-Whether it is an independent risk factor or not , psoriasis § is clearly associated with higher cardiovascular risk problems
-Associated burdens include obesity, hypertension, metabolic syndrome, lack of exercise although these could be confounding factors
-Is the benefit of controlling associated Cardiovascular risk factors the result of the improvement of associated risk factors rather than a effect of the specific treatment of psoriasis ?
-Does to improvement of the appearance or extent of psoriasis have meaningful impact on patients with comorbidities ?
COST OF TREATING PSORIASIS
-for a long time, the costs of treating psoriasis were controlled
-However, since 1997 the costs to treat proriasis have multiplied by 6 in the US
-If all psoriasis patients were put on biologics, it would cost 180 billion per year (in the US): it would add 50% to total dermatology prescription costs.
IS IT ALWAYS USEFUL TO TREAT COMORBIDITIES (and rely on serologic markers) ?
– C-reactive protein is a non-specific marker of inflammation : successfully treating with a decrease of CRP might not have a positive effect on the cardiovascular effects per se.
– Homocystein deficiency is an independant risk factor for coronary and stroke. in a study of 3749 subjects there was a 37% incidence in decreased in homocyseine levels but it had no decrease in incidence of repetitive cardiovascular risk factors
– Hyperlipidaemia : Treatments to raise HDL or lowering LDL with a to statin + niacin but had no effect on the incidence of cardiovascular diseases (study concerning 10000s patients)
– Antiarrythmics : 1498 subjects were treated for heart arrythmia with antiarrythmics flecainde and encainide. It was shown that the treated patients were 2.5 times more likely than the placebo group to die of arrhythmia !
-The suggestion of evidence is based on recent studies .
-The suggestion of the absence of evidence is based on studies on treatments of cardiovascular risk factors .
-It is also a consideration of cost and efficacy . Anti TNF treatments are very expensive and the cost per avoided Major-Cardiac Adverse effect might work, but it could also be an independent effect of other (and cheaper) ways to treat them.
-History will also tell us if the newer biologics are safe? on the long term
-Primary measure includes lifestyle and associated systemic risk factors. Then medical treatment . However it remains to be seen if conventional treatment should be replaced in some cases by TNF inhibitors.
-In our opinion, the real question is whether arthritis is present or not. In that case the use of Anti-TNF s is unquestionable
No, there is not enough evidence Stern R (USA). CN04 – Is There Now Enough Evidence That Controlling Psoriasis Really Decreases Cardiovascular Risk?