At the study start, in 2004, no one had had a heart attack. Wu's team looked at the incidence of heart attack until November 2010.
Of the 8,845 patients, who were on average about 53 years old:
- 5,075 were on topical medicines applied to the skin
- 2,097 were on oral medicines, such as acitretin (Soriatane), cyclosporine (Gengraf, Neoral, Sandimmune, Sangcya), and methotrexate (Rheumatrex, Trexall); or on light therapy (also called phototherapy)
- 1,673 were on TNF inhibitors, including Enbrel (etanercept), Humira (adalimumab), or Remicade (infliximab).
During the follow-up, heart attacks occurred in:
- 152 on topical medicines
- 41 on oral or light therapy
- 28 on TNF inhibitors
When Wu compared TNF inhibitors directly with the oral medicine and light therapy, the TNF inhibitors were found only slightly better in reducing heart attack risk.
Wu says he combined the oral agent and light therapy groups to simplify the research.
There was no information available on the severity of the psoriasis, Wu says.
Generally, topical medications are offered first, and if they don't give enough relief, patients may be offered the other treatments.
Topical treatments slow down the rapid growth of skin cells and reduce the inflammation. Light therapy slows down the rapid cell growth. Oral medicines such as methotrexate and the TNF inhibitors reduce inflammation in the entire body.
It is possible some with severe disease chose to get topical treatment, Wu says.
Wu reports receiving research grants from Abbott Laboratories, Amgen, and Pfizer. All market or are developing psoriasis medicines.
None of the grants are related to the current study. The study was supported by Kaiser Permanente Garfield Memorial Fund.