and for older agents, counterbalanced, by further safe and effective preventive measures.…”