Psoriasis — SCE Dermatology MCQ

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ModerateDermatopharmacologyPsoriasisSCE Dermatology

A 65-year-old man has chronic plaque psoriasis and metabolic syndrome. His dermatologist explains that certain psoriasis treatments may improve his cardiovascular risk profile. Which biologic class has the most consistent evidence for cardiovascular risk reduction in psoriasis?

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Correct answer: E — TNF-alpha inhibitors (anti-TNF biologics have the longest dataset showing reduced cardiovascular events)

TNF-alpha inhibitors have the longest and most consistent observational evidence for cardiovascular risk reduction in psoriasis patients. Large registry studies (BADBIR, Danish registry) demonstrate reduced rates of major adverse cardiovascular events (MACE) in psoriasis patients treated with anti-TNF biologics compared to those on conventional systemics. TNF-alpha plays a central role in atherosclerotic plaque formation and destabilisation; blocking it addresses both skin inflammation and cardiovascular inflammation. This evidence supports the concept of treating psoriasis as a systemic inflammatory disease. Methotrexate also has cardioprotective properties (seen in RA data). IL-17 and IL-23 inhibitors show favourable early data but with shorter follow-up periods.

Reference: BAD 2020 Biologic Guidelines; BJD Cardiovascular Outcomes