Systemic anti-inflammatory drugs, including biological agents, are widely used in the treatment of patients with moderate to severe psoriasis and may attenuate the risk of cardiovascular disease events. Systemic anti-inflammatory drugs, including biological agents, are widely used in the treatment of patients with moderate to severe psoriasis and may attenuate the risk of cardiovascular disease events. Individual-level linkage of nationwide administrative databases was used to assess the event rates associated with use of biological agents, methotrexate or other therapies, including retinoids, cyclosporine and phototherapy, in Denmark from 2007 to 2009. A total of 2400 patients with severe psoriasis, including 693 patients treated with biological agents and 799 treated with methotrexate, were identified. Long-term treatment is required for the management of moderate-to-severe psoriasis. Here we evaluated the safety of ustekinumab in patients treated for up to 5 years. Risk was similar in patients with severe psoriasis affecting only the skin and in those with psoriatic arthritis. Measurement of serum CRP levels can be useful in cardiovascular risk assessment in patients with intermediate risk as defined by the Framingham score. Incidence of MACE in Clinical Trials With Biologic AgentsIn 1 of the 4 pivotal studies of briakinumab, a monoclonal anti-p40 antibody, 18 MACE had been recorded (11 cases of nonfatal myocardial infarction, 3 of nonfatal stroke, and 4 cardiovascular deaths) by the end of November 2009. 5 MACE were reported in the 1582 psoriasis patients treated with ustekinumab in phase II and III clinical trials (0.
Medical history of patients with severe psoriasis treated with biologic agents in the time period 2007 09 was retrieved from a Danish nationwide registry (DERMBIO). In 2008 the US National Psoriasis Foundation recommended that all patients with psoriasis should be referred to a general practitioner for cardiovascular risk factor assessment, including family history, annual blood pressure measurement, biennial screening for obesity, and lipid and glucose screening every 2nd or 5th year for patients with or without classical coronary risk factors, respectively 16, 22. Rates of major adverse cardiovascular event and death are lower in biologic cohorts compared to non-biologic cohorts. Psoriasis Diagnosis and Initial Assessment. The overall efficacy of biologic agents in the treatment of moderate-to-severe plaque psoriasis is evidenced by the disease response in clinical trials and in post-marketing studies. The analysis showed a slightly higher risk of infection in patients treated with TNF inhibitors but no increase in the risk of serious infections or malignancies. Younger patients with severe disease had the highest risk of MI. R. Major adverse cardiovascular events in the psoriasis longitudinal assessment and registry (PSOLAR) study: Current status of observations.
Safe use of biologic agents requires thorough risk assessment of potential candidates for treatment and careful monitoring during and after therapy. With the exception of etanercept, TNF- inhibitor therapy is contraindicated in patients with class III/IV heart failure 20 23, and these agents should be used cautiously in patients with less severe CHF 20 23. CVD. During randomized controlled trials, tocilizumab-treated patients had durable CRP reductions to within normal ranges as early as week 2 and experienced rapid ESR reductions 66. Treatment Goals for Moderate to Severe Psoriasis. Future studies in this area will greatly inform clinicians and researchers of the patterns of topical medication use, which is a cornerstone of treating patients with psoriasis of varying severity. Monitoring for Methotrexate Hepatotoxicity in Patients With No Risk Factors for Hepatotoxicity. The biologic agents are pregnancy category B and should be used cautiously in pregnancy after consultation with the patient’s obstetrician. The patient’s assessment of current disease severity – eg, using the static Patient’s Global Assessment. Second-line therapy which includes phototherapy, broad-band or narrow-band ultraviolet B light, with or without supervised application of complex topical therapies such as dithranol in Lassar’s paste or crude coal tar and photochemotherapy, psoralens in combination with UVA irradiation (PUVA), and non-biological systemic agents such as ciclosporin, methotrexate and acitretin. Consider an individual’s cardiovascular risk where the psoriasis is severe (affecting 10 of the body’s surface area; if there has been previous inpatient treatment or the patient has had UV light treatment or other systemic therapy) and monitor and manage this appropriately.
Plos One: Pharmacological Undertreatment Of Coronary Risk Factors In Patients With Psoriasis: Observational Study Of The Danish Nationwide Registries
Reduction of adverse cardiovascular events in patients with severe psoriasis treated with biologic agents or methotrexate: a Danish real-world cohort study. Treating geriatric patients with moderate-to-severe psoriasis remains a challenge due to immunosenescence and comorbidities. In addition, different treatment modalities including biologic agents, acitretin, cyclosporine, and methotrexate were combined with the key words geriatric and elderly. After a thorough assessment of articles in the Medline database, 14 relevant articles were included in this review. Ustekinumab has been implicated to increase cardiovascular risk due to earlier phase II research findings, although later data did not demonstrate such risks. This risk is particularly high among patients with severe psoriasis 5,6. The increased cardiovascular morbidity in psoriatic disease may be partially attributed to the high prevalence of metabolic abnormalities, such as impaired glucose tolerance and atherogenic lipid profile, in these patients 9,10. Most cases are not severe enough to affect general health and are treated in the outpatie. Biologic agents used in the treatment of psoriasis include the anti-TNF agents adalimumab, etanercept, and infliximab, the anti-interleukin (IL)-12/23 antibody ustekinumab, and the anti-IL-17 antibody secukinumab. Patients with less acute disease can be treated with acitretin or methotrexate as first-line agents.