title: Cardiovascular event risk assessment in psoriasis patients treated with tumor necrosis factor-α inhibitors versus methotrexate.
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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Kaiser Permanente Los Angeles Medical Center, Los Angeles, California. Electronic address: jashinwu@gmail.com.
authors.forename: Jashin J
authors.initials: JJ
authors.lastname: Wu
authors.affiliation: Analysis Group, Inc, Boston, Massachusetts.
authors.forename: Annie
authors.initials: A
authors.lastname: Guérin
authors.affiliation: Health Economics and Outcomes Research, AbbVie Inc, North Chicago, Illinois.
authors.forename: Murali
authors.initials: M
authors.lastname: Sundaram
authors.affiliation: Analysis Group, Inc, Boston, Massachusetts.
authors.forename: Katherine
authors.initials: K
authors.lastname: Dea
authors.affiliation: Analysis Group, Inc, Boston, Massachusetts.
authors.forename: Martin
authors.initials: M
authors.lastname: Cloutier
authors.affiliation: Health Economics and Outcomes Research, AbbVie Inc, North Chicago, Illinois.
authors.forename: Parvez
authors.initials: P
authors.lastname: Mulani
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000368:Aged; D000789:Angina, Unstable / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003879:Dermatologic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000068800:Etanercept / Q000627:therapeutic use; D005260:Female; D006801:Humans; D000069285:Infliximab / Q000627:therapeutic use; D002546:Ischemic Attack, Transient / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D016016:Proportional Hazards Models; D065840:Protective Factors; D011565:Psoriasis / Q000188:drug therapy*; D018570:Risk Assessment; D020521:Stroke / Q000453:epidemiology; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D055815:Young Adult
chemical_list: D003879:Dermatologic Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept; D008727:Methotrexate
keywords: cardiovascular event risk; methotrexate; myocardial infarction; psoriasis; stroke; transient ischemic attack; tumor necrosis factor-α inhibitors; unstable angina