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

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-alpha 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). Limitations: 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.