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

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 riskreduction (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.