Cardiovascular event risk assessment in psoriasis patients treated with tumor necrosis factor-α inhibitors versus methotrexate
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- 作者：Jashin J. Wu ; MDa ; jashinwu@gmail.com ; Annie Gué ; rin ; MAb ; Murali Sundaram ; PhDc ; Katherine Dea ; MAb ; Martin Cloutier ; MAb ; Parvez Mulani ; PhDc
- 关键词：psoriasis ; cardiovascular event risk ; methotrexate ; tumor necrosis factor-α inhibitors ; myocardial infarction ; stroke ; transient ischemic attack ; unstable angina
- 刊名：Journal of the American Academy of Dermatology
- 出版年：2017
- 出版时间：January 2017
- 年：2017
- 卷：76
- 期：1
- 页码：81-90
- 全文大小：710 K
- 卷排序：76
文摘
Psoriasis is associated with increased risk for cardiovascular disease.ObjectiveTo compare major cardiovascular event risk in psoriasis patients receiving methotrexate or tumor necrosis factor-α inhibitor (TNFi) and to assess TNFi treatment duration impact on major cardiovascular event risk.MethodsAdult psoriasis patients with ≥2 TNFi or methotrexate prescriptions in the Truven MarketScan Databases (Q1 2000–Q3 2011) were classified as TNFi or methotrexate users. The index date for each of these drugs was the TNFi initiation date or a randomly selected methotrexate dispensing date, respectively. Cardiovascular event risks and cumulative TNFi effect were analyzed by using multivariate Cox proportional-hazards models.ResultsBy 12 months, TNFi users (N = 9148) had fewer cardiovascular events than methotrexate users (N = 8581) (Kaplan-Meier rates: 1.45% vs 4.09%: P < .01). TNFi users had overall lower cardiovascular event hazards than methotrexate users (hazard ratio = 0.55; P < .01). Over 24 months' median follow-up, every 6 months of cumulative exposure to TNFis were associated with an 11% cardiovascular event risk reduction (P = .02).LimitationsLack of clinical assessment measures.ConclusionsPsoriasis patients receiving TNFis had a lower major cardiovascular event risk compared to those receiving methotrexate. Cumulative exposure to TNFis was associated with a reduced risk for major cardiovascular events.