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The Goeckerman Regimen for the Treatment of Moderate to Severe Psoriasis

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Published on: July 11, 2013

Cardiovascular event risk assessment in psoriasis patients treated with tumor necrosis factor-α inhibitors versus

Jashin J Wu¹, Annie Guérin², Murali Sundaram³

¹Kaiser Permanente Los Angeles Medical Center, Los Angeles, California.

Journal of the American Academy of Dermatology

|November 30, 2016

Abstract

Background:

Psoriasis is associated with increased risk for cardiovascular disease.

Objective:

To 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.

Methods:

Adult 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.

Results:

By 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).

Limitations:

Lack of clinical assessment measures.

Conclusions:

Psoriasis 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.

Keywords:

cardiovascular event risk methotrexate myocardial infarction psoriasis stroke transient ischemic attack tumor necrosis factor-α inhibitors unstable angina

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