Are TNF Antagonists Beneficial for Cardiovascular Disease?

Jeffrey P. Callen, MD

A significant decrease in intima-media thickness of the carotid and brachial arteries was noted in psoriasis patients who took TNF antagonists.

Three tumor necrosis factor (TNF) antagonists are approved for the treatment of psoriasis — etanercept, adalimumab, and infliximab, all of which have demonstrated efficacy for psoriatic lesions as well as for psoriatic arthritis. Some reports suggest a beneficial effect of these agents on cardiovascular disease in patients with arthritis. To determine whether this benefit might also occur with methotrexate or other biologic agents, these authors studied 16 patients with moderate to severe psoriasis who were treated with TNF antagonists and followed for 6 months. To determine the effect on intima-media thickness, a marker of subclinical atherosclerosis, the researchers measured the carotid and brachial arteries using noninvasive, high-resolution, B-mode ultrasonography.

In all patients, psoriasis responded well to the therapy. In addition, in the 13 patients who had no clinically apparent atherosclerotic plaques at baseline, a significant decrease in intima-media thickness of all studied arteries was noted at 6 months.