title: Methotrexate reduces the occurrence of cerebrovascular events among Taiwanese psoriatic patients: a nationwide population-based study.
abstract: Psoriasis is a chronic inflammatory disease. The aim of this study was to evaluate the effects of methotrexate and retinoid on risks for developing cerebrovascular disease among psoriatic patients. A population-based nested case-control study was conducted using the Taiwanese National Health Insurance database. Cox proportional hazards models were adopted. The hazard ratio (HR) of newly developed cerebrovascular disease was 1.28 (95% confidence interval (CI) = 1.162-1.413; p < 0.0001) for psoriatic vs. non-psoriatic subjects. In terms of the effects of methotrexate or retinoid on the occurrence of cerebrovascular disease, a significant protection effect (HR = 0.50; 95% CI = 0.27-0.92; p = 0.0264) was found for patients with methotrexate prescription. Retinoid prescription showed no protective effect. Further analyses revealed that a low cumulative methotrexate dose is associated with significant protective effect (HR = 0.53; 95% CI = 0.28-1.00; p = 0.0486) while a high cumulative dose was not (HR 0.80; 95% CI = 0.11-5.68; p = 0.8214). These results suggest that psoriatic patients receiving low-dose methotrexate treatment may have reduced risk for developing cerebrovascular disease. Further prospective study should be performed to validate the vasculoprotective effect of this treatment strategy.
authors.affiliation: Department of Dermatology, Kaohsiung Medical University Chung-Ho Memorial Hospital, No.100, Tzyou 1st Road, Kaohsiung 807, Taiwan. ec_lan@hotmail.com
authors.forename: Cheng-Che E
authors.initials: CC
authors.lastname: Lan
authors.forename: Ying-Chin
authors.initials: YC
authors.lastname: Ko
authors.forename: Hsin-Su
authors.initials: HS
authors.lastname: Yu
authors.forename: Ching-Shuang
authors.initials: CS
authors.lastname: Wu
authors.forename: Wan-Chen
authors.initials: WC
authors.lastname: Li
authors.forename: Yi-Wei
authors.initials: YW
authors.lastname: Lu
authors.forename: Yin-Chun
authors.initials: YC
authors.lastname: Chen
authors.forename: Yi-Ying
authors.initials: YY
authors.lastname: Chin
authors.forename: Yi-Hsin
authors.initials: YH
authors.lastname: Yang
authors.forename: Gwo-Shing
authors.initials: GS
authors.lastname: Chen
mesh_terms: D044466:Asian People; D016022:Case-Control Studies; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000208:ethnology / Q000517:prevention & control*; D016009:Chi-Square Distribution; D015897:Comorbidity; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015994:Incidence; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D011565:Psoriasis / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology; D012176:Retinoids / Q000627:therapeutic use; D018570:Risk Assessment; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D012176:Retinoids; D008727:Methotrexate