Journal of Clinical and Aesthetic Dermatology

Updates on Psoriasis & Cutaneou Oncology

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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S18 P r o c e e D i n G s JCAD jOUrnAl Of ClInICAl And AEsthEtIC dErMAtOlOgy september 2017 • volume 10 • number 9 • supplement endothelial dysfunction, considered an early phase of atherogenesis, is a systemic and pathological state of the endothelium that results from an imbalance between vasodilating and vasoconstricting substances produced by and/or acting on the inner lining of blood vessels. accelerated atherosclerosis has been recognized as a comorbidity of moderate to severe psoriasis. 60, 61, 62 a new study explored whether the use of tnfa inhibitors in patients with moderate-to-severe psoriasis (n=29 consecutive patients) would improve endothelial function measured by brachial artery reactivity measuring gow-mediate dilatation (fMD%). 63 Patients had completed six months treatment with adalimumab. fMD% values increased (improved) from 6.19±2.44 percent at the commencement of adalimumab therapy to 7.46±2.43 percent after six months (p=0.008). arterial stidness is considered an independent predictor of cardiovascular disease, and it was likewise found that after six months of treatment with adalimumab, patients with moderate-to-severe psoriasis showed signifcant improvement. carotid arterial stidness was assessed using pulse wave velocity (PWv) at baseline and then at six months. PWv decreased (improved) from 6.28±1.04m/sec at baseline to 5.69±1.31m/sec at six months (p=0.03). 63 in a single-center, prospective, observer- blinded, controlled study, noncontrast coronary artery calcium computed tomography (ct) scans along with contrast-enhanced coronary ct angiography were performed at baseline and again at 13 months in 28 patients with severe psoriasis treated with adalimumab, etanercept, ingiximab, or ustekinumab. 64 Patients could rotate to diderent drugs from this list over the 13 months of the study at the discretion of their physicians in order to control ingammation. noncontrast coronary artery calcium scores remained stable in the active-treatment group but progressed in the control group (p=0.02). luminal narrowing remained unchanged in the intervention group but worsened in the control group. 64 thus, these biologics could be associated with a reduction in coronary artery disease progression in patients with severe psoriasis. to compare the risk of Mace in patients treated with tnfa inhibitors versus those treated with methotrexate, a retrospective claims-based analysis was conducted using data from the truven Health analytics Marketscan® databases with data from the frst quarter of 2000 through the third quarter of 2011). 65 in this large study (n=382,059 psoriasis patients), figure 2.tumor necrosis factor-alpha (tnf-a) inhibitor patients also endured a longer time to frst major adverse cardiac event (Mace) than methotrexate patients 5 reproduced with permission from Wu, et al. cardiovascular event risk assessment in psoriasis patients treated with tumor necrosis factor-alpha inhibitors versus methotrexate. J Am Acad Dermatol. 2017;76(1):81-90. tAblE 3. adjusted hazard ratios for number of adverse events in psoriasis patients taking tnfa inhibitors or methotrexate EVEnts tnfa InhIbItIOn MEthOtrExAtE AdjUstEd hAzArd rAtIOs n95% CIO pMVAlUE nUMbEr Of EVEnts n=9,148 n=8,581 Mace 183 (2.0%) 305 (3.6%) 0.55 (0.45–0.67) <0.0001 stroke or tia 100 (1.1%) 180 (2.1%) 0.55 (0.42–0.71) <0.0001 unstable angina 59 (0.6%) 90 (1.0%) 0.58 (0.41–0.82) <0.0024 Myocardial infarction 52 (0.6%) 89 (1.0%) 0.49 (0.34–0.71) 0.0002 ci: confdence interval; Mace: major adverse cardiac events; tia: transient ischemic attack adapted from Wu JJ, Guerin a, sundaram M, Dea K, cloutier M, Mulani P. cardiovascular event risk assessment in psoriasis patients treated with tumor necrosis factor-alpha inhibitors versus methotrexate. J Am Acad Dermatol. 2017;76(1):81–90.

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