Background

Psoriasis is a risk factor for cardiovascular events.

Objective

To assess the risk of major cardiovascular events and the effect of cumulative treatment exposure on cardiovascular event risk in patients with psoriasis treated with tumor necrosis factor–α inhibitors (TNFis) versus phototherapy.

Methods

Adult patients with psoriasis were selected from a large US administrative claims database (from the first quarter of 2000 through the third quarter of 2014) and classified in 2 mutually exclusive cohorts based on whether they were treated with TNFis or phototherapy. Cardiovascular event risk was compared between cohorts using multivariate Cox proportional hazards models. Cumulative exposure was defined based on treatment persistence.

Results

A total of 11,410 TNFi and 12,433 phototherapy patients (psoralen plus ultraviolet A light phototherapy, n = 1117; ultraviolet B light phototherapy, n = 11,316) were included in this study. TNFi patients had a lower risk of cardiovascular events compared to phototherapy patients (adjusted hazard ratio 0.77, P < .05). The risk reduction associated with 6 months of cumulative exposure was 11.2% larger for patients treated with TNFis compared to phototherapy (P < .05).

Limitations

Information on psoriasis severity and mortality was limited/not available.

Conclusions

Patients with psoriasis who were treated with TNFis exhibited a lower cardiovascular event risk than patients treated with phototherapy. Cumulative exposure to TNFis was associated with an incremental cardiovascular risk reduction compared to phototherapy.

中文翻译：

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一项观察性队列研究：采用肿瘤坏死因子-α抑制剂治疗的银屑病患者与光疗相比发生心血管事件的风险

背景

牛皮癣是心血管事件的危险因素。

客观的

评估相对于光疗的肿瘤坏死因子-α抑制剂（TNFis）治疗的牛皮癣患者的主要心血管事件的风险以及累积治疗暴露对心血管事件风险的影响。

方法

从美国大型行政理赔数据库（从2000年第一季度到2014年第三季度）选择成年牛皮癣患者，并根据是否接受TNFis或光疗将其分为两个互斥的队列。使用多变量Cox比例风险模型比较了队列之间的心血管事件风险。根据治疗持续时间定义累积暴露量。

结果

本研究共纳入11,410名TNFi和12,433名光疗患者（补骨脂素加紫外线A光疗法，n = 1117；紫外线B光疗法，n = 11,316）。与光疗患者相比，TNFi患者的心血管事件风险更低（风险比调整后为0.77，P  <.05）。与光疗相比，TNFis治疗的患者与6个月累积暴露相关的风险降低大11.2％（P  <.05）。

局限性

关于牛皮癣严重程度和死亡率的信息有限/尚无。

结论

接受TNFis治疗的牛皮癣患者的心血管事件风险要低于接受光疗治疗的患者。与光疗相比，累计暴露于TNFis与降低心血管疾病风险相关。