生物製劑治療是否降低乾癬患者的重大心血管疾病發生率？

我們很努力的衛教乾癬患者，乾癬這樣的免疫發炎疾病，除了皮膚以外，也增加了心血管疾病等共病的發生率，近年最成功的乾癬治療莫過於生物製劑的發展，但是生物製劑是否降低了乾癬患者重大心血管疾病的危險呢？

英國皮膚科醫學雜誌(IF=4.317)2017年4月有一篇systemic review+meta-analysis的文章，納入了38個隨機對照研究（RCT）做meta-analysis:
結果是不論哪一種生物製劑，包括TNF inhibitor，anti-IL17a或anti-IL12/23
都沒有辦法顯著地降低心肌梗塞/缺血或出血性中風的風險!!

結論是在現有的證據下，生物製劑治療目前並未顯著地改善乾癬患者重大心血管疾病的風險，雖然這只是目前的短期研究結果，也許拉長時間，更多樣本數會有新的結論。

我想作為臨床醫師來說，我還是會提醒病患，打了生物製劑，還是要好好控制其他的心血管疾病因子！

pubmed全文
https://www.ncbi.nlm.nih.gov/pubmed/27518205

In conclusion, the existing evidence suggests that biologic

therapies including TNFi, an anti-IL-12/23 agent (usteki-

umab) and anti-IL-17A agents (secukinumab and ixekizumab)

had no significant impact on the risk of MACEs in adult

patients with plaque psoriasis over the short term. Moreover,

nor did the different licensed dosages of ustekinumab and

secukinumab impact on the risk of MACEs. However, these

results should be interpreted with caution given the short

duration of follow-up and the characteristics of patients partic-

ipating in RCTs. Well-designed observational studies that

involve larger numbers of patients and longer durations of

treatment exposure reflecting routine clinical practice are

required in order to better examine the impact of biologic

therapies on the risk of MACEs in patients with psoriasis.In conclusion, the existing evidence suggests that biologic

therapies including TNFi, an anti-IL-12/23 agent (usteki-

umab) and anti-IL-17A agents (secukinumab and ixekizumab)

had no significant impact on the risk of MACEs in adult

patients with plaque psoriasis over the short term. Moreover,

nor did the different licensed dosages of ustekinumab and

secukinumab impact on the risk of MACEs. However, these

results should be interpreted with caution given the short

duration of follow-up and the characteristics of patients partic-

ipating in RCTs. Well-designed observational studies that

involve larger numbers of patients and longer durations of

treatment exposure reflecting routine clinical practice are

required in order to better examine the impact of biologic

therapies on the risk of MACEs in patients with psoriasis.mpact of biologic therapies on risk of major adverse

cardiovascular events in patients with psoriasis: systematic

review and meta-analysis of randomized controlled trials

W. Rungapiromnan,

1

Z.Z.N.Yiu,

1,2

R.B. Warren,

2

C.E.M. Griffiths

2

and D.M. Ashcroftmpact of biologic therapies on risk of major adverse

cardiovascular events in patients with psoriasis: systematic

review and meta-analysis of randomized controlled trials

W. Rungapiromnan,

1

Z.Z.N.Yiu,

1,2

R.B. Warren,

2

C.E.M. Griffiths

2

and D.M. Ashcroft