To the Editor: The meta-analysis by Dr Ryan and colleagues examining the association between biologic therapies for chronic plaque psoriasis and cardiovascular events reported no significant difference in the rate of major adverse cardiovascular events in patients receiving biologic therapies vs placebo.1 The rosiglitazone example demonstrated that single trials can be underpowered to provide conclusive evidence regarding rare cardiovascular events and meta-analyses can improve power.2 For meta-analyses, availability of high-quality data on harms and selection of the most appropriate analytical methods are essential.2 Specific concerns are raised about the validity of the findings by Ryan et al.
Tzellos T, Kyrgidis A, Toulis K. Biologic Therapies for Chronic Plaque Psoriasis and Cardiovascular Events. JAMA. 2011;306(19):2095–2096. doi:10.1001/jama.2011.1660
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