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. 2014 Oct;28(10):1380-7.
doi: 10.1111/jdv.12296. Epub 2013 Nov 7.

Initiation of TNF inhibitor therapy and change in physiologic measures in psoriasis

J J Wu  1 , L Liu, M M Asgari, J R Curtis, L Harrold, C Salman, L J Herrinton
Affiliations

Initiation of TNF inhibitor therapy and change in physiologic measures in psoriasis

J J Wu et al. J Eur Acad Dermatol Venereol. 2014 Oct.

Abstract

Background: Psoriasis may predispose to cardiovascular disease and diabetes. However, the role of tumor necrosis factor (TNF) inhibitor in mediating this risk is controversial.

Objective: To assess this relationship, we estimated change in metabolic physiologic measures before and after initiation of TNF inhibitor therapy compared with methotrexate (MTX) therapy among psoriasis patients.

Methods: We conducted a retrospective cohort study, 2007-2012, using computerized clinical data for 1274 new users of TNF inhibitor and 979 new users of MTX therapy to compare change in blood pressure, lipids, triglycerides, fasting plasma glucose and body mass index (BMI) before and after start of TNF inhibitors or MTX. The study was restricted to new users. We computed within-person change in each measure, so that each patient served as their own control. In addition, we compared TNF inhibitor patients to MTX patients, by computing the adjusted difference in their group means. In secondary analyses, we examined phototherapy as a comparator.

Results: Among starters of TNF inhibitor and MTX therapy, within-person change in physiologic measures at 6 months did not differ significantly. We observed no important or significant changes in any of the physiologic measures with initiation of TNF inhibitor compared with MTX. The same results were found in subgroup analyses focused on men, and on those with hypertension, diabetes mellitus, or obesity. The same results were observed with phototherapy, except that diastolic blood pressure declined by 0.6 mmHg within person during the 6 months after starting phototherapy (P < 0.05).

Conclusions: The study provides no evidence for improvement of physiologic measures associated with the metabolic syndrome resulting from TNF inhibitor use for psoriasis.

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Conflict of interest statement

Potential conflicts of interest

The other co-authors do not have any disclosures.

Figures

Figure 1
Figure 1
Causal Model Posited for the Study
Figure 2
Figure 2
Study Population
Figure 3
Figure 3
Within-person Change in Physiologic Measures, Based on Measurements Made Within 6 Months of Starting TNF Inhibitor or Methotrexate Therapy.*
See this image and copyright information in PMC

References

    1. Ahlehoff O, Gislason GH, Charlot M, Jørgensen CH, Lindhardsen J, Olesen JB, Abildstrøm SZ, Skov L, Torp-Pedersen C, Hansen PR. Psoriasis is associated with clinically significant cardiovascular risk: a Danish nationwide cohort study. J Intern Med. 2011 Aug;270(2):147–157. - PubMed
    1. Ahlehoff O, Gislason GH, Jørgensen CH, Lindhardsen J, Charlot M, Olesen JB, Abildstrøm SZ, Skov L, Torp-Pedersen C, Hansen PR. Psoriasis and risk of atrial fibrillation and ischaemic stroke: a Danish Nationwide Cohort Study. Eur Heart J. 2012 Aug;33(16):2054–2064. - PubMed
    1. Ahlehoff O, Gislason GH, Lindhardsen J, Charlot MG, Jørgensen CH, Olesen JB, Bretler DM, Skov L, Torp-Pedersen C, Hansen PR. Psoriasis carries an increased risk of venous thromboembolism: a Danish nationwide cohort study. PLoS One. 2011 Mar 25;6(3):e18125. - PMC - PubMed
    1. Wakkee M, Meijer W, Neumann HA, Herings RM, Nijsten T. Psoriasis may not be an independent predictor for the use of cardiovascular and anti-diabetic drugs: a 5-year prevalence study. Acta Derm Venereol. 2009;89(5):476–483. - PubMed
    1. Wakkee M, Herings RM, Nijsten T. Psoriasis may not be an independent risk factor for acute ischemic heart disease hospitalizations: results of a large population-based Dutch cohort. J Invest Dermatol. 2010 Apr;130(4):962–967. - PubMed

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