全身治疗可使银屑病患者心梗风险减半

根据《皮肤病学文献》8月20日在线发表的一项研究结果，肿瘤坏死因子(TNF)抑制剂、口服药物和光线疗法等全身治疗可使银屑病患者心肌梗死(MI)风险减半(Arch. Dermatol. 2012 Aug. 20 [doi:10.1001/archdermatol.2012.2502])。

凯撒医疗集团洛杉矶医学中心的Jashin J. Wu博士及其同事指出，银屑病是一种全身性炎性疾病，可增加与炎性有关的心血管疾病风险，采用积极治疗方案控制银屑病炎性反应似乎可降低MI风险。

迄今，有关全身性银屑病治疗对心血管疾病风险的影响尚有待研究。为此，研究者利用HMO大型数据库考察了8,845例2004~2009年确诊的成年银屑病患者的医疗和处方资料，并进行了中位时间为4年的MI发病率随访。受试者基线平均年龄53岁，男女各半。其中1,673患者(19%)接受TNF抑制剂治疗，2,097例(24%)口服药物或采用光线疗法，其余5,075例单纯接受局部治疗。随访期间共计发生221例MI。

结果显示，接受TNF抑制剂和全身药物或光线疗法治疗患者MI发病率分别为3.05/1,000(患者·年)和3.85/1,000(患者·年)，两者未见显著差异，但均明显低于局部治疗组的6.73/1,000(患者·年) MI发病率。与单纯局部治疗患者相比，接受TNF抑制剂和其他全身药物治疗患者MI发病率分别降低55%和43%。此外，受试者年龄分层分析显示，TNF抑制剂、口服药物和光线疗法对60岁以上患者的保护作用优于年轻患者。研究者认为，一种可能的解释是老年患者常患有2型糖尿病，而上述全身治疗也可减少2型糖尿病风险。

研究者指出，这项首次大规模研究表明TNF抑制剂可降低银屑病患者MI发病率。既往有关类风湿性关节炎(另外一种与心血管疾病相关的炎性疾病)患者的大规模研究也表明，TNF抑制剂可降低患者心血管事件发生率。

该研究的局限性在于未能说明受试者应用非甾体抗炎药物(NSAID)等非处方药物情况。

该研究由凯撒医疗集团加菲尔德纪念基金会资助，Wu博士报告与雅培、安进和辉瑞制药存在经济利益关系。

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By: MARY ANN MOON, Cardiology News Digital Network

Systemic treatments for psoriasis – including tumor necrosis factor inhibitors, oral drugs, and phototherapy – reduce the risk of myocardial infarction by approximately half, according to a study published online Aug. 20 in the Archives of Dermatology.

Psoriasis is a systemic inflammatory disease known to raise the risk of cardiovascular disorders, which also have a major inflammatory component. "It seems that controlling psoriasis with aggressive therapy and, thus, lowering inflammation, leads to a reduction in MI risk," said Dr. Jashin J. Wu of Kaiser Permanente Los Angeles Medical Center, and his associates.

The effect of systemic psoriasis therapy on cardiovascular disease "has been largely unexplored" until now. Dr. Wu and his colleagues performed a retrospective cohort study to examine the issue, using their HMO’s large database to examine the medical and prescription data on 8,845 adults who were diagnosed as having psoriasis between 2004 and 2009, and were followed for a median of 4 years for incident MI. The mean age of these study subjects was 53 years at baseline; half were men and half were women.

In all, 1,673 subjects (19%) were treated with TNF inhibitors, 2,097 (24%) were treated with oral systemic agents or phototherapy, and the remaining 5,075 received only topical treatment.

There were 221 incident MIs during follow-up.

For patients who took TNF inhibitors, the rate of MI was 3.05 per 1,000 patient-years, and for those who received systemic drugs or phototherapy, the rate of MI was 3.85 per 1,000 patient-years. These rates were not significantly different from each other, but were significantly lower than the rate of 6.73 MIs per 1,000 patient-years seen in the topical therapy–only group.

Compared with patients who used only topical treatment, those who took TNF inhibitors showed a 55% reduction in MI incidence and those who used other systemic treatments showed a 43% reduction in MI incidence, the investigators said (Arch. Dermatol. 2012 Aug. 20 [doi:10.1001/archdermatol.2012.2502]).

This is the first large-scale study to show that TNF inhibitors in particular, when they are taken for the treatment of psoriasis, reduce the incidence of MI. A previous study using a large database of patients with rheumatoid arthritis, another inflammatory disease associated with cardiovascular disease, found that therapy with TNF agonists also reduced the rate of cardiovascular events in that patient population, Dr. Wu and his associates noted.

In their study, an analysis of the data that stratified study subjects by age suggested that TNF inhibitors, oral agents, and phototherapy all exerted stronger protective effects in those older than 60 years, compared with younger patients. One explanation may be that older patients are more likely to develop type 2 diabetes, and these systemic therapies may cut the risk of that disease as well, they said.

This study was limited in that it could not account for study subjects’ use of nonprescription drugs, such as NSAIDs.

This study was supported by Kaiser Permanente’s Garfield Memorial Fund. Dr. Wu reported ties to Abbott Laboratories, Amgen, and Pfizer.