Psoriasis Drugs May Curb Heart Disease Risk

Remember the unproven  miracle drug etanercept from a year and a half ago? It supposedly reduced the TNF, tumor necrosis factor, just like this drug does. So contact your researcher  and have them see if reducing TNF actually helps in stroke rehab and then if this drug might help. No one else is going to push this so you have to.
http://www.medpagetoday.com/Cardiology/MyocardialInfarction/34300
Treating psoriasis patients with biologic drugs that inhibit tumor necrosis factor (TNF) may cut risk of heart attack compared with other treatments, observational results suggested.
TNF-treated patients were half as likely to have a myocardial infarction (MI) as those treated with topical drugs after adjustment for other factors, Jashin J. Wu, MD, of the Kaiser Permanente Los Angeles Medical Center, and colleagues found in a retrospective cohort study.
Oral drugs and phototherapy were also significantly better than topical treatment in terms of MI risk, though rates tended to be even lower with the TNF inhibitors, the researchers reported online in the Archives of Dermatology.
"It seems that controlling psoriasis with aggressive therapy and, thus, lowering inflammation leads to a reduction in MI risk," they wrote.
As a systemic inflammatory disease, psoriasis is linked to many cardiovascular risks, from obesity and atherosclerosis to type 2 diabetes, stroke, MI, and cardiac death.
The same is true in rheumatoid arthritis, but a large observational study linked TNF blockers to reduced cardiovascular events in that disease.
To evaluate the effect in psoriasis, Wu's group retrospectively analyzed the Kaiser Permanente Southern California health plan databases.
Among the 8,845 members with multiple diagnostic claims codes for psoriasis or psoriatic arthritis and no history of MI at baseline:

• 19% took a TNF inhibitor for at least 2 months
• 24% were TNF-inhibitor naive and received other systemic agents, like methotrexate, or phototherapy
• 57% received none of the above and were classified as treated only topically

During a mean 4.3 years of follow-up, MI incidence was 3.05 per 1,000 patient-years in the anti-TNF-treated group compared with 3.85 in those on oral drugs or phototherapy and 6.73 in those on topical drugs.
That translated to an unadjusted 55% lower risk of MI with the TNF inhibitors and 43% lower risk with oral drugs or phototherapy compared with topical agents (both P less than 0 data-blogger-escaped-.001=".001" data-blogger-escaped-p="p" greater than TNF blockers were associated with 21% lower MI risk compared with other systemic drugs or phototherapy in that analysis, though the difference wasn't statistically significant.
In an age-stratified analysis, both treatments appeared more protective against MI in older adults. Compared with topical agents, the hazard ratios were:

• Among patients age ≤60, 0.46 with TNF inhibitors (95% CI 0.25 to 0.88) and a nonsignificant 0.60 with oral therapy and phototherapy
• Among patients age >60, 0.32 with TNF inhibitors (95% CI 0.14 to 0.73) and 0.35 with oral agents or phototherapy (95% CI 0.21 to 0.59)

"One reason for this is that older patients are more likely to have type 2 diabetes mellitus, and the benefits of TNF inhibitor use may be mediated through improving risk of type 2 diabetes," the researchers noted.
Alternatively, older patients may be less likely to get a TNF inhibitor because of lower coverage of prescription benefits through Medicare for these costly drugs, or because of recent history of cancer as a contraindication for TNF inhibitor therapy, they added.
The study didn't compare the individual TNF blockers -- infliximab (Remicade), etanercept (Enbrel), and adalimumab (Humira) -- used in psoriasis.
The study was limited by lack of data on psoriasis severity, which could have been a confounding factor if severe cases were more likely to receive no systemic therapy.
Other limitations were lack of adjustment for over-the-counter medications like nonsteroidal anti-inflammatory drugs and for duration and dosing of drugs analyzed in the study (statins, beta-blockers, or methotrexate).