Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
J Intern Med. 2013 Feb;273(2):197-204. doi: 10.1111/j.1365-2796.2012.02593.x. Epub 2012 Oct 11.
Psoriasis is a chronic inflammatory disorder associated with cardiovascular morbidity and mortality. Systemic anti-inflammatory drugs, including biological agents, are widely used in the treatment of patients with moderate to severe psoriasis and may attenuate the risk of cardiovascular disease events. We therefore examined the rate of cardiovascular disease events in patients with severe psoriasis treated with systemic anti-inflammatory drugs.
DESIGN, SETTING AND PARTICIPANTS: Individual-level linkage of nationwide administrative databases was used to assess the event rates associated with use of biological agents, methotrexate or other therapies, including retinoids, cyclosporine and phototherapy, in Denmark from 2007 to 2009.
Death, myocardial infarction and stroke.
A total of 2400 patients with severe psoriasis, including 693 patients treated with biological agents and 799 treated with methotrexate, were identified. Incidence rates per 1000 patient-years and 95% confidence intervals (CIs) for the composite endpoint were 6.0 (95% CI 2.7-13.4), 17.3 (95% CI 12.3-24.3) and 44.5 (95% CI 34.6-57.0) for patients treated with biological agents, methotrexate and other therapies, respectively. Age- and sex-adjusted hazard ratios (HRs) were 0.28 (95% CI 0.12-0.64) and 0.65 (95% CI 0.42-1.00) for patients treated with biological agents and methotrexate, respectively, using other therapies as the reference cohort. Corresponding HRs for a secondary composite endpoint of cardiovascular death, myocardial infarction and stroke were 0.48 (95% CI 0.17-1.38) and 0.50 (95% CI 0.26-0.97).
In this nationwide study of patients with severe psoriasis, systemic anti-inflammatory treatment with biological agents or methotrexate was associated with lower cardiovascular disease event rates compared to patients treated with other anti-psoriatic therapies.
银屑病是一种与心血管发病率和死亡率相关的慢性炎症性疾病。包括生物制剂在内的全身性抗炎药物广泛用于治疗中重度银屑病患者，可能降低心血管疾病事件的风险。因此，我们研究了接受全身性抗炎药物治疗的重度银屑病患者的心血管疾病事件发生率。
设计、地点和参与者：利用全国性行政数据库的个体水平链接，评估 2007 年至 2009 年丹麦使用生物制剂、甲氨蝶呤或其他疗法（包括类视黄醇、环孢素和光疗）的患者的事件发生率。
死亡、心肌梗死和中风。
共确定了 2400 例重度银屑病患者，包括 693 例接受生物制剂治疗和 799 例接受甲氨蝶呤治疗的患者。每 1000 患者年的发生率和 95%置信区间（CI）为复合终点的发生率分别为 6.0（95%CI 2.7-13.4）、17.3（95%CI 12.3-24.3）和 44.5（95%CI 34.6-57.0）接受生物制剂、甲氨蝶呤和其他疗法治疗的患者。年龄和性别调整后的风险比（HR）分别为 0.28（95%CI 0.12-0.64）和 0.65（95%CI 0.42-1.00），以接受其他疗法为参考队列。接受生物制剂和甲氨蝶呤治疗的患者的次要复合心血管死亡、心肌梗死和中风终点的相应 HR 分别为 0.48（95%CI 0.17-1.38）和 0.50（95%CI 0.26-0.97）。
在这项针对重度银屑病患者的全国性研究中，与接受其他抗银屑病治疗的患者相比，生物制剂或甲氨蝶呤的全身性抗炎治疗与较低的心血管疾病事件发生率相关。
