Study

Treatment for Psoriasis

Cardiovascular Endpoint

Number of Patients

Relative Risk

Population/ Type of Study

Abuabara et al., 2011 [74]

Systemic immunomodulatory therapies (methotrexate, cyclosporine, alefacept, efalizumab, adalimumab, etanercept, infliximab)

Myocardial infarction

Psoriasis: 25,554;

Phototherapy: 4220; Systemic treatment: 20,094; Both treatments: 1240

Hazard ratio (compared to UVB phototherapy): 1.33 (95% CI 0.90 - 1.96)

United States/

Cohort study

Ahlehoff et al., 2013 [75]

Biological agents; Methotrexate

Cardiovascular death, myocardial infarction and stroke

Severe psoriasis: 2400;

Biological agents: 693;

Methotrexate: 799; Other therapies: 908

Hazard ratio (compared to other therapies): Biological agents:

0.48 (95% CI 0.17 - 1.38); Methotrexate:

0.50 (95% CI 0.26 - 0.97)

Denmark/

Retrospective cohort study

Ahlehoff et al., 2015 [76]

Methotrexate;

Cyclosporine; Retinoids;

TNF-α inhibitors; Ustekinumab

Cardiovascular events

(cardiovascular death, myocardial infarction, stroke)

Severe psoriasis: 6902;

Methotrexate: 3564; Cyclosporine: 244; Retinoids:

756; TNF-α inhibitors: 959; Ustekinumab: 178

Hazard ratio (compared to other therapies): Methotrexate:

0.53 (95% CI 0.34 - 0.83); Cyclosporine:

1.06 (95% CI 0.26 - 4.27);

Retinoids: 1.80 (95% CI 1.03 - 2.96);

TNF-α inhibitors: 0.46 (95% CI 0.22 - 0.98); Ustekinumab: 1.52 (95% CI 0.47 - 4.94)

Denmark/

Cohort study

Chin et al., 2013 [77]

Methotrexate; Retinoid

Cardiovascular disease; Cerebrovascular disease

Psoriasis patients without arthritis: 7648

Hazard ratio (compared to no methotrexate and no retinoid treatment):

Cardiovascular disease:

Methotrexate: 0.39 (95% CI 0.20 - 0.76); Retinoid 0.47 (95% CI 0.26 - 0.83); Cerebrovascular disease:

Methotrexate: 0.42 (95% CI 0.19 - 0.95); Retinoid: 0.67 (95% CI 0.35 - 1.31)

Taiwan/

Retrospective cohort study

Lan et al., 2012 [54]

Methotrexate; Retinoid

Cerebrovascular disease

Psoriasis: 8180; Methotrexate: 258; Retinoid: 193

Hazard ratio (compared to no methotrexate and no retinoid treatment):

Methotrexate: 0.50 (95% CI 0.27 - 0.92); Retinoid: 0.70 (95% CI 0.39 - 1.23)

Taiwan/

Retrospective cohort study

Prodanovich et al., 2005 [78]

Methotrexate

Vascular disease

(including cardiovascular disease, cerebrovascular disease, atherosclerosis)

Psoriasis: 7615

Relative risk (compared to no methotrexate treatment): Methotrexate: 0.73 (95% CI 0.55 - 0.98); Low cumulative dose methotrexate:

0.50 (95% CI 0.31 - 0.79)

United States/

Retrospective cohort study

Wu et al., 2012 [79]

TNF inhibitor

Myocardial infarction

Psoriasis: 8845; TNF inhibitor: 1673

Hazard ratio (compared to topical therapy): TNF inhibitor:

0.50 (95% CI 0.32 - 0.79)

United States/

Retrospective cohort study

Wu et al., 2013 [80]

TNF inhibitor; Oral/phototherapy

Myocardial infarction

Psoriasis: 8845; Caucasians:

4645 (TNF inhibitor: 857; Oral/phototherapy: 1011; Topical: 2777);

Non-Caucasians: 4200

(TNF inhibitor: 816;

Oral/phototherapy: 1086; Topical: 2298)

Hazard ratio (compared to topical therapy): Caucasians: TNF inhibitors: 0.35 (95% CI 0.20 - 0.62); Oral/phototherapy:

0.36 (95% CI 0.22 - 0.59); Non-Caucasians: TNF inhibitors: 0.27 (95% CI 0.11 - 0.67); Oral/phototherapy:

0.58 (95% CI 0.32 - 1.04)

United States/

Retrospective cohort study