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

Journal of the American Academy of Dermatology. Jan 2017;76(1):81-90


Psoriasis is associated with increased risk for cardiovascular disease.


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.


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.


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).">


Lack of clinical assessment measures.


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.


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Wu JJ, Guérin A, Sundaram M, Dea K, Cloutier M, Mulani P