The Effect of Systemic Psoriasis Therapies on the Incidence of Myocardial Infarction: A Cohort Study
Source: Br J Dermatol
Abuabara K, Lee H, Kimball AB; British Journal of Dermatology (Jul 2011)
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Background: Psoriasis confers an independent risk of cardiovascular disease that is likely related to systemic inflammation. Anti-inflammatory treatment could theoretically reduce the risk of cardiovascular disease, and initial data suggest treatment may reduce the incidence of cardiovascular risk factors.
Objective: To determine the impact of anti-inflammatory therapy on the risk of acute myocardial infarction (MI) in patients with moderate-to-severe psoriasis.
Methods: Cohort study using administrative and pharmacy claims data from a large US insurer comparing psoriasis patients>18 years of age receiving systemic immunomodulatory therapies (methotrexate, cyclosporine, alfeacept, efalizumab, adalimumab, etancercept, and infliximab) to a control group treated with UVB phototherapy that has limited systemic anti-inflammatory effects. The risk of acute MI was calculated using a proportional hazards model while controlling for sex, age, hypertension, hyperlipidemia, diabetes, and depression. Significant interaction terms were included in the final model.
Results: The study group included 25,554 psoriasis patients receiving systemic treatment or phototherapy. There was a trend towards an increased risk of MI in the systemic treatment group but not a significant difference in overall MI risk (HR 1.33; 95%CI, 0.90-1.96). Additionally, there was a significant interaction with age: in patients under 50, the HR for MI if receiving systemic therapy was 0.65 (95%CI, 0.32-1.34), and in patients ages 50-70 it was 1.37 (95%CI, 0.79-2.38).
Conclusion: Overall, there does not appear to be a reduced risk of MI in psoriasis patients receiving systemic therapy compared to a group undergoing phototherapy. The risk of MI may vary by age.